|
r ~yyy .
<br />}1
<br />qWN..,
<br />P:=t'I
<br />PERMITTEE NAME/ADDRESS R.d.y FrwryNrr/Lecntan dDlp rn)
<br />NAME C{',t i'.'.!~ '{1 •~I`A '{E T.T.': .{ ~~1L CDR?,
<br />ADDRESS«~~~'~'.~ I, f`;J `C 'Irl ..n, r.--vat! ,.i ny
<br />N,
<br />. ~ 111 '~R~,• NI.1s;frT ^IHUi.
<br />FACam
<br />LOCATION
<br />M1'..;,, 0:'.'T.: de z:'PT.`'Y, '..~ 2L:. 31"I°
<br />NATIONAL POLLUTANT DIaCNMOE ELIMINATON SYSTEM INPOES)
<br />DISCHARGE MONITORING REPORT lOMR1
<br />17-161 l17-191
<br />;:Jn~znSU Dpi
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 'i' ., TO '~ ~ -' ~!
<br />!76711 l11-731 171-751 176771 l79-191 l3Q311
<br />Form Approved,
<br />v-.~ :, •, ,Ir r .n_OMB.No12Q40-0OOAc~'
<br />(~„.. .,' ,' APProvei expiiPe 05-31-98
<br />+,-w •„
<br />NOTE: Raed Irutructions bsiore complatlnq this form.
<br />PARAMETER !3 Grd On/Tl QUANTITY OR LOADING l4 Grd On/y! QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE
<br /> 116-531 154611 !3B<61 !46531 1546/1 µ~
<br />I37-37I EX M
<br />y9 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITB (61.63) !64681 l6S701
<br />I'iJlr SAMPLE ~ , tcg;t X'k;:; :•~; ~...{.:..:,: { t'1)
<br />T. U :" E L .7 '. ~'} V ~: k 0 ~ 1, p MEASUREMENT
<br />0 `1?~ l ^ J PERMIT ~"k:'Sr.','-' ..:,x:#L` .. #^` 's t:!:'x :k'= 7-. !; n^UIfT^ ' "#tdP.$/ :Fti~
<br />[. t'?Lll i. '. "' ::'?J3S V4L'JT REQUIREMENT #'-}: ;t 3'1^F SYr `'!TIY `FY ~`•~/T, MON ii
<br />SI:,Y R, ?U°. P.NTIAI.LY SAMPLE '::0•'.:Gf t:'<.t#`. ##w..,,. / ,'1)
<br />DI~SULY,.p MEASUREMENT
<br />Jl IrJU 0 0 PERMIT ##;: #;`-6 T##### .. Sst ;tae~# ^cn^. :, •P . :±r.. Dr"' / •NC}•~ 'RP .
<br />.'.F?LL'°_`I ;• 'K'ISS VRLUF' REQUIREMENT ##Q.k 7t1nA AS'r; r,pr Lr MR ~r/I NOe3'"p
<br />"ni e.:H, PUiF. ."ITIRT.LY SAMPLE ^-t?:#LtR #:3.'.:Y ~.+: +; n•rivS'v :;; ( C.?~
<br />IS_:0L7 c'1 MEASUREMENT
<br />O1.iU6 1 0 it PERMIT .-'+~r-ifs •^.-G3fi4'fi. Q :"~,^. irt. ".w4V n~~-17
<br />..
<br />rt -; ({J1, I'T/ .PA°.
<br />':f F'T. L'EtiT '75S 7AL'!r REQUIREMENT +:`-~ 3^i ,l 19r PR~Ta >rp Yr-/L lKb`!"'3
<br />7A'-!i']4ki~i':, '."]^+.L SAMPLE 4C: :1k4.~ Grt7 : :;::;: {:~~•..; .. ( lal
<br />•{ F;C G V °,': '~. '. L ° MEASUREMENT
<br />11123 i 0 ;> PERMIT %trf4#--^•# #;?fi#r ~ r',:`. ~+-.rG~:; ?r
<br />O}TT c.•
<br />t'fln~"
<br />{
<br />8Rlt*
<br />?
<br />;RA'
<br />'(FPLUEI"C ;H7i" V?L-t REQUIREMENT t;<:# r
<br />7^nS „ r^ :
<br />`L?k, Il C~'I~UIi' .7R SAMPLE ( 73) .^'.:;-.n.,: ter-<:-::... ..
<br />Ni~;r] IRF.q!"PVT '-LACi MEASUREMENT
<br />i~1?~C+ 1 0 U PERMIT REPORT ?EPOAT x~!>•Ax:# ':###'": rr;t~>~~#: IIt=~ : FSKI,y "!'ST?::
<br />~F~LUF.~T ~RD55 YALUF. REQUIREMENT ;ODA AYG DAILY !!Y NCO Ort#a
<br />)I'. AyD :;RL:ASI? SAMPLE +PL+:~Yt ( al(~ .^4+R #'-~P' >.`.#O##:`.
<br />I ~:J A L MEASUREMENT
<br />14'.5:1 1 0 0 PERMIT ~~#Y##- ) t E5=1 ~'P#4t-s Ot1LLCn]>34 ''.+-Rt{tt¢h?: > !1-~~- t r4KLY '~!'S!!~L
<br />:PF'LUEN'i _; :!OiS V4L0°. REQUIREMENT I95T ~A8 N!1=~0 ~ :+:--}
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF lJ1W THAT I HAVE PERSONALLY E%AMINED MD
<br />AM FMIILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />Firharci IJIIIIS OSTNNING THE INFORMATION, I BEDEVE THE SUBMITTED INFORMATION IS
<br />TRUE
<br />ACCUMTE MD COMPLETE
<br />I AM AWME TNAT THERE ME
<br />n
<br />t
<br />l t~! ,
<br />.
<br />SIGNIFIgMT PENALTIES FOR SURMITTNG FALSE INFORMATION
<br />INCLUDING
<br />er
<br />~nvironr!en
<br />a
<br />ana
<br />J ,
<br />THE POSSIBILITY OF RNE M
<br />PRISON
<br />EE
<br />E v
<br /> D IM
<br />MENT. S
<br />to U.S.C.
<br />1001 MD ~]
<br />U.S
<br />E 1 Gle
<br />C
<br />IM1rWni. MMr 41.Y .6fuln. wlrY it[lld~ fnu I
<br />ro 80
<br />000 BIONATURE OF PRINGPAL EXECUTIVE n ~ n _ ~ ~ ~ ~ q;;
<br />TYPED OR PRINTED ,
<br />.
<br />.
<br />q
<br />,
<br />ANrmuYmAn inpriotnnnr elbMwtemenNa rM6Frra1 OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />E:UMMtN I~ nrvu cnr~nnn I Ivn yr nn r nv~n I Iona Innrrence sn errecnmenrs oars/
<br />~LTERN.M1;`. LI~IyS F!7? T:S SPTPL°".9L? iJLT.9S (LJC Flr) d.^31,v r+tTY T° r= T^-"r ~':--' ~-r-C-~
<br />CLAIMEC~. ;cc r.R•?, P. I ~• FnP B'!R9?'! ,~`' 'r4JJ° .1 ...)JI?: y.'F T^. ~Ti 4 rDVn~ _~p.. _-r+.. T,.,. .;_ [.
<br />-~. -,.
<br />EPA Form 3320.7 108-951 Previous editions mey be used. IREPLACEB EPA FORM T-40 WNICN MAY NOT BE U8ED.1 ~ n "! ~ „ ~ ~ I ~ _ I PAGE OF
<br />1 / I^ »„
<br />
|