|
PERMITTEE NAME/ADDRESS O•el.e. F..+GryNaWL«ana. dDlp...,p
<br />NAME C'!PRI;j YEvIE Y"RLL`'Y ~~~I. "lvn.
<br />ADDRESS }.[ (:. i ~ , J g l ' !7 ] ?", '' ' { v a N r
<br />~..~"910'1 ca5• "7>rh'nt,I. 'i9CLP
<br />FACILITY
<br />LOCATION
<br />r, .Ir,,: .,^•(r: ~. .:cL.~Y ~.r~;a+L ~rtrY
<br />NATIONAL POLLUTANT DISCNMOE ELIMINATION SYSTEM l/VPDESI
<br />DISCF(ARGE MONITORING REPORT IOMRI
<br />l1-161 17.191
<br />790?271~U nn? n
<br />PERMIT NUMBER DI$CHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM 1 ... TO `+'' _ 1 _
<br />!16211 l12-331 /74151 /76171 l18-291 /36311
<br />Form Approved.
<br />... ,, :• 1 ~ ~.n~•,~ ,- ., 10MB~No~2040-0004•.
<br />Approval ezpiree OS-31-98
<br />P C7_ AI
<br />T.-n
<br />NOTE: Reed InetrucNotle bafor eompletlnq thb form.
<br />PARAMETER l3 Ord Onlyl QUANTITY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> I<6531 150-8/1 138<51 14653) 150-51 EX OF
<br />l3I-371
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />!sz-esl MALYSIS
<br />/8a-581 TYPE
<br />159-701
<br />I.?vN, ..,~P3 L. SAMPLE „ ~. rca.,`y...c ~.......~; ,. { 191
<br />~~~ c~1 MEASUREMENT
<br />)114h J i 7 PERMIT ;e rkG t:4~ r,;:?>k 'ck k'z'.:~t;!;:e P^t'n"'" :9 F`t T"' ( •rtCF/ :'tA7
<br />S ° is C 7.:', . ': r 5 9 - [, ~ q REQUIREMENT ~- ~' ;: .1 ,
<br />i!Tn1! A T
<br />f?A.1Y HY'
<br />"'7
<br />^1!)N N
<br />CRU'r, ~.CU~i ~t.1. SAMPLE ;=iu;:;;;: hrc{:r,•~-_ ~:¢:r,:•-tr.'.c ( t n)
<br />~:i.~ co) MEASUREMENT
<br />II;'IS J. n J PERMIT ..-`?t.z , .#~Ar krxr;^"`~. ~.~ 7.~ { .kCi:/ RAT+
<br />;P''L~!T.'i!' C;f955 C*L(1" REQUIREMENT --F ~~~; Etr^ g!tTLY °g ,~/L Y~'1t p
<br />'LJi+, I: CAN^DT; ^p SAMPLE ~ 1~) .. -tt: ~-, .: 1~~;. ,
<br />r d 31! ~ ~- (; r ~ ry r ~ [, A N MEASUREMENT
<br />UI~IID '1 .1 PERMIT ;iz~p32T PTIIF,L •".~>;" r"Y' 4i`;:;:~".- "~'k~+":=^ : ( F.?RLY YS^'1:'
<br />i}FLU1~f%T ;;4n;3 Y!LL'i REQUIREMENT jOJ;A AV.; OkILY '1 :{ arv df:S';c
<br />J I L A 1: D ..~. ~ 4 i F SAMPLE .: :a : ~ ~ a 1 ,..y .-,... .r,t~ ~... ,: #; ,^-;r ..
<br />J I.i .7 :. L MEASUREMENT
<br />111115,1 1. l1 7 PERMIT ,.-+v ~¢ ) •C c..1 °?.+::k x,,. ~.~«.~:t:'c ,.k w+:.,+r fir; 9F1:IY ~.
<br />'I r!
<br />
<br />sE'FLIIE`I' ;.;"~;S VAL^^
<br />.REQUIREMENT
<br />Ih3T wAi
<br />NP=7
<br />Y'a~~
<br />- .
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br /> SAMPLE
<br />- MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED MD
<br />AM FAMILIM MATH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDINDUAL$ IMMEDIATELY RESPONSIBLE FOq
<br />.I
<br />I C{la rd Il1~~~5
<br />r'' OBTNNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION I$
<br />. TPUE, ACCUMTE AND COM0.ETE. I AM AWME THAT THERE ME ,~~ ./~
<br />A
<br />Tt
<br />na
<br />er $IGNIFICMT PENN-TIES FOR $UBMITTINO FALSE INFORMATION
<br />INCLUDING A
<br />g
<br />a I a
<br />F.nvironmP/ ,
<br />TNEPOSSIBILITYOFFlNEMDIMPIiISONMENT
<br />$EE18U
<br />S
<br />C
<br />11001MD]J 970 370-?712 1 23 99
<br /> .
<br />.
<br />.
<br />.
<br />u
<br />s
<br />1 t]te
<br />1ROrro.. ulsr In.r mrlma el.
<br />ileArM r
<br />.
<br />e
<br />ro lfO
<br />ODO SIGNATURE OF PRINCIPAL EXECUTNE
<br />
<br />TYPED OR PRINTED .
<br />.
<br />l,,
<br />. y
<br />.
<br />.
<br />,
<br />r
<br />.rM Ormu.m.n Lnpr'ranlrNlr a/blwwlenwneu rWeyw.l
<br />OFFICER OR AUTHORIZED AGENT AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />r.VMMLI'1I J wnv ~.., ...~.......,.... ..~. ~ ....~.., w•w ... e......~o e.. e..o~.....o...~ ..vier
<br />1LTr..:i l'. LIvIr~ c ,p ;5, [S:Oy 54!'!'LG.4~LE SJLrC (Ll' 111) rn'1LV ry ",- !_ f-. .. n.1 ~r• rm
<br />i$ CLA I`-. '11. ~:~' T•A.?, rt+~~ LH, P03 111 ~'1°^ Uf PR')n° .+^,l^).~I~ar•. ,^• iTr :+ ..~ 1 ~ r"-„-7:^ C....P .'v.
<br />pTriY ~r0/TN''- t: O^DnO TTN[ rNC Tag ~TTnA ..•'inr~mamv •/ /-^ /I r" ~•
<br />1
<br />mey De uee ~ ~ (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 ,t ~ T ~ / ~ ~ ,~ n ,~ _, _ ~ r PAGE ~ OF
<br />
|