|
PERMRTEE NAME/ADDAESS pnclyde Fxiliq•.vomm/(grarion ijDBerenq
<br />NAME riOYIF. Rr:i;+~I _I ~-~~ «I
<br />f 1. L 1' L' D
<br />ADDRESS BOYIB KO. "' f rrr
<br />P. o. Box t: ,
<br />FACILITY PAOHIA ~;i; Itlt1?3
<br />LOCATIOtJBO~IE CU 71G29
<br />:,7'ZK: ,(ILLIA~ A. ~'~•'AF .t'+.. *1:':I? !:Gd
<br /> (3 Card Ony) pUANTI
<br />PARAMETER (46-53 (5aB1 (38-05) (4G53) (54 Bf) ETC OF TYPE
<br />(388n AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />lsaaTl ANaLrstS
<br />84-68
<br />6370
<br />L"R SAMPLE ##:v## ..#### :?##'s',: ( l2)
<br /> MEASUREMENT
<br />Jo+4uu 2 D o ;,~~WL1~.~ ~;~ ~>I t ~~I~~s, _ ### ~~ ~ 1sar±~ ~, ~r1i ..
<br />r~
<br />'Ff'LUENT GPOSS VAI U ~ NT' ,(*,~r) ~•.~ ~- ~r'~k~x~ r#t~ ~ r, -V -,. r ,;~ 1 ,~__ r, -.
<br />,U L;llS• TOTAL SAMPLE ii:### #####DI ###;`-#M ( lq)
<br />J FENDED MEASUREMENT
<br />0 U 5 J U 1 O 0 PERM , r:=. ~' i, sl##q~ ### ~ ~ ~~"
<br />-
<br />:. I ~ A, ~.,
<br />b r'e'LOhINT GROSS PALL' A~oUIgEN( '""" ,~-:=s ~ #### ~;.,~~. ;`s, .,
<br />~-`
<br />>~
<br />S:+Li US, :ifiTTLEABLE SAMPLE C##### R#G### #.r h'.`•;t4 ( 2S)
<br /> MEASUREMENT
<br /> ~ ~ '~ ' ~ ~ '
<br />FFLUt^I'p GPOSS YALD EMENT ~, §i
<br />,,. ~'Y F
<br />.: (+ '
<br />~ , ~~. 'p„~
<br />+3
<br />] R:, :I, TOTAL ~ SA PLE #¢'F### ###+!R ###d`•'•` { 29) - r^'~
<br />(A`5 PE- MEASUREMENT
<br />L`iCU`., I o n EE~NI ~ L' ';,, ~ ### +P4'4n ''
<br />
<br />I
<br />„.
<br />`
<br />,
<br />(r.q ~ ;
<br />:;Ff'L'LiENT G!0`~ ~ IALU REQU1
<br />a ~
<br />UIL AND GREA`:i SAMPLE 47R#'''## ###### #^#'.`•## ####'''= ( lq)
<br /> MEASUREMENT
<br />J35B2 1 0 0 F~HNlI '`~ ~ ~~`
<br />~ '~
<br />~ r;•',
<br />+1~',
<br />~
<br />~ ; (1
<br />~
<br />`"~! >
<br />F.FPLUEtaT VP.OSS 'lALtl AEOUIREM9N~''
<br />y k
<br />t '``
<br />,
<br />F'LU4, I : CONDUIT ^P SAMPLE ( 03) ###### ####`;- ##4##a
<br />'[H6U ?~;YA'iMSNT :LA": MEASUREMENT
<br />S0U5G 1 0 D PERMIT 0~ ~ ~ ~?~lk'~
<br />- ~ `fY$ fi ', k ~".- #'=f I
<br />t $E~T
<br />h1'FLUENT f,Rn55 YALU AEQUIREMENT _ ,
<br />j>T., aGD I ,i: - ###+,~ m ,,ro_kA.
<br />:;OI.IDS, TOTAL SAMPLE #.•~### ##:##.A ###$#^ ( 1R)
<br />CI.~~OLYFD MEASUREMENT
<br />Iu1v5 1 0 U ;- :PfSAMIT .ap *i+1~ ##3~4~P' ##;t ~~t~0~4 ~'`lr~l1C? .'* iS~'T2GMh~'- $L~
<br />f
<br />t.t'r'LUENT GROSS PALO HEQUTAEMENT _ ###a ~ .s
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERRFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY FJUMINED AND
<br />IN: AND BASED ON MY TELEPHONE DATE
<br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING /
<br /> THE INFORMATION, I BELIEV E THE SUBMnTED IN FORMATION IS TRUE, ,i1 /
<br />
<br />' ACCURATE AND COMPLETE.
<br />NALTIES FOR SUBMITTIN I AM AWARE THAT TH
<br />G FALSE INFORMATIO ERE AAE SIGNIFICANT
<br />N
<br />INCLUDING T
<br />E ~! ~/,~~ ~ y~(J i
<br />•
<br />(
<br />)
<br />r I ~~ E,r~ /( `~J/ PE
<br />POSSIBIUTV OF FINE AND IMPR
<br />~
<br />e ,
<br />H
<br />ISONMENT. SEE 18 U S.C. 41001 AND 33 U.S.C.
<br />ro jr0
<br />~
<br />0
<br />d
<br />•
<br />~ 6
<br />~
<br />SIGNATURE OF PRINCIPAL IXECUTNE ~
<br />.
<br />~'L
<br />C~~~ ~~ J Y
<br />~~ l
<br />~ ' S
<br />TYPED OR PRINTED '
<br />,
<br />m,
<br />m
<br />~s w
<br />mexlm mm^nno^meM of be
<br />Me
<br />e^ sm
<br />onfl~a ends
<br />p rears.) OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rererence ell attachments here)
<br />;k.T'fLEl6LE SOLIDS LIF;f APPLI?S OKLC IF G10TR,2=lHR PRECIP cVFeT T5 CLAI!'~D. TF CLAIa+ dPPPnVF.^v HY '»pCD,
<br />T55 E IRON LI(7IT5 yTI;. NOT RE APPLIaD TD 4EPORTRD `1EASUft°MENTi-SEF.. L.1.2, PG 5 F09 R^RDF.N OP PROCF
<br />EPA ~`orm 9320.1 (0 -9 Previous Itions may no( be u3+e .' ' ~.' (AEP CES E A F 7- I ~ AY NO E ED.) " ' ~ ' • ' PAGE OF
<br />07^1~/9'tOT12-7222 ,
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form ApproV¢d. [
<br />DISCHARGE MONITORING REPORT (DMRI OMB NO. 2040-0004
<br />Approval expires OS31-98,
<br />(Snag siC)
<br />PERMIT NUMBER DISCHARGE NUMBER p _ F; N A L ~dlL'C ~
<br />MONITORING PERIOD ~~ ~,I• ~ O F `~ P T'7 ~ F E' R T'7 A I L D TC Q'
<br />YEAR MO DAY YEAR MO DAY ~'
<br />FROM 07 00 07. TO ~1 !15 n '?r'= N!1 OT`CNAPGF I x~ "~~' i„~
<br />(zaz+) rzz-z3) rzazs) (zo-v) tze-zB) (3as,1 NOTE: Read Instructions betor ZRJTflpleting this form. ~~'~ ~„
<br />TY OR LOADING (4 (aN Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE ~~~
<br />I
<br />
|