Laserfiche WebLink
:~ I c/ <br />'I'ERMITTEE NAME/ADDRESS/Include <br />" <br />` <br />~F <br />' NATIONAL OLLUTANLPISCHARGE ELIMINATION SYSTEM (iVPDESJ <br />C <br />. <br />g <br />acili(I' I\ <br />ame/Ln lalinn if differrn(J~~ 1~. <br />~ .yL DIS <br />HARGE MONITORING REPORT pDh1R) <br />NAME - -------- r.C tI WIC _ __ (_'-IhJ (1i-19J <br />ADDRESSYca -T.K `tIN~ ~'^~'ii0~`•~ n^l <br />u <br /> <br />~ ___ <br />~-- " _ <br />'~ <br />41,~ 3 ~ <br />5. V t sr:. ~ <br />127 <br />U <br />PERMIT NUMBER nc <br />u <br />M'!!9' 'l <br />_ _ <br />"~+~f <br />ytr.y GT _ ~ ` <br />U frob37 <br />___ _ <br />_ _._ MONITORING PERIOD <br />FACILITY <br /> <br />^ - _ <br /> <br />h CJ <br />Y <br />~ <br />YEAR <br />MO <br />DAY <br />YEAR <br />MO <br />D_AY <br />LOCATION <br />-- / <br />I <br />---- FROM ~ _ TO ~,/ <br />'" " ' a <br />~T <br />n; ~ <br />YV ~,PON, cNG?'~F.~ <br />~ r1p.,11 e <br />zll r7J-?il r?n-nl rl.c-~91 (m-rn <br />~. <br />(S U 9 4° F 1 Form Approved. ~ • ~"~ <br />~ - OMB No. 2040-0004 ~ <br />"I A 1. I ~ <br />.; j q ~ a Approval expires 10-31-94 <br />NOTE: Read instructions before completing this form. <br /> <br />- (? Card Only/ OUA NTITY OR LOADING (J Curd Onh 1 QUALITY OR CONCENTRATION _ <br />PARAMETER .1 (J6-S.il (iJ-611 (iS-JJ1 !J6-ci) (Tq-6// NO. FPEOOF NCB SAMPLE <br />r7?J71 ~ <br />' <br />-~ EX ArvAL[515 .TYPE <br /> wt AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS <br /> <br />~ lelory r6J.6Y1 (69-1J1 <br />C.. i?IT,., r(9KR A^'1 _ <br />'MPL <br />D <br />~ .r:tr.•,...~ ...~~.4:.~ ::r.~a~: ,.:':OClff ( '~) <br />~ <br />nSPi1^AD `5IA MEA <br />RE <br />ENT" 71DO O ~ <br />' v <br />\`I?~ 1 `) f, ~P~PMIT <br />:'~ - #+kp0rk r, Kr4AcdflP Ik 'Y:`--"~ RY.PORT 4'i11C1'stAh rfCutts hdl ER- B' <br />~ . <br />-- <br />'REOUIREMENT ~ ' " <br />cF L77V? ;R <br />?)S VALD~ a4~1< hK Y_AZ.tlxC. - -, CSH? <br />~ <br />. <br />. <br />~ =': <br />~` <br />~ <br />."'S0 "Tq.".:• 96"R ~~') Il.rIC%F'•.`•:': ~.'.<O3=:F: O~'~+Jr:::: ;.1.4 !r :k .Y ( 73) <br />P r r L`r.l A( c SAMPLE <br />MEASUREMENT y (QO D t <br />/~{ ~ <br />~ Y ~ 1 .; <br />MIT 4r>01 +RCaIDda.... {eC <br />- RL.pp$. ~_~'; ~ :p IMO4r +9NM 6~I ° r - <br />- <br />iSL~ <br />A <br /> <br />~FFLU~..'~- '755 VAI,I)r. ~PER <br />REOUIREMEIJT <br />{rC•'.[ i. <br />~~~ •~~~~.•• <br />~ N<F. ~... <br />~~`«, <br />..C1T ;. <br />, .. <br />p~.~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~' ' ~ ' <br />.. <br /> REQUIREMENT ~ ' <br />' <br /> <br /> <br />,t t SAMPLE <br />MEPSUREMFyfJY t - <br />1 f' <br />: n 1 <br />,+~ .. _ , <br /> J. • <br /> PERMIT <br />REb UIREMENT <br />n~ <br />'iz„ <br />- ~ " <br />s ~'(~~ ~~ <br />~'~'~`.< <br />° ~•~tl~ <br />~ <br /> <br />- . <br /> (~ 4q(~a~ <br /> SAMPLE - <br />''' <br /> MEASUREMENT rt i5a <br /> PERMIT ~ ;±;'i« .s' <br /> REQUIREMENT r ,,, Nfr, ,kA+„~y`.... ~'.~„ <br /> SAMPLE <br /> MEASUREMENT <br /> _ ..- .,. y-.. ._ W} -- .. <br />' , <br /> PERMIT... <br />REGUIREMENT~ ,. <br />~~ <br />~ ~ .. :' <br />'c`• .,:~`; ;~;}; <br /> #R . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. .. .. ' :..~ .. .:~ . <br /> ~ <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I cERTIFT uNDEft PENALTY OF LAw rHgT I HavE REftBONALLV Ex AMwED TELEPHONE A T E <br />D <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AND BPSED <br /> <br />3'. M COO 4lit ON MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMPTION I BELIEVE THE SUBMITTED INFORMATION IS <br />fr TRUE ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE <br />T <br />FA <br />FO <br />MATIO <br />NC <br />NG <br />D <br /> <br />G~.~TA) AQ4A0. SIGNIFICANT PENALTIES FOR SUBMI <br />TING <br />LSE IN <br />R <br />N I <br />LU <br />I <br />33EUBOB151L'TwOFrPn'IrsNDnltlrlR`SOeMSa(ulrsEE Ieuue~cs!^oolu4N~ <br />GNATU EOFPRINGIPALE ECUTIVE <br />07 <br />~I~-~OVI p <br />Qp <br />Ot+ <br />L' <br /> e <br />) <br />W <br />i <br />r b <br />6 <br />h <br />d 5 <br />f <br />OD <br />%1 <br />i <br />i OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED crxeen <br />~earz <br />a <br />nr m~s <br />mum <br />sonmrnr n <br />mnnl <br />s <br />n <br />I <br />( <br />mpr <br />C DE NUMBER YEAR MO DAY <br />COMMENT AND E%PLANATION OF ANY VIOLATIONS lRclrrrn[r all alra[hmrnrs here) <br />°~n6F.F. ?RRT i. y. 2. C) Fl; !?F*AI'.S OF TFgr neTjCp~llno~ <br />LE. 9.1 :. ~°O ~.~ : nF '"~5' 7d ;ANIS.95, A9^ AT'*~~4 A~T1T? <br />~~. cn or ern r cm <br />~E,, PA Form 3320-1 (Rev. 9-88) Previous a 1110/15 may De USE . /REPLACES ~A Ff <br />R?nOP.' 'C~ - ';TATicT.i~-.• p~rP,T - T... ,,,Tr-_ <br />TOXiCI?'Y PEST R?P7R'!' F0271 "'0 ' "F. "SGT=•-: ]F ACT 1 <br />WHICH MAT NOl tlt U5hU.1 00053/95623-1]I1J PAGE OF <br />1 <br />1~ <br />