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PERMITTEE NAMEIADDREBB R+eYd. F,ctliryN~,/I,or.ne, d0,p,..,d
<br />NAME THA~!'C.•. "1 ~,I : :, 1, :.
<br />ADDRESS TRA!-i''r: '-] <°
<br />v,o. :. ;x II I
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<br />FAaun
<br />LOCATION
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<br />NATIONK POtIUTANT dSCHMOE ELIMINATION SYSTEM /NPDESI Form Approved.
<br />DISCHARGE MONITORING REPORT lOMRI ~ 10 No. 2040-0004
<br />r?-r51 n-rel pt R1 ^r•. F.LY, ;,'1.,~Q
<br />C D O U 3 211 i (( p (S U r F f• q) Approvallezp;rAe OS-31-98
<br />PERMIT NUMBER nst ARGE NUMBER F' - F I A A I,
<br />MONITORING PERIOD ' I !J C F
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~. TO ~ ~ '%%~ NC ~I~~'t'A45E X '~'~
<br />!?6111 !??-?31 I?I-?51 !T6-?71 118-?91 !36371 NOTE: Reed imeruetlom betonlcompletinp~thie form.
<br />PARAMETER 13 GFd Only) QUANTITY OR LOADING
<br />1~6-531 /51-611 /4 Grd OnIYI QUANTITY OR CONCENTRATION
<br />138-15 !15-53 151-5/I ND FREQUENCY
<br />DF SAMPLE
<br />l31-371
<br />
<br />AVERAGE
<br />
<br />MAXIMUM
<br />
<br />UNITS
<br />
<br />MINIMUM
<br />
<br />AVERAGE
<br />
<br />MAXIMUM
<br />
<br />UNITS EX
<br />
<br />Ir3a31
<br />ANALYSIS
<br />154-sgl TYPE
<br />
<br />169-701
<br /> SAMPLE #r/r:?r,:y Y:?'%FrF# '.{OYC# ( 12)
<br /> MEASUREMENT -
<br />
<br />UULL~U C J
<br />LFF'LUEN'i GRDSS 'lALll ~~ PERMIT ~
<br />.REQUIREMENT Jrl {N#,~Oys YS ~~ ~ ~ rlr#-7!Y?#1P KF C#
<br />fiL7{:# 6. 5.,~ ~
<br />M.I.It3lltiii 09#iI~O# ~.0 ~
<br />:!AX3NUi"•..
<br />SU ~~: -S~KL. .. NSTTI
<br />~ULI ~, oTAL
<br />:i U'-+e LNU~~U SAMPLE
<br />MEASUREMENT #;~.#,,^•Y~ ###t:## #aao>;o ( lg)
<br />
<br />JUS3'v 1 0 0 T:: PERMIT '::
<br />~ KtXO# #O{~ Ck.1R i.#.~ ..
<br />~ ~5... :.: ;. .:: .T.t}: IiCEY ~
<br />:i F'FLUENT u4DSS YA LU :REQUIREMENT ..-:~
<br />~:.~': .,. ~: .~. ~~. {: ;,r {k ~~ ~~ ~~
<br />3CC) R:Y6
<br />:'D;iTYY. tf
<br />M~/L
<br />MONTi'
<br />:;U.. ~, S AN P. SAMPLE :XR4#{~# #'I+*C: {I'.`• :t,#OIIY ( Jam)
<br />. MEASUREMENT
<br />
<br />~U~uS 1 0 0 PERMIT Tt'1• u#xC-rF#
<br />cFtlcb+~I.
<br />h~r<c;:r.
<br />NcF~t
<br />';R:EFi
<br />::FiLJENT GROSS PALI) REQUIREMENT .{_# 30CA ..pYG LAI:It C7( !!L/L t!0!:I'H
<br />D .•
<br />(AS~') SAMPLE
<br />MEASUREMENT '%i~.7,•y.y ,:::.. {: Ca
<br />
<br />Dis #{, i'0i,: ( 1~)
<br />U1045 1 0 U PERMIT 'r=+~'x^~ ~a~ .x #oc ~#caaT+ 7:C NC;'! A
<br />",
<br /> .-, t
<br />tFFL'JLNT GROS YpL'i REQUIREMENT 3CL A'AYr EpITY t'N Yi;/L MCI N'!'ii
<br />v .1 i, A l: SAMPLE ;:I;1;:;:r~:t ::::i:C;F.t 04L^fi3 :{#O#'.~ ( 19)
<br /> MEASUREMENT
<br />
<br />U .f Stl1 1 0 U .PERMIT,. ~ r,-u1Y 7 . :~~; ~:: :. y1.#. 'R L+CS .Cti rT#O# - :: a~.. #,~,~ .~.D ~~Ori".'I4 ;RAE
<br />cfF'LUENT DROSS Jkl,!) REQUIREMENT #y:F4
<br />:.:.~
<br />~ IM$T 'FkX Mr/L G$h"
<br />:, U G:: SAMPLE ( 03) #0s### LtCL
<br />t=4 hr, ;~#`r
<br />'1 1! :i U T H 6 A'f tl 1; N 1' 1• L A N MEASUREMENT
<br />
<br />;~U70 1 0 /~
<br />~F'FLu~N'I :.ROSS V.4LU PERMIT
<br />'REQUIREMENT R8F'4RT
<br />3UAp A.YG RBPCRT
<br />GAILY MY
<br />t!GU '~K~#1d~3.# #t~d4iYta t':~l,rsysg •{Iy.
<br />a:x{~a F,~:i'I.'! 7'.)°.iA
<br />:, L F SAMPLE s^-.•.•..:.. {i_}{e#4:3 !` 'J-0O ( I9)
<br />DI:iSULYnU MEASUREMENT
<br />J01S5 1 0 O PERMIT '' { ~ ~ ~ #~'~ ~ ~%'~ CFTIClp2.. EF:GP'C `THEY ":tAL
<br />c:FFLUd[iT GROSS YALU 'REQUIREMENT . #.;_# ~F.TF AYG. .. DAIIY CX rc/L
<br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER I tERTIFV uBDEfl PENALTY of uw THAT I NAVE PERSONALLr ExAMINEO AND
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; AND EASED ON TELEPHONE DATE
<br />
<br />
<br />
<br />. Gordon Paters
<br />MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPnxcIB!E FnP
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INF011MATION IS
<br />TRUE, ACCURATE AND COMRETE. I AM AWME THAT THERE ARE
<br />SIGNIFICANT PENALTIES FOR SVBMITTINO FALSE INFORMATON
<br />INCLWING _
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<br />
<br />70-824-4401
<br />
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<br />President /feneral Manager ,
<br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 1B U.S.C. F 1001 AND 3]
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<br />A
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<br />f BIONATIIRE OF MUNCMAL E%ECUTNE
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<br />TYPED OR PAINTED . /
<br />U.S.C.
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<br />,M mmn, InEY NcA.d,
<br />,w, y m i 10,000
<br />e,s or wl..hN.n Nr,v:eawwNWMnrwnemmeh, r.Y6 yra/
<br />OFFICER DR AUTHORRED AOEM
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OY ANT VIVLA HUNS I7(tlennCl M/IttIC/Iminfi N/e/ --
<br />;:i:i ~: TUTAL I>IUN LI'1LT°S SILL Eii: wAIYEU, AGp :;ETTLFA6LF. 5)L ICS LI'.IT AFFLIFU FGB C=lOYF.,24PF PbECI^ :YENT-
<br />S~t UU4DE~ OF P:?DOF RF;,UZRF'ICN2S UNDER I. A, 3. TDS CONITOFI:iG - T.F.?. OIL `; GFFA~ti - SF. F. I.H.1.(~),
<br />30 ['AY AV6XAG£ IS $TGHFIST MII wTH LV •V F'H-GF i11IU TNC nc4Tnn aF DPR7F~-
<br />EPA Form 3320-1 109-951 Prsvloue edmom mey be used. (REPLACES EPA FORM T30 WNICN MAY NOT BE USED.) ~ D (R I! / 9 7 1211-1 ~ 4 ~~ PAGE lOF
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