|
-[RMITTCE MAMC/ADORlfB ~tnrtYd[
<br />F~dli(y Name/LBnrbn if diffoenr)
<br />~~Ctt '~~_ Y.4MfF VSI.L_.Y Cad= Crnf'.--
<br />AooR[[ah_.h_~ i °'~' _?J'ljr' '~ •L:n?At. c:.
<br />-s-- i--------
<br />~__ht:u~. ..NUO J____-__-U_J_~~ J_-
<br />rwclarv_______--___---_-
<br />LOCATION -_-_
<br />r r'! ... --i ---- r n r n I l
<br />HwnoR wL rouDrw Mr oncHww DE uIMlNwnoN srsrEM tNPDE51
<br />DISCHARGE MONITORING REPORT /DMRI
<br />z-lb t7.re .<6JGi; FormApgroved.
<br />Cc(, ..:7154 (i U c r :: -) OMB~N(i.~2040-0004.
<br />PERMIT NUM9Eq wcL NuNPEw ~ t' 1 :, l Approval expires 630.91.
<br />orFC •'ii. ~ LJ_i ;~ .. .'ii F17': C.d .: P.
<br />MONITORING PERIOD yP
<br />YEAR MO DAY YEAR MO, OAY _\~~[~_
<br />FROM .J< ~l TO _ .. ~ :fv nV )1JL. 1': {hLa I/~. ~~.
<br />NOTF ~ Rwwl instrueliem hefor/B-eomoleting this form.
<br />__ _ _ _ _ _.... - -.. ..... ....
<br />
<br />PARAMETER P _ .. _ _ _ _
<br />(! CRrd Only) QUANTITY OR LOADING
<br />(M-J!) (JI61)
<br />(~ Card Only) OU ALITY OR CONCENTRATION
<br />(lB~J) (1637) (Si6))
<br />
<br />NO'
<br />EX
<br />Tp EOU ENCr
<br />of
<br />
<br />6TYPEE
<br />
<br />(33-37)
<br />AVERAGE
<br />MA%IM UM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MA%IMUM
<br />UNITS
<br />
<br />63dA ANALr515
<br />
<br />1616N)
<br />
<br />(A9.]0)
<br />.l BAMPLE ~... :p ~,:}CY irV L=:,.:~:J ( ) ,'. -•: ~,; :, ( Imo)
<br /> MEASUREMENT
<br />J I~ L' (1 1 V l}
<br />tFFLUr:N1 ~nO.SS ° : °PF.ItM t7 `.
<br />~REQUtN[MClItT.
<br />O ,'x°'~D 9ti•F` <
<br />
<br />~ i Q'a ~~:~2$
<br />,I +''~;'
<br />•. L..y= b z °.""e
<br />°°,'~~° ~Sa`ia; °a~ 'g"a`i'r"~,`ga° <'
<br />`4<,` ~s(k~«.'n ," `, ;'~+
<br />`~a,~`~a`I`.~
<br />~~ "'- '~a31y~1•%~ i~°~'~:lmp n%.
<br />JJLIJ~, J.TTLE:A.Lr. 6AMPLE -~~'#### vo;.r=:+ ( ) ###~wx: 1 ~~)
<br /> MEA6UREMENT
<br />.~~45 +: G
<br />
<br />,~~ cor.I- ,s s1,LCV, °s°,P$iiHlT`='°
<br />.REOUIRCM ENT' °°a:gx~~a;~,.
<br />° v tw:?~?~~s>
<br />
<br />' ##i~
<br />
<br />:f##u '.~;xHF ~~a,.e'
<br />aR.`+„ «•«
<br />, ~; x;~,~i~&~3,~~g`a,
<br />x~s`91.~x.
<br />;°3~~~° a°~k~p, 13m=A
<br />
<br />~s
<br />',~,~~sr ga`'~~xx
<br />
<br />nL L
<br />~ kiq~Cc,1:.~~ fi
<br />
<br />~xt3.
<br />yr•R g ~~r
<br />~JLIDJI .. =TiEI•hLr 9AMPLE =r,:p>3#c+# ~Y#k=.: ( ) ~##cF# ( 15)
<br /> MEA6U REM ENT
<br />
<br />:]4rj i '. V
<br />LI FLLI t N'1 (~ F (755 V A ;,J ~
<br />n`'YCRI+tT°.°.
<br />°REQUIR EM ENT.
<br />'s~~)'d°NFa%~$~T6,""
<br />
<br />s
<br />a
<br />s
<br />R
<br />+e~as`
<br />.
<br />R
<br />x
<br />R
<br />i/#r
<br />##f~i-
<br />=« a=~~,=:i§T3~%~P
<br />er +'& py ~)
<br />•,'1~&~:~kF<k~'~9
<br />s°e'1~IJ't+ S1:s~'fNe= y~~
<br />A~"t~~&'^<"e.~~'+s•,.~•°
<br />A°
<br />
<br />n
<br />p«,
<br />~,(,Y~.~`-x~
<br />+ Z`~.4, y:
<br />'Ci~'ii~bY'•
<br />'
<br />J1.. 6YL <...._:1..:. BAMPLE +il.:~l
<br />Yt
<br />QY :.
<br />Xs
<br />=/i
<br />: ~ \ 1 iiVv:~..;::: ri~%i~i~%i ( 1 ~)
<br />If GL I( Ld.°•-+ttAY r~ln MEAeUREM ENT
<br />(. ~ S b i ,, L'
<br />rFt'LUEhT (;h(i;,5 YBL: . ° - , ,_
<br />"nEgu1R,EN,iNi,
<br />
<br />'• . ° ~ei6YrW ° d?sa
<br />" {• . M
<br />Ir:: xLTx~~t~Xt~ ~,
<br />
<br />
<br />&
<br />; <#,tJ,7RdtT}:~.°,;
<br />°:',"" x,° . `. ,' _ ° x
<br />°,~1i~3;'.'@~.~•~_
<br />
<br />Lv
<br />/:. _~;T'
<br />.~',.:° ,~S:~t,§.+,' ° ~
<br />' ,'~:
<br />f k CGNCUI2 U`~
<br />' Ll~ F L1+
<br />BAMPLE .r~)
<br />( #
<br />:'r~
<br />-. YCP### +#;:#;+;: ( J
<br />1 -i .(LI Tt-Lr•-Yf ::NT ~Ll) h ~ MEA6U REM ENT
<br />
<br />
<br />(I Q
<br />:'J.~U i
<br />t.r"r1.USdT „HOSS YALUE
<br />a,, ~,r
<br />"''PERMIT
<br />,R$AUIREM'•EN'f'
<br />~,
<br />yy.
<br />.~k~~~ta+kr•,g
<br />
<br /><".T4~~1~''~+~'~,Y+~' tt
<br />~y °nn^
<br />'~~ °
<br />
<br />°~~'1:~~`.,?°'°°2~~m'
<br />
<br />
<br />
<br />lili Ys
<br />s5Y ,9A d,, 1~
<br />°a
<br />x~~<p;: n$g;
<br />,?~%y Y£~~«
<br />
<br />~• °z°'
<br />
<br />"
<br /><''~E~v11+'~(R'n'
<br />..
<br />
<br />°'%,:~`,°
<br />Y,r f: :.
<br />
<br />.
<br />3:~~ ~,f-
<br />~"Mpa~:'pS
<br />°!',
<br />~r~~Rt~~
<br />1L AhL L:liEASE BAMPLE #####i} ( +j t~) ####~# #####.'. #+~:}### ( )
<br />1 ~ ~ ~ L M EA6U REM ENT
<br />] •~.: t: G 1 () L
<br />
<br />~; 0 S Y r1 L U £
<br />ErF1.UEN"_ ° 'P$RM~iT ,'.'.,
<br />RHO IREMENT'
<br />~ « L:•P$?~.°.~,&`, . >'f< ' '
<br />
<br />` ~7iSm~>",{!°IL'D[9-` :.i =I
<br />
<br />N .. = 1. °: R7L',4'Frj;~.:`d.°•; .n e94~~!.$L <..° ` : e>4.51e$?'la(F°,~,'e`~+r
<br />
<br />_ 4+:0
<br />';Yi
<br />? '`.: f==.`<<i x y~~;(i.~. ;1.7<l~'J~l.'.
<br /> 9AMPLE
<br /> MEA6UREMENT
<br />~'REtlul RE M SNT`
<br />5 YS°A (4 y°v
<br />~
<br />V
<br />~ as
<br />p
<br />p
<br />a
<br />°
<br />
<br />e
<br />°
<br />NAM ENTITLE PRINCIPAL ExECUTIVE OFFICER LAw THAT I
<br />NAVE P[RSONALLr E%AMINEO
<br />//
<br />TELEPNONE
<br />uHDER
<br />PENALTY OF
<br />r CERTrFr
<br />/
<br />/ ~
<br />ANO AM FAMILII,p WITH THE INFOPMATION SUBMNTEO HEREIN AND BASED OAT
<br />E
<br />
<br />ichard ~~ills ON MV INQUIRY OF THOSE INgVIWI,LS rMMEOrA1ELY RESPONSIBLE FO/I
<br />OBTAINmG TNC INFd1MATIOV I BELIEVE iNE SUBMTED rNFORMAirON'
<br />6 TIRIC ACCURATE I•NO COMPLETC r I•M AWARE THAT THERE IRE 9G
<br />iOR SUBMITTING FALSE MFORMATION INCLUpNG
<br />T PENA
<br />T ~
<br />/
<br />T
<br />/ ~ it > 2L
<br />
<br />'570)670-7.71 ~
<br />p
<br />J
<br />
<br />?b
<br />
<br />3F.
<br />C
<br />L(1VlrDn nenl•dl !lla n~~er
<br />_. IES
<br />MFICAN
<br />L
<br />THE POSSrBapr OF FINE An0 IMPR5pNMENT SEE IB USC f i00i AnO
<br />ma
<br />nn u
<br />llr/nxr
<br />1 i3~9
<br />I
<br />f
<br />b
<br />l
<br />d
<br />/
<br />I
<br />h
<br />M
<br />A 61GNATURE OF PRINCIPAL EXECUTIVE
<br />
<br />TYPED OR PRINTED n
<br />.prm
<br />rr I
<br />rv
<br />n
<br />u
<br />n
<br />y mr
<br />u
<br />r
<br />r
<br />]~ u5C
<br />rr. u
<br />.
<br />V
<br />o.d•u maarmwr mlRn.umvnr„/M1.mvnAm.mtA.antl.i .ra.v
<br />OFFICER OR AUTHORIZED AGENT
<br />A EA
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENT AND E%PLANATIOn Or wnr vlOLwr u.ns .nrrrrr~.r un w,....,,,.r..., ..r,r.
<br />S•$TTLyAui.. J'J :,1. L.I.=_ ~_ An1V'. I- (Ll. 1, si ri ~t:,Y i, li,.-_n~ L~+-,. ^a~_'r JEtT i-. CiA I. ~~. :._ _<~.~T
<br />~,1e, E,;.. ':G~! .:I . f ,l. (,F ..t'~UIa-.I.,L:.,. _~: t. Ln..nJ_-_.:t iJL."!::Jlt. r/F L., _. tatOcLY ~h.2i.. (. ,
<br />(wEPLwc[s EPA FORM r-IO wNICH MAY ROr EE USeD.I Ji226/93GJ~,i-i. ~%. PwcE of
<br />
|