|
PERMIIITEE NAME/AODRE55O~s, FacWry Naw/Leraflm UD,p...tq
<br />~
<br />r
<br />NAME .,t r'. .,~ .r + rni .-_ 7 .. ..,i u..:.r
<br />ADDRESS;; ~,~~~ LFL ._ ~-.u T::. ', _..~... •v r..
<br />
<br />
<br />FACILITY ~ - r L ~
<br />~ 5' r .. v u ~1 r ... ti L I-. 1.
<br />-. _- .
<br />LOCATION
<br />I I I .. :.. . 1 I .: Y. .. I .. I; i
<br />NATIONAL POLLUTMT DIBCNMOE ELIMINATOM 6YBTEM /NPDESf Farm Approved.
<br />DISCXARGE MONITORING REPORT IDMRI OMB No. 2040-0004
<br />l2-761 If7-191 '. I ~ _ 1 ~., .1 :. •~.. T..
<br />Appiovtil expires OS-31-98
<br />.. r ~ . _. L c .'I
<br />PERMIT NUMBER DIBCHMGE NUMBER ~ f 1 .~.L
<br />MONITORING PERIOD ~'>' -'''
<br />YEAR MO DAY YEAR MO DAY
<br />FROM l .,_ vl TO ~: ~ ~. I ~:, r1 :a. .r_ :'. .
<br />!10.2/1 122-231 !24151 !26771 128-191 !36311 NOTE: Raed Inetruetiorte bef a pletinp this form,
<br /> !3 Grd Onlyl QUANTITY OR LOADING !4 Grd Onlyl QUANTITY OR CONCENTRATION N0 FREQUENCY SAMPLE
<br />PARAMETER Mt:531 154-511 lJ6-451 1065 /5461/ ,
<br />EX of
<br />TYPE
<br />137-371 MALVSS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161-ey) 154-581 !54701
<br />~ SAMPLE - ,, ,. '.. ~, v' :..
<br /> MEASUREMENT
<br /> PERMIT n>; ~q. ,}.,..; ~ fy:;.-~. >: . ~ : a'.,ti.r ~ ; ~~ ~ ~ y
<br />rr~_..L..1 ,~ .,~_ ..I
<br />REQUIREMENT
<br />., tt:'. ]~
<br />~
<br />~~:~t~ t~`^~.,,.~
<br />.
<br />.ua.lu3E ...I ~._ SAMPLE C... ,,': ..y.. .+. u.a 1:
<br /> MEASUREMENT
<br />
<br />..: Jl
<br />A L . ~PERMIT.~ t+r :•i i=>:+~ 'r4 r{.3b « ,.. i, ,. {e [a ;. a• a.~. .. . . ~. ~ ~
<br />lJ ~) cS•cY:-:'.t .dA~
<br />.
<br />.
<br />~rl LJL•>I ~.LJ~_ REQUIREMENT ~ ~ ciU;i: Av:. .
<br />"A ~.Y.~!^r i<~ :5 ,/ ('ILi-r' :i
<br />-., ,. SAMPLE ! i `l
<br />i .. 1 •. L ...- ~ .. v :. . , , ~ MEASUREMENT
<br />.L V.,,, a u . .PERMIT ;: ,. >,u4 ~e >p ii,: •~N>. is ai -.. ¢p,, j. >,:..: Lau ~ ..`. E.Y u!1 i~ ~ ":~;~.:./~
<br />~ '><, is
<br />1
<br />-rh LJ>-.t '-J •J •LJ.
<br />'
<br />a ~REQUIREMENT~
<br />~
<br />`!~"' ~ u,
<br />/'~).){. H'.J I' ~i .(
<br />'Iris {_I lj/'.
<br />t'l/L p J
<br />?{i.1.Yr :1
<br />~i. r~.'r :'u
<br />I ~_..(l
<br />.~~7 SAMPLE :~:••. 4rA4 1'!
<br /> MEASUREMENT
<br />` .IUL I ~
<br />. ~-. L I, .,
<br />i PERMIT ~1.~~1.}~,<>,< ,V;un >'. : >. ., ~, {r :. ,; ,: ,. nLi'~~;:T ~~~ 'J~f ~~ ~
<br />v~. lihi ../": .`.:. ~.
<br />.
<br />.
<br />.rrl_.. u..l uY. ~~~~ ~~. REQUIREMENT ~ ~; U.)„ .~. '/:,-~ .
<br />-„w~i:-Y~ i'+4 t
<br />:~.,/L ?<..)IOii'f
<br />_Lrr! ;:F ~ ui. .I i .~..I SAMPLE ,. i I
<br />i ~ ....L V ~ .. MEASUREMENT
<br />11JlrU L ~; >. PERMIT 'vl if tit.b ,F '7YN$;:>7 :a iai• '. >y na l,. ych lS.U ~'_5 .. '"~' t, dia:.
<br />_Fr Luu+T ~n J:.~ 'r l.L.,~ 'REQUIREMENT .1. ~. :. ~ ~SUUA .~f.V C> iii: si:~Y`~~~F'~~~ ML/L ~ ;`',..iw:ll
<br />.1L 1...u ~r.l A7c SAMPLE F+r tv. •?'. •'#, P.a 1°>. 4'.{a :a+.• ly
<br /> MEASUREMENT
<br />1J!-~ > ~ PERMIT ~ry ;.if :•;•. l"'r~^rov? u4r .,. t(.,,' tk~>;,}:ch k~. ~ i Uiu~~i.; ~ri 41 t:
<br />
<br />rf'~UL.11 ,.r~~ r .-L, 'REQUIREMENT
<br />4'
<br />Ii~:,l ;`IE.A
<br />'v/L
<br />u:.I:.l
<br />.Hrv.. .,,.._.~F I..j„L SAMPLE ~ d•. ... ~ i.
<br /> MEASUREMENT
<br />. L,., 1 L ..+.ur
<br /> PERMIT .;~
<br />;•
<br />KTt %. i :;t
<br />?.'; .>;> .L. ~w;a {;>,i ;r
<br />i ~~
<br />":
<br />f :J ')
<br />~ R_i Jn~
<br />~1
<br />i-
<br />t l
<br />~
<br />/
<br />t
<br />i
<br />i alarm t .. _ . .
<br />.
<br />. .
<br />, .
<br />:. I.
<br />:
<br />{.
<br />i . f
<br />c:
<br />--_u L.:.~ ~ _ REQUIREMENT ~ ... ~Ei.~s. ~:+Wtr t'~~li. Y~~ ^X .1.~iL ;/: Jln;:i ~ .
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF lAW THAT I HAVE PERBONN.LY EXAMINED MD
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN: MD BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF TNOBE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOP
<br /> OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB
<br />t
<br />U rCi I: IIIs TRUE, ACCUMTE MO COMPLETE. r AM AWME THAT THERE MF ', ; _
<br />
<br />C"1 1':p1tt.^.I ~'nn~r~r- SIGNIFILMT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
<br />THE P059BILITY OF FINE MDIM%IISONMEMT. BEE IB U.B.C.f 1001 MDJ3
<br />61GNATURE OF PFIINCIPAL EXECUTIVE
<br />970
<br />U70-Z7~2
<br />~
<br />1~
<br />~t
<br />
<br />TYPED OR PRINTED U.B.C. E t J t p, IP.n.re.1 ne6.I N..r .bvNa rryy McMIA film ap ro S 10,000
<br />.nd avmwinun impiatnwrr orMM.w+6 metres rM 6 yFra/
<br />OFFICER OR AUTHORIZED AGENT AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EJ(PLANATION Or ANr vwl-A I was Irrererence en errecnmenrs oars!
<br />., 1.. .. .,<L~~_ - .~ ,- .;•1~i_ ,/r ~. ... .,,~, ~_;_„li. ~..tt. - _.. ,..IT..,~I~ ~/. ~„r_..r..~L•r ..1.,.,.._,r.,
<br />_.. ~] r1, .,T "_ ~./. (.~- I.,~.I T.. r. 1-lu - -. _ __ _..1 1. ~~: -.i •~. , ~ _1,.. .. ~~f ,I• J•
<br />EPA Form 3320-1 (08.951 Previous editions may be used. IREPLACE6 EPA FORM Td0 WXICH MAY NOT BE USED.)
<br />V.~-_/,. ..,1. U"_/ PAGE IOF
<br />
|