Laserfiche WebLink
PERMITTEE NAMEIADDIIEBB (IrviJrsfNBryNw/1«um /DlpearO <br />NAIRE F; ;, w I c, - - - ~ ~, f "~ r '.. ~, <br />aDORES9 1 n W I .i - ~ - ~ '~ ^ '. ;- , -^ t ~ E 5: <br />r f J • 1 ' <br />4 <br />FACILITY j U = l E ~ ~ - ! f r' ~. <br />LOCATION <br /> <br />nAn DISCHARQEDMONRORINA RnEP~OR~T (OMRIPoES) <br />1-/6 1 /9 <br />PERMIT NUMBER pSCHAROE NUMBER <br />MONITORING PERIOD <br />YE R MO DAY YEAR MO DAY <br />FROM :. I ~' . TO .' • ; c <br />!10111 !11.131 !14161 !24271 !16.191 !3631! <br />' •- e- rntrod. <br />.'• f '~ c. n I ^: e. " "1 ~.. r','PMQ ~°-~5~-0004 <br />,. 1. t, , I `.) Approval irzpifee OS-3 T-98 <br />f - f-: i;. <br />NOTE: Reed Irrtructlarr before eompleilng •thla form. <br />PARAMETER 13 Ord Onlyl QUANTITY OR LOADING !I Gird Onlrl QUANTITY OR CONCENTRATION ND fREOUENCY SAMPLE <br /> 44631 61-81 36-161 !16-63 6461 of <br />132.371 <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX <br /> <br />rsreal <br />ANaysls <br />161-s6/ TYPE <br /> <br />!s9.7o1 <br /> <br />- <br />, .. L ..., ~ d t~. .1 SAMPLE <br />-: :.-. <br />.. .. ~ V'1) <br />~-:::....,: <br />,.. .. <br />..... y:;, <br />.. <br />, ......,.:. <br />... . <br />f L .; 0 \ L MEASUREMENT <br />.u`.,I,; 1. U PERMIT ~. <br />-~ +k CO:;=~a~ ~ <br />~ . R'~"PU'rtT -=1 -a;+~N#t:: s;r~fx's:~~k.. . ,~.,,.~k-r>t ;,v=aL Illa:lA <br />~. t ~ ~ <br />LJL G .l' EQUTAEMENT ~ ... ~ku~ <br /> <br />I. MAK r, _ <br /> <br />-J . <br /> SAMPLE <br />• MEASUREMENT <br /> ~~~ .PERMIT .. <br />~ <br />~~ .. ... .. .. <br />~ <br />. <br />. ~ ~ ... . . <br /> :REQUIREMENT ~.. <br />.. ~ <br />. . -' .. <br />~ ~ . <br /> SAMPLE <br />~ <br /> MEASUREMENT ~O ~ - ~ <br />Afi'~L <br /> PERMIT ~ ~ ~ ~ ~ ~ ~ ~~ ~~`J~ <br /> .REQUIREMENT ~~ ~. <br /> SAMPLE <br /> MEASUREMENT <br /> .: -ERMIT <br /> :REQUIREMENT ~ ~ ~ ~ ~ ~~ I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMITT <br /> .REQUIREMENT .. <br /> SAMPLE <br />• MEASUREMENT <br /> - PERMIT <br />' REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> ~.1 <br />NAMEfTITLE PRINCIPAL EXECVTIVE OFFICER I cERnfY UNDER PENKTr of uw n+Ar I NAVE xRSONALLV ExANBNED AND <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HERON AND aASFD ON - ~ j TELEPHONE DATE <br />J IR <br />Y <br />N / ~ / <br />W} <br />.J Q <br />N ' IJe A 1 <br />W I I I <br />I~ M <br />I <br />QU <br />Y OF TNOSE INOIVIDUALB IMMEDIATELY REBPONSIBLE FOR <br />\ <br />, <br />I <br />I " OBTNNING THE INFORMATION, I BELEVE THE SUBMITTED INfORMATON iS - ~' <br />~ <br /> <br />7 1 <br />~ TRUE, ACCUMTE ANO COMPLETE. I AM AWAPE THAT THERE ARE <br />BIGNIFICANT PEMALTES FOR eUBM1TTING FALSE INFORMATON <br />INCLUDING -/ ° <br />I <br />~/ <br />V / <br />~ I ~p' ~4 <br />r" <br />I p )Ly , <br />THE P059BILITV OF RNE MID IMPRISONMENT. BEE tF US.O. 1 t001 AND 77 <br />F 1510 <br />U <br />S <br />O <br />lP <br />~WRi <br />d <br />OS <br />( <br />N <br />A <br />6 , <br />_ - <br />gIONATIME OF PRINCRAL EXECUTIVE ~,~ J )7_c7/J L J'i ~ ~ /' <br /> <br />' <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />a <br />f M <br />r <br />fr rar <br />GifF mfr . <br />CA <br />~ <br />Mf y m t IO,OCFI <br />rtd ormuMUn NrPnfonnrnt we.nr..nemendu.nsb w.ra! OFFlCER OR AViHORRED AOEMT CAE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReferenee ell elTechmenGS here! '~ <br /> <br />,~ ~ . - , <br />,, <br />7V' I ,. I_.. <br />°":L:..~;IL.°. SULI',.- -.. i'- ,.. .'Li (~.~L7 _. <=1~'(.. <br />?.; .. - .. . r ' <br />i' <br />, <br />. <br />- <br />- <br />t.., -. .., :. L~°..: r, :. .. r.',_ t. `. ~". r.! .~ -' ~2 .`?J °"..i - ,. -'. r~ t .. , ,r f <br />r '• <br />'Iri NL 4: N" 1T _ _- f -'/i1' ;T~ I'~TT - ~/ t <br />~ , <br />~ <br />~ <br />EPA Form 3320-1 IDB-861 Pravloue edibone <br />mey be used. <br />IREPLACES EPA FORM TAO WHICH MAY NOT BE <br />U6ED.) - - PAGE OF <br />