|
PERMITTEE NAMElADDRESSpMIbimlSryNs.ulacanw ljD.gnsq --
<br />NAME C.YP4!I~ Ys." a ~~T.T,..Y .,._ ~~RP.
<br />ADDRESS M I 'i ` ; , ' ~ ? ~ , -. ,; I' _ ,~ ~, ? C
<br />910') '1 `. ~' - r- ..~-.
<br />FACaITv
<br />LOCATION
<br />?_it ML09 RI'S .7. .`c r: 5: '=aI. Ar7v
<br />NATIONAL POLLUTANT DISCMMOE ELIMINATION SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT IOMRI
<br />!J-lel l17-f91
<br />'~OJ2711'i ^n-r a
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ ~. _ TO :I
<br />/10.111 OJ-031 /I4J51 /J6DI /JB-291 !3631/
<br />Form Approved.
<br />~• r .~ o ~ ~ ~ y . -• ~OMBINoa 2040-0004-. ..
<br />~ . ~ , r Approve e~pirea OS-31-98
<br />~:' 1 {.
<br />c _ ~ r -
<br />.;~
<br />• NOTE: Read Inetructioru bet i omplatlnp this form.
<br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING I/ Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> !0653/ /5F6f l39-451 !4653 154-57/
<br />l3I-371 EX µryY~S TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /e1-etl 154581 159-701
<br />I ~.;. li SAMPLE '~;t Y $~: $-^:: :~,t : .-... I 1. '~)
<br />-'J "~'iL ?E~GVF44~I. s- MEASUREMENT
<br />,0-1•J 1 0 J PERMIT $;;57. ;'.'.`,..,,. '.'; '~'?' ±;"s t,~ -~ nT
<br />.'Fr'LU;"'r '•R7Sa VAL~Jf REQUIREMENT ~$$ 7Q(la eVG DAjIT '!T "!'JL
<br />' ND!2TR ..
<br />~i~Y '~'F _-r)T°YTISLLT SAMPLE :t:Y rx'. $. .^-DS<xEu Rs#yi~$t~ "I)
<br />~
<br />} j ; ~ L ;_'_ ./ MEASUREMENT
<br />J1i!)11 1 0 U PERMIT 17Xt.#k~,l' $':$~;-',-' v=;:; ?=kskhySts J:[POj]R'1' nvprDT ( 'ffir'I?/ I$~?
<br />•.FFL!lr,:l;' ;F73S YALEi REQUIREMENT .$g$t 3(}nA Ayr reTLT •C 'Pff MDR '!
<br />,l1PPE~= ?U^F'+TI4L'..y
<br />F SAMPLE ;r~?t-: ;s :` G$;:'.`•'t 'k .'."=^-^::
<br />~ 1~)
<br />I" .al L'/ F. :1 MEASUREMENT
<br />J1±Lb 1 U PERMIT yY=~4RR'-s $4`,",.r.: tX# S:Is#.'?t:'=' '1,()?1 'l,i~ is.n='F./ ;?A'.
<br />P:'1.78NT GROS ~ yF. J. U?; REQUIREMENT ;-;:? 3ngA EV' P5'rT `rx '1 fT. `1 ')`: T'I
<br />:AN?SP.r T1 T'- SAMPLE .~ .,-Fe's.`- ~'.tv OG,'t ~: t:.s:., _` ( t9)
<br />"~ O V= '> A N L F. MEASUREMENT
<br />~iii.3 1 0 Q PERMIT .. ~'J 4Sx .:-"=. F"f ': .. ~#~'r;:a o,, ~..:An• n.. n'~^ F'%xT.y 'R ~.=i
<br />'c'LO°NT GROS$ P4I ,~ REQUIREMENT .. ~ oRr.E qtf^ ^r.+Ty +T 'n:/L
<br />:.O dF P.! COADDI" "`7 SAMPLE f J 3)
<br />-o-..... ..
<br />... ..
<br />..,-::
<br />..;tr,'.-
<br />~ ...:,.....
<br />..
<br />i~.=L TR6ATMP.Nf rLA y'.' MEASUREMENT
<br />
<br />,;JUDO 1 Q
<br />PERMIT
<br />R="P~~.I' ^~~yy
<br />RF''I''J=l~
<br />. wN~wA
<br />lY+`;~~w1
<br />!~:~ ai
<br />$ f/.
<br />iFF'L'JF"'i ':"'~S VALU~ ~REQUIREMENT 307A iVG DAILT hY !!;;p - v^:k
<br />J I L d N D ,. "' E. 4 f' SAMPLE ~ F F'7!"s ( ) 4) ,.t.;e;:$;t r$:;;,`:•.'r ~ . , .
<br />~ j y 1, A L MEASUREMENT
<br />i4UF.b 1 7 U PERMIT ':+$;rxFG . ) T ES=1 r#!3Czf$ $#rJ#"-": $$~}:~:~ .. S c•.•~,i''. 'I`~I"'=I,
<br />'FFLUcNT :'G =S~ V '. Il' REQUIREMENT Irgp MAY Vn_!!
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT '
<br />NAME/TRLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE
<br /> AM FA MILIAA WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON ~ '
<br />
<br />~. MY INQUIRY OF TH09E INDINDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 19 ~ /;' ~ y
<br />// I'J
<br />1'.IChi3 YCl iIII~ TRUE. ACCUMTE ANO COMPLETE. 1 AM AWARE THAT THERE ARE ~
<br />I/~
<br />~~
<br />//~Ll.
<br /> SIGNIHCANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING ,(F
<br />A
<br />
<br />~-,viron~^^nt"! P
<br />:-i'L`I' ,
<br />THE POSSIBILITY OFRNEANDIMPNSONMENT
<br />SEEIBU
<br />S
<br />C
<br />IIOOtAND73 _
<br />7
<br />'
<br />^
<br />,
<br />` .
<br />.
<br />.
<br />.
<br />R
<br />S
<br />510NATURE OF PRINCIPAL EXECUTNE Q 7 ~
<br />~
<br />7n- (, CIE
<br />
<br />TYPED OR PRINTED 0.
<br />.C. E 1lts. l
<br />b.rbi. uMr 1Mr mem. mry NcAW 5r. w ro t IO,OOD
<br />r=0rmurim.nt+wlaaw=r.nr orNrwrnemenlM rM eYrral
<br />OFFICER OR AUTHORIZED AGENT AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DqY
<br />COMMENTS AND EXPLANATION OH ANT VIOLA I luno lrtsrerence sn errecnmsnw nere/
<br />°:, :'dRY11 ',", T.. - - ^,c :~ ~ '~TL F tL .ALT. (L 7C F7E1 ~'. L'( "'L't TF ~= 7/_r^ ~a_'- ~=''r'rC -/^, ,r r'
<br />LLb7"IN.~. ..iF ~ t-'• 'n `~7;.. 7° FR7nP 4F'lIT°' "°'"'-. FrTr s• ~A;r._ ~ r ^r~-I""~.., ''f
<br />F
<br />EPA Fam 3320-t 108-951 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.( ~ ,,, ~ ~ 7 ^ ~ (? L ^ -'- 1 ,1 l ^ PAGE ~ OF
<br />.-_ .- ~ J
<br />
|