|
.~ - -
<br />PERMITTEE NAME/ADDRE66 p+eb6iarlNryNe./L«+r1en darBi.alp
<br />NAME vY- ~.,_ t_Plr'(t<.~ L~ ..-.:'1:I .1.
<br />ADDRESS r' J ;;ud L.b
<br />L riA(L (,V b1uL ~
<br />FACILITY C,YFr:uS tF{FTkL Cur:hu~ATll~iY
<br />LOCATION L R a 1 L ~, •, `t a ;- ~~
<br />:i I {„ P,1 LrIAEL n+ l UUI iIN• Gt Nr KAI hl Clt
<br />NATIONAL POLLUTMT D19CHMOE ELIMIMATION 9Y9fEM //NPOESI
<br />DISCHARGE MONITORING REPORT OMRI
<br />1-16 17-19
<br />PERMIT NUMBER • DISCHMOE NUMBER
<br />- MONRO 1NG PERIOD
<br />" MO DAV YEAR MO DAY
<br />FRO O ~ 11 jiJ
<br />'99 0/ JJiI r9L~1 {' /9t9T1 /JMJOI /M311
<br />
<br />Fonn Approved.
<br />.~ ~ r, I i LOMQ No. 2040-OQ04
<br />Approval"expii6e'05.31 ~J8
<br />f - hI:.,.~
<br />KINU: ~
<br />ll
<br />NOTE: Rud Imwcdons bsf • comp .tlna thb form.
<br />PARAMETER 13 Qrd OnlYl QUANTITY ~tOADING Td Onlyl QUANTITY OR CONCENTRATION
<br />~ NO. FRED ENCY SAMPLE
<br />131
<br />37 146-531 151-611 ~ 138-151 !16-53 546/1 OF
<br />-
<br />1 EX
<br />MALYSIs TYPE
<br /> AVERAGE MAXIMUM UNITS :MINIMUM AVERAGE MAXIMUM UN175 Is1-sdl 164681 159-70)
<br />r'rr <, SAMPLE ,<4}}## k4+Yk5F:: {•,tnq<t,. 1Z
<br /> MEASUREMENT ~
<br />~~t,y ~:: i U U .:~.:~ PERMIT .~~: •k>t {, ip'Q4 L1 .`. .~~.lh .?k1F4 a•#..
<br />1y.5 ., ~°
<br />;
<br />. #'I#.'IF#W1~
<br />~~G :
<br />,;
<br />::
<br />i~t1iLY
<br />aKAG
<br />
<br />~hrLuchT ~KU55 VALU
<br />;.,~nUIHEMENT~.
<br />
<br />
<br />...
<br />.. .:. ~ ~
<br />
<br />
<br />.
<br />*p5•p .;:;
<br />..
<br />i;. ~ .. ~:.
<br />
<br />. .
<br />~.
<br />
<br />
<br />. .
<br />
<br />..
<br />.: .. ~..
<br />. ~..
<br />
<br />..:.: .
<br />.
<br />~~L ili`F II,TAL SAMPLE r'i tiY{•4 4 #TfY{<
<br />~ 5•'f ;.{•}p 19
<br />~L ~h Li. LL.u MEASUREMENT
<br />- S ~
<br />U L.~ u a U L :.;:.:PERMIT: ..
<br />:..... ,..:.:. ~. ~...::..:
<br />~t>{.o.;,:~..
<br />~### - .... .:..:.
<br />.. •., {rN#+1.111Mb:i ~
<br />t##
<br />~„t '4'4KIft#tt ........:•..
<br />~;r`!';i'':
<br />
<br />~
<br />
<br />I~
<br />~
<br />~
<br />~
<br />.. .
<br />tiFf-Lt,C~\T urtUSS YALU` :R.EQULREMENT .
<br />~: ~.: J.~:.:..:'
<br />_.::.... .
<br />,.:.: !:. ..:; :. ~:..: .~:~ ##•M# ....
<br />
<br />:. .
<br />
<br />. ~. .
<br />r
<br />:
<br />~.
<br />•. iv rihL u,<tA $t SAMPLE i•;r dri#4 •Ovl{<#.~ ~. isM$dr4+,< 0##Ih 11•k 1~ ~•
<br />r n~Lir IXIK-GkAV MCT MEASUREMENT
<br />u~',b t G U :;:::`Pt;•M1T ..:
<br />:r~E
<br />¢uIkEMENL: xr4•PI-~li+l.::: :.'..~}+Ri~{k~l
<br />..
<br />:
<br />' i•4~i r:?k?)RiA.?~IFdI
<br />.
<br />:
<br />:
<br />~i
<br />:: r,$41F?N>,1".° :;;:::.'"J. .• i:[l'+i7lti+ zedlFi3
<br />FrLutnl L,b.GSS YALUE . ; .
<br />.
<br />.
<br />.,,;: ,
<br />:
<br />15.:.^:.
<br />:: ;;::. ;$:
<br />~:
<br />[kL, 1. SAMPLE. -s'a4•+?•b {•}+r 5<}4r }}}#}{. 19
<br />7~ FAL [CI,LiYtKAdLL MEASUREMENT •
<br />v 1.y~.:.l 1 U 0 :: PERMIT ~::~E#'}4illlaY ~~
<br />...~..
<br />. :s::~"i:«•'+1'+i'{+#
<br />, : 4#i< ~'~{•P kFx+ll#>:::~
<br />~ :~'::: ~~
<br />.. •O~.
<br />~:#{f.P~~T~.:
<br />..
<br />:
<br />M~CEf'
<br />:
<br />t~~IT a3
<br />- ~ r ~REQU.IREMENT :
<br />... .. :: -~: ;
<br />;.
<br />
<br />,. ; ...
<br />,...
<br />.... .::..:.Ib ;:
<br />. . .
<br />.
<br />..
<br />; .. N H
<br />cl!.u SAMPLE, :•4}91#} 5i4p5•}+F 45<{:i„k:< 19
<br />I ~ (.:~ r.~~LVE1cAuLE MEASUREMENT
<br />., 1L.: ~)•1 i U 0 :~: ~PERMIT~ ~~ ~#5?#>{I:llraOF~:. ~. .:.~>t!Yi#+Lt#~# >K#5• ~~ ir~t ~?+III#P~ ~ ~
<br />(~i'~~. ':
<br />fi~:~14~':r:. *>~''.
<br />~~f
<br />~
<br />s.12liU.
<br />i t LUL . [ ukUSS YALtiIc REQUIREMENT '. }}}* tl A A ~ ,. Y. hX ML .MCk~
<br />rLJ~t1 .;V CiiNpUiT. ~< SAMPLE J3 }#a°{•,A•.< }##•1145• #e•
<br />4bv5F
<br />IhriL 1ri~:.T":ENT h1LHNT MEASUREMENT -
<br />~uu~u 1 u v PERMIT,
<br />~ •U.i Rt~C{KT '+8Y##*sV ,.; #i###!-. #.#4{15.4 u{. {. ~t
<br />'
<br />x.
<br />~~~ ~Ai
<br />~
<br />LFrLUt~rl t,kU$$ YALUL REQUI
<br />flEMENT ~ jL9LN :~>•~:~~ ~•g~l~tF.:MX. 1G:1 ~ ~ ~,:. " :...~ :- ~~ .. {•*A.}, :.
<br />::: :
<br />~ .
<br /> SAMPLE
<br /> MEASUREMENT .
<br /> ~~ PER.MIT. ~ ~.: ~~: iii:
<br />~
<br />~ `::.;.: ..
<br />:~
<br />~ ~ {T~
<br /> REOUIREMENT.:~~
<br />:: ~: ~
<br />~ ~ `~~ `~~
<br />~
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF l
<br />MILIM VATH THE INFOR iSW THAT I HAVE PER90
<br />MATION SUBM
<br />TTED H NILLLY EXAMIN
<br />MD B
<br />ERE ED MD
<br />ON ~ TELEPHONE DATE
<br /> MY INQUIRY OF TH09E IN
<br />OBTNNING THE INFORMATION I
<br />IN;
<br />A
<br />OIlR0UN.5 IMMEpIATELY RESPON9B
<br />I BELIEVE TNE-SUBMITTED
<br />NFORMA SED
<br />LE FOR
<br />19
<br />TIO
<br />'
<br />`:ICha r(1 !~~1116 TRUE, ACCUMTE MD COM ;
<br />I
<br />PLETE. 1 AM AWME THAT THE N
<br />RE ME /
<br />~ ,
<br />E
<br />^
<br />i
<br />,
<br />~ 910HIFCMT PENKTIEB FOR 9 UBMITTINQ FKSE INFORMATON
<br />IN CLUDING ~ 9
<br />,v
<br />rn~;
<br />Nnt:-
<br />.:I 'G( AY
<br />I
<br />I THE POSSIBILITY OF RNE M ,
<br />EE 1
<br />N90
<br />1 Q7
<br />~ - ~j~ _
<br />~ ~ ~ 7 ~ ? ~ Q '~ ^"
<br /> D I MP
<br />NMEMT. S
<br />B U.S.C.
<br />1001 MD Ji BIONATORE OF M1INCIPAL EXECUTNE
<br /> U.S.C. 1 1]IB. !/MWeY+ 1N.r eMrr mrlm+ ••rI hcAd+ nw+ W ro S 10.000
<br />TYPED OR PRINTED wltlnmuYm+n irlniae+nr+em MMwnBmmU++rM6 WFra1 OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />.,..:.,~.:.:. ~., n.... .n. .n..n ........r n,.. .1v~n ~...n.a moorncr m rurcmm~n> nrre/
<br />I'L., rr Lii{11 ANPL IE~ I~~ :: •.;~i,ir.Li; fL;;H FkLiM OU36 011 L u1.1. '.~1L~ ur(t:~~it ..<AI-, ~ANYL~ ut.ALY~l~ ^•:..~.Iri~u it
<br />•i~1~LL ~rlLt_1v 1~ u~~cr:rLu. ~I:Tii~Y ~AIMPLGVu ~IVSTkU(.T1LIV;-/,,;.;.. PU ri.
<br />EPA Form 3320-1 (08.961 Previous editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) UV :I ~ ~ / 7 L 1 U:i 1-1311 PAGE i OF
<br />
|