PERMITTEE NAME/ADDRESSQmirL facdlry Naw/Eeraeen UDl]liraq
<br />NAME rCY YRLiS .;~et'1~~ L.. -.~., ,.:,T ~.. `,
<br />ADDRESS N U O G X L U
<br />C r+ A l v L.r,, :, I o 2 u
<br />FACILITY LYr wS EMPIkt CURYUkATEO~
<br />LocAnoN~;;,,L~ ' 'LU b162~
<br />aT I r. r11L.rIAEL w. LUULOw. UEM~fR~ Mwc
<br />NATIONAL POLLUTMT DISCNMOE ELIMINATION BVS'fEM //NPDfS1
<br />DISCH1 R6E MONITOpINO REPORT (OM91
<br />(I~
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM O 70 1 ~ ~ ~;
<br />126111 R 31 !24261 !26.271 !28.291 136311
<br />Farrn Approved.
<br />.mot;,. ~ ~r,-31ti T.~ Gn~e.r~o{{2Q$0ooD4..
<br />l~pproveCeicp yZe 0531-98
<br />,l:nk n~ G~4')
<br />F - r1.Ia~
<br />lilWuk
<br />NOTE: Reed Inetruetlone before omp etlnp this form.
<br />PARAMETER l rd Onlyl QUANTITY OR LOADING ~~ ~ !I G Ontyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !16-53 61-61 38-16 15-63 6181 Df
<br />!32.371 EX
<br />MALrsTa TYPE
<br /> AVERAGE MAXIMUM UNITS 'MINIMUM AVERAGE MAXIMUM UNITS ro2.ea~ (51-681 15&701
<br />~L~iU~F IL;T AL SAMPLE ,p .p *yl K.y ;.4p ',.*qe #e+**~Ip 1~i
<br />U 1 S ~ u L Y ~ U MEASUREMENT '
<br />IL.c7~ 1 U V ...~.: PERMIT .. ~:: ~ ~~4~##II+R;': ~: ;[;~:':;(t-~#!YJt.,, ~4 .. .$$.!#': .: ..!k:.;~ ~ 1~E.PQR'~:::~: ,~IFE~J:.~.~~.H..'iX L'.:: .: ~: `rstt ~~ ~ il~.it E ~.:
<br />
<br />LrrLULhI Uk055 VALU
<br />.::.Q..:.. ...'
<br />"-,:?:.:: .
<br />,..:..
<br />:':: ;3:;':'";
<br />~~*
<br />«:s:::;.
<br /> SAMPLE '
<br /> MEASUREMENT ~. i~,.
<br /> ~'~::PE,RMIT~..~~. ~ :...~..:
<br />~~
<br /> .
<br />~REQUI
<br />REMENT~ ... .. .~ ~. ~:
<br />.~;:....~..:.
<br /> .
<br /> SAMPLE
<br /> MEASUREMENT
<br />~
<br /> -: PERMIT .~
<br />
<br />~ :;
<br />r f:`;>:::~ ~ ~
<br />.
<br />. .::..:
<br />. ..
<br />.
<br />. .
<br />. :~5.. ~'<. ~::
<br /> ~AEQUIREMEN7 b......
<br />.... ~:::::..:. ~:: ~. M:i:. '!:''w~
<br />Y::<::
<br />`~' .
<br />..
<br />.~
<br />'.
<br />~ .
<br />.
<br />
<br />!k
<br />
<br />'
<br />
<br />... <. ...,.
<br />•N,. .
<br /> SAMPLE
<br /> MEASUREMENT
<br /> .PERMIT .~•.~~::: ;,,::... ~. ~
<br />~ .:... ..':~:: ~:
<br /> REQUIREMENT
<br />......
<br />..: ... .
<br />~
<br />~ : :<`s::r~ -
<br />
<br />~~
<br /> ..
<br />.., r:.,,:,...
<br />,~:,y,:::e: ..
<br />,..:.;
<br />
<br />.
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT:. .::.-:
<br />~ rc:,:...: ., .... ..
<br />:
<br />.. ..
<br />~
<br />~
<br /> REQUIREMENT . .. .
<br />.::..: ... .: ..
<br />. :
<br />.:;.
<br /> ,
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT ~
<br />~
<br /> .
<br />R
<br />~
<br />~~~~~~
<br /> EQUIREMENT
<br />:. ~ , .. ,..
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT:: ~ .. ~ ..;.:.3.;'. ;:.:~.::. .. .
<br /> ~REQUIREMENT•.
<br />,: ~ .: ~' ~ ~ ~'~~
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTFY UNDER PENALTY Of LAW THAT I NAVE PEg50NALLY E%AMINED MD
<br />AM fAMILIM NATH THE IN
<br />ORMATION SUBMITTED HEREIN
<br />MD BASED ON TELEPHONE DATE
<br />
<br />F;icharc
<br />+ ,dills F
<br />:
<br />MY INQUIRY OF THOSE iNPINDUAL3 IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING THE INFORMATION
<br />Y BELIEVE THE SUBMITTED INFORMATION IS 7 `
<br />V
<br />_
<br />1=nvirnnlr~ettt.=1 .ti~: na-~~r ,
<br />TRUE. ACCURATE MD CjIMRETE. 1 AM AWME THAT THERE ME
<br />SIOMIFICMT PENAlTlE9 FOR 6UBMITTINO FALSE INFORMATION, INCLUDING .'/
<br />.
<br />I~~Q n7'?-2112
<br />T~
<br />/~
<br />QQ
<br />' THE POSSIBILITY Of RNE MD IMPNSONMENT. SEE to U.S.C. 1 1001 MD BD ~
<br />BIONATURE OF P111NgRAL EIEEglTNE
<br /> u.B.e. 1 1B7Y. IhrWeY. urav eMr mean. eee.F AcAnl. fvw. w ro ft0,000 A A
<br />
<br />TYPED OR PRINTED
<br />.red ev muMUn NephnnwrtWMewwn emmrA. rW 6Twa/
<br />OFFIq:R OR AUTHORIZED AGENT
<br />CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe/arence e/l ettschmsnfs here/
<br />~r_TiLtAtltc Si1L1~S LIl.II ei::1Jt_~J FLIk l0YK.247~ :'rt~LL' ~VI_~+T-St.c-[.~.iE r'L; IYr r;. r; .-~.r,JUI~:;.r1~t.1~.. ._IL ;.
<br />;,nLASt UKAL :,A,-+PLt aI,ALY,I~ K~~l;[RC0 IF Vt~1aL~ SriEl_'r. I~ L.u:Scxv~;,. .:nl~_Y ~AMF'LL,~C ir~ST~:UCi1Lrv;-1.~.<:F
<br />~r v
<br />EPA Form 3320.1 108-861 PraNoue editiane mey ba used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) .J~ 1 3Y/ i01 JU L- lj I L PAGE i F
<br />
|