|
PERMITTEE NAME/ADDRESS prwY,4 FM4ryHwWLuaum l/D+di.mt)
<br />NAME LAY r'-, ~.. :. :. ^;;'i.-cam t^,,:.I'u^:A[1:-.v
<br />ADDRESS t' ,/ t L' A b d
<br />CnM1J LU aIU26
<br />FACILITY CYPKU~ cMPlkr. LI};cPLiICAT1liN
<br />LOCATIONLiiA [u LL Ti[G29
<br />AT 17. n1L, h1LtL n. LJLLIIM. ~~htkll Mi.R
<br />NATIONAL POLLUTANT DISCHAIIGf ELIMINA710N SYSTEM INPDE$)
<br />DISCHARGE MONITORING REPGRT IOMRI
<br />aoei rs 1a91
<br />PERMIT NUMBER DISCHARDE NUMaER
<br />• MONITORI .PERIOD
<br />YE MO D y YEAR MO DAY
<br />FROM -,1~ ya y 3p
<br />'!I ?ll" •231 !2 1 !26191 128-191 !3631/
<br />
<br />Form Approved.
<br />OMB No 2040-000.4
<br />IApL(Tfove ezplres 0531-98
<br />F - F [naL
<br />,.[,+Oic
<br />NOTE: Road Inetructiorn 6a}ore pl p this form.
<br />PARAMETEII" !3 ~ rd Only! QUgNTlTY bR LOA !I Grd On/yl QUANTITY OR CONCENTRATION NO FREDUENCY SAMPLE
<br /> 115-531 (54617 (38-15 (46-53/ 15b61/ OF
<br />(31-37/ EX W
<br />LLY'S TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS let-eJ/ '
<br />'
<br />/64681 /89-701
<br />h. SAMPLE #*'k'4+A# ii#4+F ti• *{..,<h. ;. {. J~•
<br /> MEASUREMENT " ~,
<br />~
<br />
<br />
<br />UL4(.~ 1 U 0 ..,. ... T ..
<br />
<br />~:~'~~.::~A.~~.:•^:?i%S .. ,. y
<br />
<br />I~y :'
<br />"'""':''~~.E.' .
<br />
<br />'~:`iJ~fj~"p•ii
<br />:
<br />
<br />4{•
<br />~... ,.
<br />•~.
<br />:
<br />'c
<br />"~ ~
<br />: .
<br />
<br />~r#i<i#
<br />
<br />9Y
<br />Q
<br />
<br />`
<br />
<br />Ir.
<br />t~
<br />
<br />i
<br />?
<br />
<br />cFFUUtrvT L,k 5 VALU
<br />7.i< .
<br />:
<br />:: .: :. :,^. .:;: .
<br />.
<br />,~:
<br />~Fr•Fn ; .
<br />.
<br />.
<br />.,,,
<br />Zt,
<br />M....... ": ".:: : r
<br />,:.~ .
<br />~ .1 .
<br />R
<br />;
<br />~L-L1USr ~tTTLEAdI,L SgMPLE Epp*y~•t ~i>ryf i•'1' 46i### _ ,
<br /> MEASUREMENT
<br />v ~~T7 I U O ..,."::PERINk::::';~::"
<br />~. ...
<br />E ~"~'?~~f.1T'$#ui'"~"
<br />..
<br />.,.
<br />;.; :.""".Ai~.!t?0~#~ i!• W•Y M.itIF?fi";...: ".:~".fZ~P1iR"T" ". i}":K~~...:.:"..:: l+t i,. i./ ~~A~':
<br />
<br />-rFLUt~VT L,RC~S VALU-
<br /><it€Gu~R?
<br />.:...n~:.:
<br />: -.
<br />:' ~. ,
<br />..
<br />:::.:.. ..
<br />IL AIrU VKt ASE SAMPLE #4fi#+f S•+F •Y*#^} {.64### 4r it ~~#q#
<br />: `i
<br />_
<br />' ?icL;N cXilt-GKAV Hr;T NfEASF/REMEN`i
<br />JG~~SO 1 L' Q
<br />" P "::
<br />I
<br />(EQUIREM~NY; ':?ai#~M~!:::
<br />"
<br />.`
<br />' '
<br />"`'
<br />" ::::">k#li#?k~Y
<br />" ti~:< #4*>~a,r +~+Mdt~;.:"
<br />:,.. lil. l~P4TIP[. .X;Aa
<br />cF-rLutNT LkL755 VAT.L ,
<br />` .
<br />".
<br />:::.
<br />::r .:
<br />. .;':`:.:' p;.,}
<br />,..
<br />"
<br />;r
<br />Lung [n CUM1UUIT ~.iK SAMPLE Jj 4#+t •::•: 4>M#iifF ii-baFB
<br />iHKU TntA [MINT VL 4NT MEASUREMENT
<br />~Liu7U I L (/ :,- :::,,:rP.E~1Ml~''.; :,.~ . ,,dt~P[7#}.f:~~~~ : ~.~~R~C?72 t~ ~ ~~~#~* +r#8+k#li:.-~: ~~:"k~i~t~~+-~>k*.'~ ;.~c. ~ t l~c~:l~ r+5 rAr~
<br />hl-LUtlrr t;kG:iS Y~+iU .,RIUWAEMEN4..
<br />"" . ,"A'Y.y. ..." Y:`' ~1X ,~~<::;"-°.." ... ##*# Af' 'tld
<br /> SAMPLE -
<br /> MEASUREMENT ,
<br />
<br /> ,.
<br /> SAMPLE-
<br /> MEASUREIYIEN?
<br /> . .. :.~:.
<br />:.."
<br />
<br />::
<br />
<br /> ""~~
<br /> SA P.LE
<br /> MEASUREMENT
<br />~ ~ ~ -
<br /> ..
<br />p.E MIl"::
<br />..
<br />. ,....
<br />
<br />...:
<br />
<br />
<br />..
<br />"
<br />i.::
<br /> .
<br />.
<br />":REhUIR.EdA~N~~; ;::.sc~:.`::,~~':~:.::r ...
<br />,c;':;:::~ ::.., ..,
<br />NAME(TITLE PRINCIPAL EXECUTNE OFFICER I cEryT1
<br />AM FA FV UNDER pENATTY OF L-AW7NAT 1/fAVE PERSONALLY E%AMINED AHD
<br />MILINi N1TH THE INFORNA'f10
<br />SUBMITTED HEREIN
<br />AND BASED
<br />N TELEPHONE DATE
<br /> ;
<br />O
<br />N
<br />M ~ INQUIRY OF THOSE 1HD1VIDyAALLgg 4MMEDIATELY RESPONSIBLE FOfl
<br />OBTNNING"THE INFORMATION
<br />1 BLUEVE THE SUBMITTED INFORMATION
<br />S _
<br />9
<br />
<br />F:IC[13 Yd ~~17~5 ,
<br />I
<br />TRUE; ACCURATE AND COM0.ETE. { AM AWARE 7NAT TNERE ARE
<br />- 7
<br />f
<br /> SIDNIHOANT PENALTIES FOR SUBMITTING fALSE INFORMATION
<br />INCLUDING
<br />Fnvlronme tal Marla Ef' ,
<br />THE POSSIBILITY OF HNE ANp 1AP11150NMEHT. SEE IB U.S.C.E 1001 AHD SS
<br />IONAi'URE OF PRINdPAL EXECUTNE ~97 ~g70-212 ~Q ~ 9
<br />
<br />TYPED OR PRINTED u.s.C. f 13fe. ! Atgr.rbw moms m.r YrtN,d~ 8wa w ro F10,000
<br />.nann•viw.nMw/zM~ntolbr~wnemonN. YnJ6 y.ra1
<br />OFFICER OR AUTHORQED AGENT AREA
<br />CODE
<br />NUMEIER
<br />YEAR
<br />MO
<br />DAY
<br />T^ V MMCn I J AIY V CAt'LAnA I I V N V r' ANT vwLA nuns lrrersnncY~ qll srflcnmmrs nPie/
<br />~[ITLCADI.c SuLIuS L1?i[r wA1VtU fpR 1QYR~24HK PKEC[E' cVt.Vl-~L~ I.A..iF PL 1V, FL;ri RE'.i,"ll<L-r1LnT:i. L:1L r^
<br />uktA~E GnAis SAMPLE ANALY~iS IikVUIkEfl IF YIS[JLF SNircn 1~ t,d:,E+:'d:-i;. .Ini+2L.Y ~A;tFLItrL inSTkU~TIL^n5-1.+..c f
<br />EP Fwm 3320.1 108-551 Previous editions meY Da used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.( J U 305 / 9 b 1 JU 1-1311 PAGE L OF
<br />
|