|
PERMITTEE NAME/ADDRESS (!n(Ai41 FrWryNa/!.•ral/bl UD~innq NATIONAL POLLUTMT DISCNMOE ELIMINATON SYSTEM (NPDESI Form Approved.
<br />NAME [+ii w v i h I! ~,; r..- _ - = L '. '.. '' r A h '( DISCHARGE MONFFORINO REPORT (OMR1 ~ r r (
<br />0 OOOAr
<br />r1-fsr r7-rsl kUe~SILi: F/2 34 i~@:NtP~.~~+
<br />ADDRESS 1. ~ ^ ~' -' - ~ ~ ~ ~ r ~ , .. , L')) ,, 7 11 G - ^ " A - r. `,- pProve~ axP,lres 05-31-98
<br />i /' • U • ' ~' ~ - PERMIT NUMBER DISDHMGE NUMBER - ~ T r A I
<br />FACILITY MONITORING PERIOD ~" }
<br />LOCATION YEAR MO DAV YEAR MO DAY __
<br />FROM -11 ~,L ~~ TO :. . ~1 w'•, ,`. '_~:"_:.~':-• ~__I
<br />T ' '' ' ~ J ~~' : .. :. :.. - 126111 l11-131 171-751 /76-771 118-791 !30311 NOTE: Raed Inetrucllau bNon compbtin0 this }orm.
<br />PARAMETER !3 Grd Ontyl QUANTITY OR LOADING !~ Grd On/Yl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !4653 /54-6i1 r38-d51 14653 r54-611 GF
<br />l31-371 EX
<br />MALY514 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsx~sx~ /64681 16'9-701
<br />I~.1 SAMPLE .. ::.-.1 .. rl ~. .: ,, ( 1 %J I "
<br /> MEASUREMENT ','. J -" %~'
<br />~•~•i i, (i i U _ PERMIT ...... ~... :31:~. Fri. (. i .. f:.~ ,;: >r ,c :y; c.ry '.,,.iY .F ;i.
<br />_.irvlc'C1 .:i,);-: ':4C:ii: REOUIREMENT O'.:1.,:7 YINIti7+Y "'AX P;U?' b
<br />_ ).,! i.i, l.? iL SAMPLE x.'44:317 ;: 7:7:3',e r3 TF ')v`. {•:~': Ira
<br />( ) I
<br />~i ., d '. ;, L` c ~ MEASUREMENT L J ~ ~) ~ I -:'
<br />..i ..f 1, i V i~ PERMIT FAC<>S IC=fG +Tfi?OX11P Q 13 Lr,. O «0~7 s}'3 35 ?e I INCI;~~ %i'n:l
<br />.rr,.~t:rf „}05 VF
<br />LI:° .REOUIREMENT~ ~ ~ ~ Y`:~~i
<br />~ 3nuF AVG L`AT
<br />Y ?' T
<br />. _L
<br />•Y ~G L HJ
<br />N
<br />~~', :JiAL SAMPLE ?~;. rp:?13 ~. ,....:. .. .. .: ,~;: ., . ,,
<br />( 1 l)
<br />1
<br />(n:i F 4) MEASUREMENT ~~ i - /;1
<br />. ~'.. L C V PERMIT . , .- , ... , .. i '_> , -r
<br />r .., _ /
<br />It ~:, '
<br />;fil
<br />c ; ~ i, f V k0:, ., C d i. ~.
<br />L REQUIREMENT ~ ... ~ r . _
<br />...
<br />h1.i Git A:~~ SAMPLE .. .. ~ ( ?t
<br /> MEASUREMENT ~ r. .
<br />.. 1. 0
<br />- - PERMIT '~ ~~ ~'" :: a: :-.. ;::: ': ;: .: .. :...: ^: :; ~~ ~:... .. ~ h ~ i i ~
<br />: ,
<br />:.~/I
<br />~
<br />. :.J :i .':f GkO:; REQUIREMENT ]•;; t Ay:' Tj '•rY ! .-,-
<br />.. .. _ .
<br />L.••, 1:1 :: (. "•.Ss'_". SAMPLE ( -1 .. ~ .. ~ ..
<br />_ , .... S .} ~n l :. F, q : ... ' MEASUREMENT f ) .
<br />~v., .U i li U PERMIT .. '.rte
<br />_ :~i ~^ ::$..
<br />i. .. iT!
<br />... v t.:r a 'v } ,.: ~ 4' _. ~ . REQUIREMENT 7 _ : r• ; ", ' .- t S a
<br />.-L1 J.,, iuT~1. SAMPLE .... .. .. - ~:) .
<br />_ - _ Ly c„ MEASUREMENT ,
<br />... ! ~ 1 0 ~ PERMIT ..:. .. ... .: r,: ::. .. .... ` T .. ~ S'. d !' _ .. i . r, .
<br />! r : ,. J c'~ : n .1 j : >. A. 1. :J c REQUIREMENT ... _ "' F k. V:; "C ti •' A =; 1
<br />~ :'. :~. .,n:.AS~ SAMPLE ~ ( ,I'~ ..
<br />
<br />. •, ;,
<br />MEASUREMENT .
<br />. ic. .. i Ii PERMIT ~ .. .. ,"i i.^ i ..: i •!Y C'. ... .. : K: - ... !. ~ ia:!r. :.
<br />I':.. [.\ : :.v.. r ~ L U . REQUIREMENT :.i:. ': A7; N:;='
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENKTY OF LAW THAT I HAVE PEgSONALLY E%AMINED MD
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN: MD BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE fOR
<br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATON IS
<br />~ /
<br />---
<br />' TRUE, ACCUMTE MD COMRETE. I AM AWME THAT THERE ME
<br />SIGNIFCMT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING ~
<br />'L_/
<br />-"
<br /> ,
<br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 13 U.S.C. ! 1001 MD 33 ~ BIONATURE OF PRINCIPAL EXECUTNE
<br /> U.S.C. F 1310. IPNrlerr unW /Mar mnnaa maY hrAW rawa y ro J 10.000
<br />TYPED OR PRINTED ansrmvlman inFdrmwnr olNrwaan emanNaaMeYara/ OFFICER OR AUTHORRED AGENT CODE NUMFIER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS lRe/erence s6 sttscnments here/
<br />1:1.- JU...w..L .. :IUf 1,}'....L.. 7'- ..._......7,. ~ 1)+ -! .., .. 1-,.rci1 ,_.1. (',..~, ...L .n !,:.:/`.
<br />r
<br />EPA Fwm 3320-7 108-95) Previous editions mey be used. (REPLACES EPA FORM T-40 WNICN MAY NOT BE USED.1 PAGE OF
<br />
|