Laserfiche WebLink
PERMITTEE NAMEIADDRE55 pMr6 F.cNryNa./Lxaum JDylrr,.U ' <br />NAME pOMDERHOHN CGAL CUISPANY _ <br />ADDRESS ~tUA DJI UE MI rl k:, K S 5 FORTA LS <br />P.0• EU$ lu3i <br />1ALLSADE CO t115LL <br />FACILITY <br />LOCATION <br />~lirG: JUHN Ai "1-~'lAr, P~cFi;IUENT <br />" NATTONM POiLUTMFOISCHMOE ElIMINAT70l7 SYSFENI'INPOfSI""" - ""' "- FOrrriApproved. ~- "" <br />.. DISCHARGE MONITORING REPGRP fOMRI yA -Lr~L -00 <br />_ _rz- el _ 17-FSl CAMEO !11_E 5R/~ 2~~'•'~•B1~P'~gnqd~O, 0~ <br />7 4 tl (S U R R II C) --ApproveL ~plr4 ti 6'3R~Ja~-__- <br />PERMIT NUMBER DISCHMGE NUMBER F- F I C A I. <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM J U TO J <br />1267// l72-731 !7415/ Iz5-771 IzB-19) !363/1 <br />!tI~CF. <br />a;a NG L'ISC4AHGE Ikl '''~' <br />NOTE: Reed Inetruetlons belon completing this form. <br />PARAMETER !3 Grd OnrYl QUANTITY OR LOADING 10 Grd Ontyl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE <br /> M6-531 154611 139-05 !96531 15461 <br />EX of <br />TYPE <br />l31-J71 MN.YSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !e7-sal !54691 159-701 <br />L r, SAMPLE afi0#4rs #.fir#t aarrat;~ ( 12) <br /> MEASUREMENT <br />JJ4GJ 1 U U PERMIT #J#4'R# M#..##O #++4• 6..5 0000a1G g,fl EEKLY INSIT <br />~rF'LUENT GR05; TALU REnu1NENIENT fitaa C{I.NT!!YI!} !1 T 'RI <br />.,GiIUS, TUTAL SAMPLE att4#4 #004001 #00taa ( 1g) <br />_U:iYENUhU MEASUREMENT . <br />Ir:lS3U i U 0 PERMIT ,. 01RIS#0<C #A014+N.# owe a:#ss+ala 35 ~C iiCE! :.RAh <br />r.hYLUt:hT i:A045 YALU REQUIREMENT 0004 3OUA ~'TC DAi' Y K G N ' <br />,::V!1, :J'1'AL SAMPLE S~4ti:#: 0Oa#4,7 =14,1,POA ( ~19) <br />(A~ FE) MEASUREMENT <br />J LJ~1 .5 1 U U ~ 'PERMIT atL*0~## #0010.#?01. . C-IC t000k,! ~~$ 7'.O ~ NCE/ /RAH <br />c.FF..UF'NT ~nU55 TALU ?PEOl11REMENT `~ <br />~~ >COC-4 <br />~ 3UDa ATG DAI <br />.1Ii ANJ ',ttEASE ~.~ SAMPLE ,`,-Y.Crk~a ::Aaa.## fiaaooa ( 19) <br /> MEASUREMENT <br />35ti1 I U U PERMIT 4#0910!tA ; <br />i..5.: :e :,tX~O## rla:c (:O~Fr~11Pa Arrl:0R9' I'0 UHTIN ~RA9 <br />tF'PLUchT i,RUSS TALU. REQUIREMENT ~s~~;;;':." GTfiaO 30PA AYG IN:iT hA$ RG L C, N <br />:'Lu., IH CONDUIT Gh SAMPLE (. U3) i#ataa :,Coat: #0taaa <br />1.1 [:L Tit6ATMENT PLAHT MEASUREMENT ' <br />7UU5U ]. U U PERMI.T~:,,~ ~ ~ RlPUt1T REPpNT ~ ~r~~at~ti#'# 000#t1#' 0:t:!aF:9il#~ , 0#0 EEP:LY YS?Ati <br />hFF'L'J(iNT GROS: V?Lyc REQUIREMENT 3auA .a<T~ AALL'! M3 ifGD " O~Ytw4 <br />.;U LLS, TUTAL SAMPLE NCO:+`% 9100### aaa#100 ` 19) <br />~L~~~lLVhU MEASUREMENT , <br />lUc'r-~ 1 U J PERMIT u~:-a#t# oas~R#o eta aoooa~a AEFO#~2 RIr~ORT R'RLY ;R~I6 <br />r!,Je.YT G~vti5 '1ALUF REQUIREMENT taa0 RTF AYG R f lfAY 14G L <br />i.. Ah~ ~., kt::L is SAMPLE Yf,, rAa#a ( gy) ntaao! rt9rk9tY~ aiattaY <br />1-, . A i MEASUREMENT <br />Ji+,/c~cl L U U PERMIT a=xu0#;~ REP9RT Y °5=1 0lr00.at 0700tt oa O+~tO o:::=, EERLY I,UAL <br />~tFLULH: (+iiG:ij iALUF. REQUIREMENT ~ .INST~!!AX N0=0 fi~aa <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENN"TY OF LAW THAT I HAVE PERSONALLY EAAMINED MD <br />AM FAMILIM WITH THE INFORMATION SUBMITTED NEREIN; Mp BASED ON TELEPHONE DATE <br />r ~ 1 <br />E. -~ I ~~~ C 1 MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONABLE FOR <br />OBTNNING THE INF011MATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> <br />` TRUE. ACCUMTE MO COMPLETE. I AAA AWME TNAT TNERE ME <br />SIGNIFCMT PENN <br />TIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />'I <br />1 <br />1 <br />n t e rl ~ , <br />. <br />THE POSSIBIUTY OF FINE ANO IMPRISONMENT. SEE 18 U.S.C. 1 1001 MD ]] <br />gIDNATUR OF PRINCIPAL EXECUTNE <br />~ ~~ <br />~ ~ ~~ 7 ~!1' I <br />O ! <br />~ <br />a 3 <br />_ U.S.O. ! t at e. NMWS• uw ewe mnm• nvr Nrlrw rrrw• y ro S IO,a00 AREA <br />TYPED OR PRINTED ..enm.rwvn MprleanwntWMMwlemmas rrd6FVal OFFlCER OR AUTHORIZED AGENT CODE HUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference ell srtschmenrs here) <br />'ini~ UUTF'ALL IS NGT FLIGLi;L:. ~'Un c%°MPTIO`15 FhOt1 TOl'AL S75PoNCEG SCLILS (.55), 7CIAL IHCN AND/Ua <br />:iETTLQAdLe: SOLIDS LIhITATLONS - :;E:d I.A. 1. <br />EPA Fam 3320-1 108.961 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 PAGE OF <br />OG35~1/9RC223-1256 1 <br />