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PERMITTEE NAME/ADDRESS (Inrlude <br />farilify A'ame/Loalion i! dilferem) <br />NAME <br />- -IJ-I~I Lm--~ ~.r E- -4Y-'v.,l-=r 'f ~.}f's--T'-i =1-. C-,- <br />ADDRESS~~T~~T______________ <br />- - - -[?-o-~')-6' ~+f'lio ~1+-Y-1 S i 7 -f°c -d E%~.-: ~ fr - - <br />- - - aA-t4 -6 f.'-:-Pik - - - - - - - -c i~ ~-i3~i:1- - <br />FACILITY <br />LOCATION ___________ ____ ___ <br />L'I Ttl '.l UT r' 4T , I <br />h'q TIO Vq~ POLLL'TA YT DISCMA qGE ELIMINATION SYSTEM (I~'PDtS 1 <br />DISCHARGE MONITORING REPORT I UkIRI <br />~. ~ ~.. ~ D <br />PERMIT NUMBER <br />MONITORING PERIOD <br />YEAR MONDAY YEAR MO DAY <br />FROM ./ ~ .J 11 TO I 15 ' <br />CO-'I1 Ir'. ~I) IN-'il I?6-771 !?5-19/ Ii0-al <br />La~Ji'. <br />.. Form Approved. <br />- F' I '~ r. L OMB No. 2040.0004 <br />proval, xpire5~.10-31; 94 <br />.;J:: r'hC:. fJ,).'1°9r r .gxn w'. _.:. r. <br />:..: i. IJ J ~.' [I n '~'v L .... . <br />NOTE: Read instructions belore~pleting this form. <br /> !.I Gr.: (nd)'J QUANTITY OR LOADING (4 Card Onl ~') CUALITI OR CONCENTRATION <br /> <br />PyyygApl~~'1,~Igr~D <br />`a ~' <br />iJr'-J i) fi4-6i/ <br />(.i9-0i; (Jirfil) (54.61) <br />NO. <br />EX FREOUENOv <br />OF <br />SAMPLE <br />TYPE <br />(]{~l-.~1 <br />`I" ))) ar+aLVSS <br />~T4-f Av ERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (67dJ) ffiJ~R) !61-141 <br /> <br />La )f pP SAMPLE .. i:.^c I :.. .. ( I ~' <br /> MEASUREMENT <br />~SgGeo~o9Y <br />JUU00 1 ~ PERMIT .::i:j+: 4c -',: . .... :'r . . r_. ti . . . . .' -!. J ~~:a.° <br />.. ~^,a=} <br />fa <br />` M B RECUIREMENT <br />, ~ <br />`• ^ ~ <br />:rULI UJ <br />'T ~.'). ~ <br />L SAMPLE .. .. ... ( . <br />~~ <br />F <br />. MEASUREMENT . <br />SUSYcNUE~ <br /> <br />00530 L J ~ PERMIT rF:Fi`.r;gi: p:::::::}fir,;: .' .... f;..',:~;S::r: 3:a :JJ 9~E/ ;rZ.9 <br /> RECUIREMENT <br />/' Ll ~ 1 11 I• T f / I f A ~P rl <br />SOLIDS, ~LTTLL.4 .I a.: SAMPLE .. :.:'r :: J=: I: '.::,: . . . . . ` t ~~ <br /> MEASUREMENT <br />005u5 I U J PERMIT „•.-.. rc I(vh;`.:o,`... { :: .., vCfp;::)(I h. <br />.t L [ J C.'1 G'O!• <br />Et .. ., J F. L ~~' <br />N 'A;.1 <br /> REQUIREMENT <br /> <br />JI L AND U C. t A S.' ':. • • • •• • : • • ' ( L I <br /> MEASUREMENT <br />FREON fXiP <br />-vFnY ~ib'Ta <br />. <br />0055G I V PERMIT ::ac^:: ....-,. r,::;r,:'a:;:<: :ct:;;:,,: 10 :0 h':I;I 'r.:4 <br /> RECUIREMENT <br />C 1 T N !'L'Y'~ ' <br />IaOSa TOT r.L SAMPLE :: 7:': Y,-:;::.: `. {: ::u):;:.1: :r:p .,::;f : t 1 a) <br />` <br /> MEASUREMENT <br />(AS r'~) <br /> <br />c <br />U10u5 1 Q V v}t,:itolQi: l.:I}r~C+$;t :; 4r :: {:r;[ic:;: 3.J ~.Q v))f~~'./ ,kAil <br /> RECUIREMENT <br /> <br />rLOW. IN C.OUDUIT JN 6AMPLE ( l~3' fF :::r: :;:i: :y:: ': ~: :;::~ :....:.... ... .. <br />^ <br /> MEASUREMENT ~ ~ <br />11HRU TflKA1t1::N'f t'L{n ~ S R <br /> <br />50056 I Q I) hLIJ~~tl FL•'?vRT :.`-%k i::=4c z;: ,,:.::$:;::: t: i,: ::e:.:/ ..r E: :. ~~LY ;f .JT ~N <br /> RECUIREMENT <br />t r~ - n Y v. <br />aC'1'aIL <br />SOLIDS SAMPLE ,.., .. .:i:li:::.: C:r>rr::':.': ( 1.1) <br />, MEASUREMENT <br />DiSSOLYY <br />U <br />. <br />70295 1' 0 J PERMIT ,..;I;rr-~ L:;::xl..r ;: ... i:-'.:+;:;<:..x LEFOft': vi'TIC:rIF.L <br />' TFi Y 3h-1R <br /> RECUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER OERTrFV uvpER PE.vALiv OF Law TraT I ItiAVE PERSONALLr EaAwNEp <br />M FGMI <br />MIT <br />LND <br />IAR <br />TH T <br />ORMAT <br />N <br />REW <br />ND 6 <br />E I <br />r <br />' <br />ED TELEPHONE D A T E <br /> WI <br />H <br />SUB <br />P <br />L <br />NF <br />O <br />TED <br />+ <br />q <br />PS <br />E <br />ON MT INOUIRV OF THOSE INDIVIDUALS IMMEDIATELY RESPONSBLE FOR <br />/^ <br />1 _~ ~ <br />-`~ ~YJ OBTAINING TF.E INFORMATION I BEVEVE THE SUBMITTED INFORMATION IS <br />TRUE PCCURa TE ANC CQMPLETE r aM PWgRE iriAT THERE 4RE ~ ~ <br />/_ _ ~~~ ~ °-~°"~~'~ <br /> SiGNIrICANT PENALTIES FOR SUBMIT LING FALSE INFORMATON. INCLUDING <br />THE R059BIUTV OF FNE AND IMPRISDNMENT SEE IB Usc 4 IOOI PND " <br />SIGNATURE OF PRINCIPE%EGUTIVE <br />D ~ 3] uSC 4 1319 lRnullia uWrr IL[•c aaNlxa m <br />r IneluJ[ Imra up ro <br />^ <br />r <br />TYPED OR PRINTED . <br />SIOUW anJ nr nu vmum unnnmrlmenr u( Oolueen 6 nlnnlns ~uW 11[Jr: i OFFICER OR AUTHORIZED AGENT C DA M R M DAY <br />COMMENT qND E%PLANATION OF ANT V WLAI IONS I K[ICrfnr[ JII Jllyrnlli[nll II[r[/ <br />TSS r; YfJ'CAL Ikl)ra -11I':S ~ILi. .'i. q. V~:ia A''I ;S,:i .. ~L_. iJLI,J:+ Li.;:i ,:E:~LI';i1 F ° C ;a Jl r{ }.F,CIf' Lr N. <br />...... I.A..1~ '.~ Pr, FJ:+ n:~Jlr....._.,... 2r •f -!. .ii-.'I•~ is ~CIU::?'.)'• -1.L.?, ;.~ SI_T=. <br />Form 3320.1 (Rev. 9-88) Previous editions may be used (REPLACES EPA FORM T~60 WHICH MAY NOT BE USED.1 PAGE OF <br />