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PERMITTEE NAME/ADDRESS !!nr/ude <br />Fari/iq' Name/Lorarion i! di!@rrnU <br />NAME - -P--I-} ~= 'Y -mr'r-- ~ ~ ' ~--'~-{ --' T - _ <br />ADDRESS-~~ <br />- - - -~Cr9 d-6 --k:.~:,d ~l,i-t -n rT -Y'=f --a r. -1-~I- - - <br />FAOILRY _ - <br />LOCgTION <br /> <br />n Al wn... ~.,~~,. ,.-~. _ _ - <br />DISCHAPGE MONITORING REPORT r In: s; <br /> <br /> <br /> PERMIT NUMBER <br /> MONITORING PERIOD <br /> YEAR MO OAY ~ ~AR MO OAY~ <br />I <br />~ <br />~ <br />FROM IJ~ '~.3I I;-.`l TO .SC <br />1 <br />,r <br />L>u-~rl r.'-]Jl f;,.,;/ (,b.,,) (Jy.,9) r:n-;II <br />w JP. <br />,~ Fprm Approved. <br />~ ~•~ •~ ~ OMB No. 2040-0004 <br />- FI'141 <br />-~ ApplovglPxgi/es.10- 1-94 <br />it 1~ Ui:r..a n:: Lei, iujy: <br />•NOTE: Read instructions before cor'lrpleting this form. <br /> rl OUA NTITY OR LOADING <br />(J Caul 'hll (! Cnrd Onlq) QUALITY OR CONCENTRATION <br />PARAMETER , <br />r~; r: -j .l (JJ-blJ i9-61) <br />Lfs-'151 Nh~i)/ ( NO. °gE00uF NCV SAMPLE <br /> . EX Av4 vG~S TYPE ' <br />lJ?-J7) <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 16'L)1 fds381 f69~I01 <br />PN is +o Y.: {:i; {: r r.;:;t ;t is ( 1L) <br /> MEASUREMENT ~ )) <br />t <br />~~400 1 Q J .PEP.MIT fj iY :/Q>;[Q v:s:~:x 1[C: r:i::: O.S :: Y:::::i .'.: 'i. l^. t'.K L'1' i:7AEi <br /> REQUIREMENT <br />` <br />SOLIDS <br />iOT <br />.iL ( I V) <br />, <br />, MEASlREMENT / / ~ II <br />SUSPE:NUi:~) <br /> <br />DOSSO I U 'J PERMIT ;[:;: s}:~>,t![ Y::;: {: ::;4:3 :. ... ::[~-or`. ;<r j:' -I 1J T11CE~ iZA~ <br /> REQUIREMENT <br />i r F' 7~ f t, ~ A J't' :[ <br />OIL AND GMLH:,'S SAMPLE c • S:r;[:`:i ~ ly) <br /> <br />" MEASUREMENT <br />N <br />F3:;ON c <br />Y.Tk^JkAV tl.'.'.i? <br /> <br />u055~ 1 '.] PERMIT Jixy{:[$: I`{:+•-f:}~ . .. .-.. ,: f,0},.:O:f tr; OV,..A i$j~fl <br /> REQUIREMENT <br />rr 1 G's r s <br />H~ f <br />jy .~ <br />SULFATE, T0!'AL SAMPLE :.: a}{:,`. .. ... . ~ 1~) <br /> <br />(AS ,U4) MEASUREMENT Z4 U )/ <br /> <br />UUy45 1 11 U PERMIT .-~::~([>}:;< X: ~:w{, {::;i { .',: ': '" {::t ~:`% '.`• ~~~ :{t; t'OtT NC's =r!Atl <br /> REQUIREMENT <br /> <br />IitON SAMPLE ;I;:i.:. ..:.... ..: '.. :i:: :,::: 1 <br />~ <br />) <br /> MEASUREMENT s _ ~ t <br /> <br />TOTAL RcC~V:;n,;:%Lc / <br /> <br />Ouy80 1 J O PERMIT :;: t4X:;tW,..!: :i~::::v:: { r::.< {I{n;:::+{[ 1,7 12[' <br />PO! <br />1' E±h;$LY 7kA8 <br /> REQUIREMENT . <br />. <br />_ <br />11ANGANESc: SAMPLE {:5{::}:t{[ ~ {:i,:;:1:;: ! 1•y) <br />, <br /> <br />' <br />MEASUREMENT r <br />l 1 <br />IC <br />POT::NTIALiT DIS:iOL <br />11131 1 - V PERMIT {::}Y/i':;::.: er:;v}i:',: .', isas~;;:;Y.;: .~. li ~(Er"J1:'i~ {efx.L)' .itAB <br /> REQUIREMENT <br /> <br />'ANCaANESd <br />PUPAL SAMPLE :<>kr3?'.:i: vg:~:::Ka: ~::}:i::[I ( LJ) <br />, <br />It::COVERA;3L~ MEASUREMENT <br />lI <br />G ~ <br /> <br />ZLLd3 L L IJ PERMIT L";}:yY~f:{: CtY,:~4:{: { °[::,::: s;[:;:i::Y'.:C: 1 <br />.7 EPtli'P <br />A 'E!'uLY r.Ad <br /> REQUIREMENT . - r <br />[' p Y +!; <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CEgnFY UNDER pErvAlTV OF LAw THAT I HAVE FEgGONAUV Ex AMwEO <br />AND 4M FAMI <br />AR WITH THE INFORMATION S <br />BMITTED HEREIN <br />ND eA5E0 TELEPHONE D A T E <br /> . A <br />LI <br />U <br />ON MY INQDIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIDLE FOR <br />O~ \ 1 O G <br />V F~ F <br />N 00TgNMG THE INF09MATION I BELIEVE THE SUBMITTED INFOgMATIOrv IS <br />T <br />M <br />T ~ <br />I <br />~ <br />"~~r{ <br />~ TRUE. ACCURA <br />E AND CO <br />PLETE I AM 4WAgE <br />HAT THERE 4RE <br />GIGNIFKANT PENALTES FOR S <br />BMP~aaG FALSE NFORMaTIOrv INCLUDING S% <br />. <br /> U <br />a S THE p0G9BILITV OF FINE AND IMRgISONMENT sEE IB u5C 6 IOOI AND <br />]] u5C f n19 (Iknuln~s unJU Ihne abmrcs mrluJr Gnes u <br />r m SIGNATURE OF PRINCIPAL EXECUTIVE 1 , <br />- <br />TYPED OR PRINTED , <br />S!alNxl anJ nr nu rrmum imOnsanrnnrt o/ hal+xrn d mondr. nnJ 3 )cars) OFFICER OR AUTHORIZED AGENT NUMBER Y R MO DA <br /> CO <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS lRalcrenn dll a!leehmmis here) <br />HINTER ~Oh1PVd:N; t'kP:t'T.D ~t:t.lrr.i:CF,55 'AY .. .. Ha',LAI;~JiJ-i 'iC .;('.,~..~~,"U!t:~ nT".art -'rA:'1.7r:.;i ~ DuCU''i;'..TiJ4. <br />?ii'LfiLY fiAhi'L1.`i'~ Iti:irtUC'lUbi-1.L.':, FG ,.:II. <br />EPA Form 3320-1 (Rev. 9-88) Previous editions may be used IRE PLACES EPA FORM T-60 WHICH MAY NOT BE USEDI PAGE OF <br />l'U147~'1u1.'.i 3-1'.•u!I ]. <br />