... ...... .... ,..,. ..,II;,....::,,,.~;;,
<br />FirYlry N[mr/CDrrrbn lJdl/Jerrnr/ ....-~ ~~L....n.,,,, ,.~.I. ~.. ,.., L,.,,,
<br />~~-~~~~~ y r) p -- DISCH A~ MONITORING REPORT IU.1lRl
<br />~$ v~~ll~_ 17~/fl ±1 I';OP Form Ap
<br />ADOR[[1~ RUS1f_IZF.F _________ (' (I ,1
<br />-__FI.~~_"i.1'bF~______~I~1)bD~l-.- ~ "" FSUOFItI'{L r'0'e'fNo. 0-0004
<br />PERMIT NUM[[R ! E% IrDa 9-30-91
<br />
<br />MONITORING PERIOD
<br />- --
<br />UliCfla RG F. TO GFA ;SY CAEFR
<br />-wcluTV
<br />------~~------------ Y[AR MO DAY YEAR MO DAY
<br />LOCATION ___ FROM ~ TO _
<br />.w~: VC UT JCNAitG F. -a.w
<br />l
<br />A'ffN: CE Zt1IS I.. ST RO ~'NSOH FRF,SIDP, tIT l1D71) I771J) (1115) r1a Lei l7a 74) Ilo I/ pletinB this lDrm.
<br />NOTE: Read instructions beforl com
<br /> (J Card ORIY) QUANTITY OR LOADING 11 Card Only) OU ALITT OR CONCENTRATION
<br />
<br />-AR AM lT[R
<br />(16JJ) (Jldl)
<br />(JHA)) (16-JI) (Jldl)
<br />NO.
<br />% FR[DUEncv
<br />DF
<br />sAMPI
<br />TYPE
<br />(J2,J7) E NwL V51$
<br />A
<br /> AV ERADE MA%IMUM UNITE MINIMUM AVERAGE MA%IMUM UNITS 676D I61L%1 IAV.nn
<br />Ptl 6AMPLE
<br />MEABV REM ENT +#>x+Y~~ I(r#vtXr#
<br />~ ( 1
<br />gb rr,
<br />5 17
<br />1
<br />1 J
<br />f
<br /> ~~ 7
<br />OI D 7 r„~~'
<br />v
<br />1
<br />DJ4DD 1 D D PERMIT .' >r 3,3 ~,~..
<br />-
<br />...
<br />`?4`~~'.1'~v .. :v"-
<br />6.0;:~
<br />:
<br />~;::
<br />: V #~'
<br />~vrt
<br />.. 9
<br />.0'
<br />
<br />EERLY B
<br />
<br />R4
<br />EFFLUF.!1T GROSS Y.ALU. RlOU1R6MENT. •.: .;
<br />. ;: •. Ar##
<br />.
<br />.
<br />.:.
<br />.
<br />SOLIDS, TOTAL 6AMPLE
<br />MEABUREM ^~++`•+`+r )x~-w.-;:1k iF ( 1 v4`vv'.`•'= / / ( 171
<br />
<br />SUSPENDS %
<br />ENT
<br />m
<br />b ~ ' 3~ ~~
<br />01)530 1 0 D '.:.PERMIT ~ r~' 4°~C~~FFrt= a ~TSFSFf%k~~; ::#.: a:~i4~t~~. 35"~ ::z;" 7D' ;'
<br />" NCE1 ` RAL~
<br />
<br />FFI. ~tiT SP.OSS vALU R[OVIREM HNT,
<br />.:...:,.:..:~ •, .;:F ~ `'
<br />~:.:.. :`':' ="':
<br />::.:..
<br />;:#
<br />y .
<br />c •~
<br />d
<br />.
<br />OIL AHD :REISP. SAMPLE %r`=-'•I~+ ~=xr##x (
<br />) ,•.-rrx:: ,r.,-r,- 19
<br />( 1
<br />
<br />FRdON FR: R-GRAY ,ry ~'I'1
<br />MEABUREMENT
<br />O
<br />D
<br />~~~ ~1I
<br />/R/l[
<br />,1
<br />/1
<br />V
<br />00556 1 0 D "PERMIT ~..'
<br />R ..:fix"~'+k ~+Y1Yi :'. •.`. ~fF;:sx3fi :. #YG ^~"+x#~~: ~x . ,.. •##t~#ttA ' iD ' . OBTIN 8
<br />A
<br />R
<br />EFFI.UEtI CnAOSS Y1 RHOUI
<br />EM ENT ~~~#
<br />~ ~.,
<br />:
<br />IRON, TJI'L SAMPLE ra~lca:x a:z~c:#a ( 1 r.#-~fi#M ( 1^1 `
<br />
<br />(r.. FEI
<br />MEABUREMENT
<br />O. I L}
<br />Or I ~'~' r
<br />~
<br />V
<br />I 3Q
<br />6RA1
<br />G1045 L D O "PGMIT. .:. •;..~`ir`R~`+5~:.
<br />.. ~, .. ." ',tOCI~`++F.t/.:.
<br />.. ~#: 'z+:,`•~~+z# 3.5.~ ,~. 7:U' NCE/ RAT?
<br />
<br />EFFLUENT GROSS oaLUf REDUIR[M [NT
<br />:
<br />•
<br />':.;: s: r:: :
<br />;;
<br />i
<br />r['
<br />'
<br />:
<br />'
<br />...
<br />.
<br /> .,
<br />....
<br />_... .
<br />. .
<br />.
<br />; C,
<br />afi#
<br />,,
<br />. M-
<br />FLOYP Ih COFICUIT O4 6AMPLE
<br />MEABV REM ENT ~•o~Z
<br />~
<br />2
<br />? ( Ojl #; ::G-~ ,x;:t;-:;:
<br />' ' ' ' ' w
<br />( 1
<br />O
<br />~/
<br />TN3U THE ITF1EFiT PLP.N 1
<br />~ ' ~N~~
<br />50050 1 D D ;.; PERMIT :.
<br />:: REPQAT•~.
<br />,
<br />DPT~IORA'I: ~.~ "
<br />; ~~#!k ix:t=:
<br />. ~ :.~R
<br />~'~~
<br />'
<br />#+`:+x
<br />""~`
<br />~'-':
<br />
<br />EERLY
<br />
<br />NST
<br />l
<br />EFFLUENT GROSS P0.L0 R[DUiREM eNT. .
<br />:
<br />3 ~: ' :
<br /> .
<br />,° ..~
<br />A
<br />SOLIDS, TOTAL SAMPLE
<br />MEABUREMENT #.I#3t# ##tr#~ ( 1 #~r##:`- Z$~IS ~Z~
<br />1 (
<br />19) O II30 RR~
<br />DISSOLYE3 o
<br />- (~
<br />70295 1 0 D . "PE/iMIT~:: '
<br />REOUIREM EN
<br />' R+if~F~~I~-„. • :YIF'~I#~+F #a r "aa.;:~~~x.:: O.~TIOfi~L: ": EE PORT.;; TRLY:. RAF'
<br />EFFLUENTROSS Y U T :::+< " •
<br />
<br />""
<br />" #,.- r~
<br />DIL AYD ;RE.1SF. 6AMPLE t¢#### ( 9111 ,.
<br />,..
<br />:~i~ ~••••.•
<br />,••,•,-ff it r„ ... ( 1
<br />I
<br />
<br />YISUlLL
<br />MEASUREMENT O D
<br />~1
<br />1{/
<br />
<br />VISVi
<br />84066 1 0 n : PERMIT .., -:~~?G?7:#.::
<br />F iY: ;..':;
<br />'.`.'~; E5=1 t+r+~~ut+t# :
<br />" ,~,~~:'.tXs#:` "'4it~.~+;r : ' . ,. EERLY ISUA
<br />P F, r. ~ i ^ REDUIREM [NT.
<br />
<br />
<br />... ... , '"
<br />"
<br />
<br />".,' ,I .
<br />y
<br />~ '"~
<br />n ..
<br />
<br />r
<br />
<br />.. . .
<br />~.' ..
<br />NAM [/TITLE PRINCIPAL E%6C UTIVE OFFICER I C[RTIFV UNDER ITNALTr OF LAw THAT 1 Hwv[ R[w$DNALLr t%AMInrD
<br />AHD AM FAMILIAR WITH THC INFORMATION SUBMITTED H[REIN AND BASCD TELEPHONE OAT E
<br />/ ON MY IHWIRr OF THO.[ INpVIDUAL$ IMM[pATELY RCSPONSIBL[ Fp1 / )
<br />
<br />(~ e
<br />~~
<br />OBTIINING TH[ IXFOIIMITIO.V 1 B[LI[V[ THE $UBMITTCD INFORMATION ,
<br />r/r
<br />/
<br />/C~r~
<br />1 IS TRUC. ACCURATE AHD COMPIETC I AM AWARC iH1T 1H[RE ARC SIG
<br />R
<br />~
<br />r
<br />H Y
<br />}L
<br />,AA
<br />7v [r~15af '•vIV ]]CUSC$11B]19v 1~ IIh
<br />l~. 11pIFYDI
<br />.M~
<br />IApI$OYIU1v. nEa. [inrl ~~U/n~
<br />u
<br />61GNATURE OF PRINCIPAL E%ECUTIVE
<br />OZ.
<br />~ r
<br />~ ~ 515 Q
<br />/ ~-I
<br />V I
<br />~~-
<br />
<br />iTPED OR PRINTED y
<br />md ~.r n.a..m.~n m~Pnu..umU ~d b~mvn [ m.,nlA. and i v.r. I
<br />OFFICER OR AUTHORIZED AGENT AREA
<br />NUMBER
<br />YEAR ---
<br />MO -
<br />DA'
<br />wnncnr wnD urLwnwTlon or wnY VIOLATIONS Ingrrrnrr uR mw.nnrnU nnrl
<br />OIL E GA'\SF,--SF,P, FO^; NOTE F/P PAGE 3. ORTRLY :,AFIPLING INSTRUCTIOFTS--POnTNCTE C/.
<br />EPA FOfT ]920.1 (R~v. 9.OB) PI[Noua edition! may b0 used. Iw[-Lwc[e cPw rowM T-.o wNICN Mwr Nor •[ uscD.l ,ACC or
<br />091:1R/92~1i75-12'1] l
<br />
|