|
. PERMITTEE NAMFJAC ~4 (Inrluae NATIONAL POLLUTAf') NARGE ELIMINATION SYSTEM /NpDES/ I 9ppfovea.
<br />Foriliry Name/LonNon nnrl DISCHAR NITORINO REPORT /DMR/ ~10
<br />2010-000/
<br />NAME _~.Ll ~. '~ (1 (.a! $-1. ~'..71~.tL~.- - - - - - - l7-/If1 (l7-19/ F - }' 7 t+ A. L .
<br />MlNOVaI explrve Cr3aB1
<br />ADDRESS 1 r
<br />.1
<br />-C
<br />.~,11'iY;Z~Iy~--------- -- 1 [+I ~ 17 ~ ,., ~
<br />~ c
<br />aAfl I10GS5 fAC r
<br />iJ 'Ce[YLgf! Ci4I Lr:
<br />~
<br />~T
<br />-
<br />-JJ_3..L~~T~~.L;a}~/L~~~---_ -- PERMIT NUMBER DISCHAROENUMBER
<br />-
<br />---GE~TW.-------.-~/l.cltilL_ MONITORING PERIOD '
<br />FAauTr .
<br />---.---------- -- -- YEAR MO DAY YEAR MO DAV ~ ~ '
<br />LOCATION---------_------- FROM I l; L' TO I n{!!~J `+ (':'I TI!t rl ~, ~: ;Mty{~a1''
<br />f 1~ ' . I :.'1 : n (; F }; :~ J N lZa111 l7I-33) !Z~-IJ/ ' /Z617/ 178-191 /30.3// NOTE: Reed Inetruetlone before completing this lorm.
<br /> l3 Card Onlyl QUANTITY OR LOADING (~CardOnlyl ~~ QUALITY OR CONCENTRATION .. ~ NO FREOUENCr SAMPLE
<br />PARAMETER /16J31 (SI-EIl 13831 (i633J IJV-61/ EX OF TYPE
<br />131-37) = AVERAGE ~ MAXIMUM UNITS "" MINIMUM AVERAGE MAXIMUM UNITS ~
<br />/6Z-Q) ANALrSIs
<br />161-6BJ
<br />/69-70)
<br />~ ..
<br />llt SAMPLE •7 Y~itJQ44 :f=dJCt I:O~ ~ ._ :: i:aKn. Y,: ' ._ ~io n,.
<br />` MEASUREMENT ~ ~ I i~' ~ ri I
<br /> [+
<br />)I)IlOD I ~' ~ PERM17~ .r C
<br />~~pl#ql##~.Fs
<br />OSS
<br />•+ ~.~ :t IF4 4 ~ 'I I.PP ,y~lr. ~•Q. ~ ~ 1{ 7
<br />` ~ ~~L A ~B
<br /> SEOUIREA~NT~ ~
<br />.[ :I~ ~.4 I '' i r
<br />[-
<br />'JLIUS, 1'O'FlI L- ~• SAMPLE
<br />, 144411V P+'J' r, !71X~[tJ t[YA ', r '4 iJJ,`hfA=F is '/ ! v }~ •_I `~ ~ . '
<br />' U S P E N G E D ~ i _ MEASUREMENT " 1 1
<br />' t L e ~ J
<br />
<br />0530 I ~" ~ J
<br />"
<br />PERMff[[ r
<br />G
<br />~
<br />~
<br />{aAlly~ ~•.
<br />~ 3A
<br />}#,':
<br />
<br />+~
<br />K
<br />~
<br />3~ r `tl
<br />^
<br />~~'~ ~ [ ~ t l
<br />
<br />-i
<br />S -t
<br />R~~/~
<br />RA9
<br />-
<br />•' EOWRE
<br />fENT -
<br />. t:
<br />~
<br />' ' ~ v
<br /> [
<br />Lt i[C: r..
<br />;OLIDS,
<br />Sa'~tTI;EABLE.~ sAMPLE
<br />~' ?~pO:kA# ~, du4~t~a _> ~ a~aurtlr=s '• utS[~Tyiau '~ i
<br />`' ~F :'.-:. ~ ~ % ~. .
<br />1 '] MEASUREMENTI ~• L' + "' ~ 0'f
<br />175u5 1 0' ~D ~ ~ PERMIji'
<br />~ M J>,glr}ti~ t
<br />~ '71~s170
<br />I~ t<~z>t ~
<br />^ ~ ~I.OilJ~p ?
<br />' ~t7~R*fii%A ,5 ~~~ ~'
<br />~ `~ IICE/ HA{)
<br />op !' PEOUIREMENT ~ 'J 9 r.
<br />' .;. [::: c. 7 r -
<br />r .. ..,
<br />- ~ tX ,
<br />C L AND v R F'A S F ~ SAMPLE K';=i=:tSG ' :IiVF+.:YA;+ JyI,Y,:ttAir : eta r:AY~t:y ~
<br />.. .,
<br />
<br />(i}I EXi))~G9AVT~Ei!}1
<br />'RF MEASUREMENT
<br />~
<br />~ iy
<br />_ '
<br />.
<br />;')`J r+Fj I {{ ~O 1~, !. i'~ PERMIT ~, F~!S fFg~~' ~ G ~ O~ '}rf4 i+~`•.Y'InY~~[ ~Q[~'i\fOIO lO4w~~ ~ ~ t O~N.1 I~ R~FJ
<br />I AEOUIPEMENT •; ,,
<br />Z 7; e y ,q .
<br />;~ i.
<br />~
<br />' t r
<br />,
<br />,': t t!
<br />1'OTdL '. :.
<br />I R1~t:, SAMPLE :Y 1;1 ;r L+{:{[' .. Kruk;: Y: Kr ~: ~ ~~ C[{i it',A.'.1 :::'
<br />~ - ,~
<br />~
<br />) ~~
<br />(A~ FF MEASUREMENT ~ Q,QZ ().02 v
<br />.
<br />IUII :l 1 ' Q
<br />~ PERMR 480tf$~J- 1% ry}~,~,rf11( i.}K: I =n1S rA.i'!¢iJra .P CC
<br />.) •3 in ~ 7 A Q i ~ {E/ <
<br />N+~ 8AJ
<br />. REQUIREMENT .. r ~, _ i' ..~ ^ I 7 ,
<br />~. I
<br />G' I ' : 1 ^' r ¢
<br />} L1){~ iN CCJN Dtl IT ntZ SAMPLE ~ id ti: Y,t lF til it I, - 1}f};: a i:j a4titYa1C[ Y:'n;: ;:.'.',e'. T _
<br />[
<br />Ar1Y
<br />CiiRU~'"kf?ATMENT PL MEASUREMENT - 0.06 ~
<br />+
<br />~OU`TO 1 ` 0 D ~ PERMIT'
<br />• _+?+i4#,~[+~ ``
<br />p
<br />' ~EP~RT +=~!MCI>tACc~t '~
<br />,l A'r13iN4`,~~' ~C:;:;I [};t!!J :=>a•t+ -
<br />~- , ~ odLY
<br />~M` v5Tn'
<br />E PL` ... [. S t ..s AEOUIREMENT :
<br />9.
<br />- I . r1.
<br />'~')!..}us, TO'CAL SAMPLE i+{: Vitt l,: Ip .[J.. w,t Lt'.`•':
<br />~ ~ ~ Lt4i~:Y et + I
<br />. .. MEASUREMENT Z44S
<br />
<br />71)Z95? i ''(1 ll PERMIT
<br />~ ~~7'04ttII{s ~. :uS~OIIL:YA" +~I:' r. ~ ''•R~~ititSF ~ #d#ysy+A~ HEPOEIT '~ r.. a ~RLY ( RAE'
<br />~
<br />• REOUIREMENT =° r t= ~ I L : , , '
<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UNDER PENALTY OF LAW THAT I HAVE P ERSONALLY E XAMINED ~ TELEPHONE DATE
<br />
<br />' „ AND AM
<br />ON MY FAMILIAR WITH THE INFORMATION SUBMITTE
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATE D HEREIN; AND BASED
<br />LY RESPONSIBLE FOR
<br />_ _ . ,
<br />';
<br />[
<br />,
<br />IATKI~SON !
<br />I(. (; OBTAIN ING THE INFORMATION. I BELIEVE THE SUB MITTED INFORMATION ,,
<br />`
<br />. ,IS TRUE , ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG ! p
<br />'J
<br />`
<br />IRS
<br />AFF NIFICANT PENALTIE6 FOR SUBMITTING FALGE INFORMATION, INCLUDING 74)3, 24-4451 '" C'4 4 •
<br />A
<br />VP LAND/F.NVIRONPIENTAL SEE IB U
<br />THE POSSIBILITY OF FINE ANO IMPRISONMENT
<br />S
<br />C
<br />t 1001 AND
<br /> .
<br />.
<br />.
<br />. SIGNATURE OF PRINCIPAL EXECUTIVE
<br />
<br />TYPED OR PRINTED 0J U.S.C. { 1018. /Penalties undrr char Jmrvtm maY inr/We /Inu up la J/0,000
<br />andor marimum tmor4onmenl o/Orrvern6monr/u and lymn./
<br />OFFICER OR AUTHORIZED AGENT
<br />E
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />•6VMMtN1 ANU tIYLANAIIVN VY ANT VIVLA I IUNJ (NQPTnrY all arla[nminrJ nlR/ '
<br />F~1P, OIL b GRF.ASF..--r;FF. F'CI!)f40TE F/ I'J T!!F. T'ENfi)T. :iE.l'TLLANLi•: 3'1LID; TF';T H}:"~11P}:U pNLY lF <= 10-T12, 7'i-'.
<br />P i^t.Lp EYE'IT t"l.f {"'°~. IF / LAI'+ '~I~P4,.Y; n .,y u `l'!+, ~i` /; Ir I~~ {,r•'IT`. v?! f. 'n~l'i' 'i:' ?I'('I,T.~'1; Tu !{°l•nkT~L'n
<br />A Form 26x1 ( ev,888) Prof/wa /f/ohs mey bA vadd~ ' 1 " (REPlA0E5EP FORN4d0 WNICH MAY NOT eE USED.) PAOE OF
<br />;)^:1 1'./ lfil 11111-Z. [I {!+ 1
<br />
|