Laserfiche WebLink
PERMITTEE NAME/" `ESS (IriJ. AediryNrWlocenm dDbn.O <br />NAME :.'.1 ~:.: ,. :. ~.... I ~ _ .. . <br />ADDRESS I. t':, ..;- !'; .' I: <br />..._... .. .. ~ i7, :1 ~ <br />FACILITY <br />LOCATION ~ ( I , ,.Ir. '~ 1, <br />NATIONAL POLLUTM' '^.HMOE EUMINATON SYSTEM INPDE$) Form Ap^-- Ved. <br />DIfiCHARG INITORINO REPORT (OMRI ' <br />1451 17-19 w c, .:.I _ ~ .OMB Nr 30-0004. <br />~.i , , <br />. ,. , ,,~ ~ n ~, ~• I ., .,, ~ , Approval eRpires 0531=98 <br />PERMIT NUMBER DISCMMOE NUMBER (,~ I ' <br />F - .... . <br />MONITORING PERIOD ` ~ ~ I~ <br />YEAR MO DAY YEAR MO DAY <br />FROM !; 7 :: 7 'J : TO q 7 f 9 ? [ '::•: I. ,..: ... .. <br />1767/1 !11.131 l1L751 I76Zll I7B-191 /3P311 ,~~NOTE: Rsad lnstructloru~batore'com)platlnp~this form. <br />PARAMETER l3 Grd OnNI QUANTITY OR LOADING /I Grd OnNI QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> /0653 (5451 73B-151 !16531 !54511 OF <br />731-371 EX MALrsts TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Is7 <br />691 <br /> - 754551 f59-)Ol <br /> SAMPLE :;: e; ::: <br />~ ~ ~ <br />~ ~ ~ ~ ~ ~ t <br />1 <br />~ ~ ~ " ~ ( <br />1 ~ <br /> MEASUREMENT ~ i <br />• 1 ..: ( <br />... (. ~PERMIT~ :;u}r ti ;:::;:. <br />......... , . >) <br />; r. ~. .. <br />' <br />' <br />' <br />~ <br />~ REQUIREMENT ~ r <br />' M ~ <br />T .. -... . <br />: , <br />~ ! <br />r <br />. [ I: <br />. -~ f~ <br />~ 1 n F .~ <br />_, i ~ L <br />...... SAMPLE ,; :: :;:::::.: is ;.:::;: -::) ;: .:: {~ :: 9 +% <br />, <br />~ <br /> <br />r <br /> <br />t ~/ <br />. MEASUREMENT J .)r <br />$~? L: L: ~ •;. i <br />.. .. <br />, :~::, . . <br />~. <br />,a;: i 1: ,. ..PERMIT <br />:::: <br />.sl:,;: ;. ,,;i /; :~.. ::i~:/:,•, ~~ ;r; ~ .. 7r „r. <br />' <br />' REQUIREMENT ~ _ <br />.: I,;l .. ., 1 '. i: <br />~ ~ i ,I •, <br />: .. ~: .. . <br />. ~ ^ T F. r 1 L . / I <br />~.IL'. .; :.':'!. •..~.'~L: SAMPLE ^: =s C.:::: :: ~~~~:~:;: ::: ~, .;. {•Y,. 1) :: :i {. rat, <br />~ <br />' <br />" <br />~~! <br />I ~ <br /> MEASUREMENT ' <br />f 1 <br /> r , <br />'/:, i U I, PERMIT ~ ::}{::?~a'r -;::f ::n;-::=;: • ? :),} lj f,: +i M~;„y .ly~o) ; f' LY {, ~ n . °,~I ~ i <br />/ <br />n d <br />r U• ~ V; I -! p REQUIREMENT .. .. .r r. <br />a ~ r <br />I s <br />,. <br /> <br />l .. ..., ~I ., :::.: - ~" SAMPLE :: r::~;, <br />.. . .. <br />:: ,; 0 r {• d <br />'i :: li'I : :;: <br />1^ <br />~ <br />( I I) <br />I~ <br /> MEASUREMENT 1 <br />r 7~ . <br /> <br />1::~'. :. 1 !'. .. ~ PERMIT ~ ,: :4 ;~4; <br />~ ~ru'cY ;t :; ;. ::, . ~..r,. r~Agr:~1~~ .~Onrl ~tj {< ~ i `; !;5 i <br />~ , <br />. <br />, REQUIREMENT ~ ~ ~ ~ ~ 1~ . <br />_ <br />. <br />;i 1 : I; <br />.. P r. i. U : .. .. ::~ .. <br />.. .. <br />. , 1 y <br />,; , <br />:. .. <br />. .. <br />.. ,, ':I: F, L SAMPLE .... ., r~: ;::: ~. {~:/:{~~: :1 (7 <br />~ <br />G ' I) <br />I I <br />~ r~,) MEASUREMENT ~ , <br />, ) ~~~ <br />~ ;: i, , <br />.: , .. v ~ .PERMIT .. -. t: ly,x:: ~ %'1;5:.+: .. .;:':).~T iti'-"J U'. .:~' ~ ~ 4' ~ <br />~ ~~ <br />J ~ . `.1 ~: :7: <br />% <br />1. is ' ~ 1 L.: ~, f J' ^ REQUIREMENT ~ 7 f 'J .' L T ~' ' , / <br />..., , ! ,. _ .. ... SAMPLE ~ I I <br />'' -t <br />) ( ~: _I) . G Y,. :~ ,} .^, ~; { J {: ,;~ ,.: ..;. ,. ,::::.:_ :: <br />' <br />'' ; <br />~' MEASUREMENT I <br />, I ; . <br />~i, : ~ I~ ! ~' ' !i <br />. . <br />.. . <br />., ,. .... I.. <br />/:.u PERMIT r~q•L[:1i .:L ?i; E'i: hr ~. .q,},}~{I J7;;: r1 ;.: ~ ,i [r, ,. .. . <br /> <br />...,.. <br />:' I. ;, c !, . <br />'i i::..::. REQUIREMENT ~ .. .i Yi7 ~ <br /> <br />1 V Uk. 'u ?.: 1.'i . r{ ~ <.:. i' ~ .. ... 1 ..... . <br />.:,:.., :i, ...'. ll. SAMPLE :....:....... :::: ::::;: r,: ;: ,. {,yy;~,y r. .:{. {::~;: <br />` ) <br />{ ] •1 <br />1 <br /> MEASUREMENT ~ <br />I I ~ <br />.., _ ,, <br />., _ ~ <br />.. <br />~... PER.M.IT .. :... ..... ... <br /> <br />..... .. <br />- V'. il' <br /> <br />Y: a~:; ....it <br />t:, <br />(: lr' A <br />w t. 31 ~ Ly l'1 <br />Ij ~' it <br /> <br /> <br />... <br />1 :' !.., :. '. '' , ' :' ': i~. [.'. r REQUIREMENT: . '..... ~ :::~ :...:. . ~ ~. .ti r r .; ~/ , I <br />NAME7TITLE PRINCIPAL EXECUTNE OFFICER I CERTI FY UNDER PENALTY OF LAW TNAT I HAVE PFASONMLY ExAMINEO MID ~~ TELEPHONE D <br />T <br /> <br />AM FA <br />MILIM MATH THE INF011MATION SU9MITTED NEIiEIN~ MO BASFO ON A <br />E <br /> MY INQUIRY OF TN09E INDIVIDUMS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNINO THE INFORMATON, 19EVEVE THE SU9MITTED INFORMATION le ~ ' <br />J <br />~ <br />. <br />I <br /> <br />. - I <br />11 <br />TRUE. ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />SIONINCMT PFNAlTIE9 FOA SUBMITTING FKSE INFORMATION <br />INCLlWIN0 ~ C <br />' <br />Jr` <br />; '_"'--'-" <br />~ <br /> <br />~ <br />~ <br />`~ <br />I. 1 17;% . l' <br />t (• ` , <br />THE POSSIeIUTY OF RNE MD IMPNSONMFNT <br />SEE fe U <br />S <br />C <br />! 1001 MD y! 1 ~' ` <br />'1 ' <br />' ~ ~ / ~' I ~ ~ <br />. <br />; . <br />. <br />. <br />. <br />/S01~TURE OF PIIINCIPAL EXECUTNE ( • <br /> U.S.C. F 1719. fhrrleY. uw swr mms. m.r irAp Em/ IV ro t 10,000 AREA <br />TYPED OR PRINTED wnmuinlnr i.w/rovrwNWMa«n smmN. rde FrAl j OFFlCER OR AIlTHORRED AGENT CODE NUMBER YEAR MO DAY <br />..vmmcn r a nnv cnr~nnn I wn ~r nn r vw~n I was rnnermcs e/r snscnmsnra oars/ <br />........f..,.~i... 1.,.1..- ...I'T.. I,.. Li}': J':Lt ii C= _U-'i it, 'i-:ii. 'r'. £i:I'r EVFM^. 1.. ~!!.1ChC. i. ,.. C .. 1 ,. .~ ~ , <br />-. ., .. _ ! -. .,. L..:i'I_ (ll.i. ...,',' n;. ni/tLLi'.{i iG !t F.1Ci.~f:;i. ^: !; hSgnFCEII'f`--SFF -. .1_n, I'L ., v'' {......', .. <br />EPA Fam 3320-1 108-861 Previous editions may ba used. IREPL.ACE6 EPA FORM T-00 WHICH MAY NOT BE UfiED.I PAGE OF <br />