Laserfiche WebLink
?:. <br />N::ME _E Y-C.D A1. ...C(L.~(!!(lf f.d ~1 L.~1 °.~ ---- <br />ADDRESS 1 T~Q(1 TES SALE- - - - --- - - - <br />FACILITY _ _ _ _ _ _ _ __ _ - _ _ _ _ _~ <br />LOCATION_________________ <br />-- rcJaenu DtrpC TITClIT <br />//l.aD! <br />PERMIT NUMBER D4CHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAV YEAR M DAV <br />r-ROM 9 l rD <br />!)call laaa7l !ad-7s1 !a5-:n /7819/ 13x311 <br />F - FINAL _ <br />STORHNATF.R DISCH.IR~F. <br />RIROR 1.YT RS <br />NOTE: Read Instructions belore completing this lolm. <br /> UC'urd Unlr/ DDANIIfY OR LOADING MCord Onl/y QUALITY OR CONCENTRATION <br />NO raEr]uENG• <br />PARAMETER ld6~J31 lJd~51) (39~dJ1 !d6-JJl (Jd.611 ' <br />EX <br />GF SAMPLE <br />TYPE <br />I--+:~ia <br />AVERAGE <br />MA%IMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MA%IMUM <br />UNITS <br />/57 h) •NAL rsis <br />Ind.rvr <br />ISV .'nl <br />Il $AIAPLE #~:#:z## ###: #r ##r.### <br /> MEASUREMENT <br /> <br />V~LV i ~ ~ <br /> <br />PERMIT <br /> <br />r r~r++~ <br /> <br />r <br /> <br />r`+F <br /> <br />~ <br /> <br /># ~##v <br /> <br />9. r / <br /> <br />R.. <br /> <br />RAB <br />r•R c REOUIRENIENT ~;~# _~_I}i_ <br />:'1LI05, TOTAL SAMPLE ~;-#.#: ###### ####t# #;.#### <br /> <br />~E4DZD ME4SUREMENT <br />~J~C 1 ~ Q PERMIT ~#~#><r %}~.~#ti~ ~ i~+iY `v `v'v+"-V# ######' RCIr rYOT <br />4[v• Wr E/ PAR <br /> REQUIREMENT <br />c r * V - <br />OLIDS~ SE'fTLP,ADLg SAMPLE ,r:-:'kvY# #r3### ##4### ###### <br /> MEgSUREMEIJT <br />OSr15 1 0 C PERMIT ###### ##~:#t# r# ###### ###### O.S NCE/ RAR <br />v RFQUIREMEN7 t_ ww ~ M, 1 <br />IL AHD G2EASE SAMPLE ###### ###### ,#Y### ###### ~ <br /> MEASUREMENT <br />°~ <br />'REON EyTP-GRAD 11F <br />T'1 <br />. <br />X555 1 C O PERMIT ###### ###### ### ###### ###### 10 NC°/ RAB <br /> REOUIREAIENT <br /> i 'F N T <br />ROY TCTiL SAMPLE ': Y_#~'-i=-'F ###+## -i##### .'t#r~~ <br /> MEASUREMENT <br />(AS Ft:i <br /> <br />01~~5 1 D O PERMIT ###### ###### ### ###### Y####3 REPORT NCE/ RA9 <br /> REOUIREM ENT <br />f U C !~ ~ VTI <br />FL07 <br />I"! C`)f1DUIT CE SAMPLE #r#### ###### :~##Y'~h <br />, MEASUREMENT NO DISCH RGE <br />'~ 'U TREAT;I P.NT PLA9T <br /> <br />~_~50 1 0 O REF09T REPORT ###### ###### ###### ,r# EEKLi NSSAN <br /> REQUREMENi <br />c Q~. <br />SOLIDS, TOTAL SAMPLE ##;### ###'k## ###### ###### <br /> MEASURF.ME.Ni <br />ISSOL4ED <br /> <br /> <br />0275 1 0 0 PERMIT ###### ##+#~'-,{ #'F# #####'t ####;<# <br />REPORT <br />TRLi <br />RAB <br /> <br /> <br />poet noom rvnCC Oef^ <br />REQUIREMENT <br />rvi <br />yr ~ <br />NgtAER1T LE PRINCIPAL EX ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE P <br />AND AM FAlAILIAR WITH THE INFORMATION S <br />BMITTE ERSON4LLY EXAMINED <br />R <br />N <br />D iELEPn Gr:E C~". <br /> <br /> <br />Bri <br />n P <br />Dunfee EI <br />U <br />HE <br />qN0 B45ED <br />ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />~ <br />. <br />a OBTAINING THE INFORMATION. I BELIEVE THE SURIAITIED INFORMATION <br />Manx er <br />9 IS TRUE, ACCURATE AND COMPLETE I AM AWARE THAT THERE APE SIG <br /> NIFIQANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INGIUDING <br />P <br />T <br />E <br />E C <br />602 <br />774-5253 (1 <br />9D -/ <br />Q C I <br />2 <br />J <br />Environmental Studies HE <br />OSSIBILITY OF FIN <br />AND IMPRISONM <br />NT SEE IB USC. 1 1001 ArJO <br />tT9 <br />A <br />S <br />C <br />l <br />JJ U <br />' SIGNATURE OF PRINCIPAU E% CUTIVE / ~ <br /> <br />TYPED OR PRINTED . <br />rna <br />nr. undo r <br />. <br />. f <br />rv emmvr mot inNuGr l~nrz v0 rP J10.an <br />!l <br />va/P•muarmum rmp.uonmrnr o/Gr.renamwllu a+e!yrau.l <br />OFFICER OR AUTHORIZED AGENT gBEq <br />NUMBER <br />YEAP <br />MO <br />DAr <br /> DQD <br />COMMENT AND EXPLANATION OF ANV VIOLATIONSlRefrrenre as arrarhmenrr here) <br />IF NO DI3CRAPGE OCCU'{5 RP.POR1^!10 DISCHARGE^. OIL AND GRRASE; SEE F00?RO?E P/. <br />EPA FOrm O92O~1(RBV.S-BB)PJBV(OUS EdI(iORS TBY be USed. (REPLACES EPA FORM I~.O WHICH MAY NOT BE USED( PAGE OF <br />00149/SOO,n4-27r1r( 1 L <br />