Laserfiche WebLink
.cRMITTEE NAM/ ~SS frMi4. FSWryNS/focauw ryDbaw.q <br />'t Cll. .St:Y L.(', <br />ADDRESS (; r1 L'}N7~1 '!T 1; ~' <br />NATOMAL POLLUT/ AROE ELIMIMATON SYSTEM /NPDESI FOrm I ed. • <br />DISCHARL ITORINO REPORT (OMRI N ], .1 N . li'.. ~ - fl f I' <br />1-r81 n-/9 c r? _ ~' 1ppproJe reg OS 3!1 t98 <br />PERMIT NUMBER DISCHMGE NUMBFA P _ r r +: + ! <br />n r. o n r. c C U tti 1 G 4 L MONITORING PERIOD ~ ~ I !! n'' <br />AGILITY <br />YEAR MO DAY YEAR MO ~ DAY _ <br />OCATION - ~ <br />. ,, <br />i•1„ ~:. L.:.... r.i ~1~;,,~,•:.:: FROM 9l 1D O1 TO 9R 17 Jl ;+w,: NO !~7c,^.I}r:~i' ~~~ r.: r:::: <br />^'; i': ; -i=: `?-.--{}y ~-; ~-;',;; <br />}---r=~~. !10.1 /1 f11-131 111-151 r16-I71 I1B-191 !36311 NOTE: Reed ImtrueUoru bdon comPltllnp ihb }orm. <br />~ <br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING !1 Grd Ontyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> !46531 154-5r1 138151 !4653 I51-5J1 DF <br />131-37/ EX ANKYSa3 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS reZ-ssl ES.F-6Bl lss7ol <br />~!! SAMPLE i{t}r: r7 it :: :`. C: {: Y,: ::: ~:q{s rp t;:::: / 1 1) <br /> MEASUREMENT ' <br />r~ <br />JJ~UU 1 L I? <br />.:.PERMIT::: <br />:: z:z:r,~lxnc:~~:: <br />~ <br />:~.~rdrs:;c 5L K=s2.:~S <br />~~ ... <br />t: ;: r: <br />~~~~~:.:.::~:~:~~:~:': <br />:.~;;:;rr~:.ri ?:;. ~. <br />.;~: ~:n.:: ~:~: ~~~: :. <br /> <br /> <br />Y.1,. <br /> <br /> <br />t4: <br />r ,; . . , ~ r 1 <br />r.}'. 1.Il r. 1' I; Vf'.iy.: V.. ,, I. REQUIREMENT <br />. .. . <br />.: ..~.:.'. ~ .. .. <br />'~~.: ~~'~:. ..' L:':G :A ''•+; ~.~~YlTy~ripi': <br />. <br />r'.; .:•t..'~ <br />-, iJ l.(Cci, '; q',';.I- SAMPLE +::.7C: r,:::: r:. :; : n:: :>Y/C~:?7>t ( 1`)1 <br />~ 1I .~ ~, i. ~ ;; ;: ~ MEASUREMENT <br />uU-, Iii 1 (t D . ~~.. PERMIT :~~~ : :... #>jI?tY ,o {:.:.: <br />~ 4rp:f ~s Y,: ,: :'< <br />.:~ .. <br />~ r,::p~: - ..}.~, rs t!{ik.'.' :~:e..::.. <br />~ qr~~:~~:~ <br />.. . 7 Yr~•' /~~~ :~Pl p. .,. <br /> <br /> <br />- <br />„''t :.U r. t; ~ f:Si)c:'~: ': qLl!; <br />- REQUIREMENT ~. <br />. ;~.:.~~ :~.:.. :~ ~..: <br />:.~ r.:': rt r: <br /> <br />... <br />~ ~.: <br />.. ~;]~ ~ :, ~x.~~ ~v::.•6J <br />••: / I. ...!.:!, . <br />.i:L(i'~, .i ..7 YL';, :-I. h- SAMPLE Y:P 5Y': C+'r ty 1, ro G: rf~ ;::;e C: {e :4:} :}f,; ,t Yy";: ( t,;l <br /> MEASUREMENT <br />~US~.S l (I ,. PERMIT It 4.::X:+.rf: ::r,Fr,:.r,:s:: <br />~ <br />~ a;. <br />'~ ..::,;;i'ct,: ,p S;nL=>;i~; :n a <br />... ~~~ : ..' <br />;li-•,:/ <br />~ <br />l: :' [., <br />~r FLU r. i:: t.h~. °~.~ l'.. 1. 1'! REQUIREMENT <br />.. ~.: .: ~~~ ~ c-r..; Et <br />,.., <br /> <br />.. ~ ~~t':.a.~T~1 r' :.+:. <br /> <br />t. ~1 <br /> <br /> <br />. <br />~4 t' <br />11 !. 6:.G ',;nl'.q_~ SAMPLE r::::+pr,..w n~;:r;:n:;: : <br />wrlrt',r;}:~ r,: 11{r r:rr.: ( ,:;) <br />`' e i ~i .: :' 1'.': ;1-'.; I; A H li ~ R ( MEASUREMENT <br />J L''..'~b 1 (~ f. ... PERMIT. ~: ~ ~ {:::: rt {t f:.C:. ': ,~tf tt to 4t ~~ <br />~ <br />~~ <br /> <br /> <br />. <br />.:R <br />~, 'h:'k ry.`:F iY ~<rlfr >;t ~:~ ~t. <br />" :• it Ili `: V 0. I.li ! REQUIREMENT ~:: ~ ~~ ~~ ~~ <br />~ <br />li'.v::, ::fi'n 1. <br />~ SAMPLE ., ~ nr. ;t rt r,: r,; ;: r. i~:;: ti Y: i.::}ry t!: ( .I ~,) <br />(!, l> 'r f.) MEASUREMENT <br />11VaS l !`. (1 ,; .. .PERMIT.: ~: ~: .~. It:;:4_w,. fit.:}~!.. <br />~ <br />. <br />~ ....~.t}Y.1 e;: rg .:;;.:~X <br />~ Y.+.':;: "~:(c h. LS, tk i'.a>}r :.7:.:~5 <br />.. <br />;.::: ..:~~n .'~.. ~.~ : -. r:'':./ i?i. t' <br />,• ,. .• <br />.. LU!:., i~ '. nL~'~'! . A1.!!P REQUIREMENT: <br />.. ..~ .. <br />. <br />. <br />~~ .~. ~~:. ~: ~-.` ...:: <br />:: ~~~:~~~ ":..~~~ ~~ <br />r: :}rt C: <br /> <br />: : <br />y: ~.: i. . <br />•,, y.; ~•~11 <br />t!-~i.:, I;1 ~CIi L'll l~f ~, lr SAMPLE ( ()3~ {nVe;t :`t y'o i,t rt yu`. Yt d/:: r: t'+: ?:... <br />'il'•.'I T!•r. ,i 1'f"~"!T :%La+;7 MEASUREMENT <br />.U.)`.V i O ri ~ PERMIT': <br />. ~PiI ~:K <br />~[:.'~ :~$E(''.Jh T. ~ <br />' ":6~•Y4tx',;v~F ~:'yri;ry Ci ;:; . :~:~::'si.•;<{~::; :P ... :: <br />r <br />1 '~'7:;iT i <br />~: <br />F I„•.-.: ~~ • t <br /> <br />:}iiiJ .:'~~'` ~~,:.;., .. ~.n (1: . <br />REQUIREMENT . <br />. <br />~ ~ ~~~ <br />~~9fl Dk"..A YIs ~ . <br /> <br />.... r, <br />~AI:.Y.:. X <br /> <br />N-? <br />~I <br />:.::. <br />.. <br /> <br />.~ .. ~. <br /> <br />; <br /> <br /> <br />, _ <br />_ <br />.. . <br />~:!l..i GS, 1(iiaL SAMPLE ;:¢(:R Rrf ;r r:.; r: ;~a ::: ,}art to t: {. s, r,:}r! ( <br />I'1) <br />S i '.. ~ U L V is 4 MEASUREMENT <br />(U1`,5 L (i (1 ~~PERMIT~..:. <br /> <br />.... <br />::-. <br />.~ -'n}.tAYA.+:~. ~:. <br />.:.. ..:~.•,: ^,:: rtpt:.~; <br /> <br /> <br />.. t<:;:~p ~~Y.~t-ifiE[Lri.~~:.. <br /> <br /> <br />~ <br />~~ ~. ~~~ia;: .'„rS iY};;:: ~ ~lx r~c:'.~„1:~ <br />, <br />~~. ~:r :,) <br /> <br /> <br />' <br /> <br />r <br /> <br />- <br />1 <br />-t'r'LO I:J1' 61?!t `",S Yhl.^; REQUIREMENT. . <br />:,..:. ,.1: ,.. :..::..:':.: ~~-::~:~:. ~:~ r:::rr. r: <br />.. <br />: <br />~:'~;: .:: .':rp:I:~:k.`~e~..,~ .. <br /> <br />./I. <br />:.. , <br /> <br />: <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERT IFY UNDER PENALTY OF lAW THAT I HAVE PERSONALLY E%AMINED AND 1 TELEPHONE DATE <br />- AM FA MILIAR VATN THE INFORMATION SUBMTED HEREIN; AND BASED ON ( <br /> MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOfl <br />OBTNNING THE INFORMATION, t BELIEVE THE SUBMITTED INFORMATON IS <br />I <br />/ Y'~ <br />_ <br />' <br /> <br />TRUE, ACCUMTE AND COMPLETE. 1 AM AWARE TNAT TNERE ARE ~ <br />~~ <br />- <br />- J / <br />~? 4GNIFICANT PENALTIES FOR SUBMITTING FKSE INFORMATION <br />INCLUDING <br /> <br />j . ("t /. , ,,. ~ \ <br />~ , <br />THE P05981UTY OF HNE ANO IMPWSONMENT. SEE 13 U.S.C. 1 1001 AND ]] <br />~ )) <br />r'I 1l) _ <br />C3 /'I - I`~ ~ <br />I ~ <br />~' <br />I I <br />~ ~ <br />_ <br />- <br />C <br />1 t DIY <br />rhn,t,lr, oMr el <br />U <br />S <br />mtun <br />n <br />AM, !w <br />b <br />i !0 <br />000 <br />SIGNATURE OF PRINCIPAL E%FCUTNE . I i <br />I I <br />- <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />.a. <br />, , <br />,r <br />. ~ ro <br />r <br />, <br />s <br />wa~muim <br />` <br />d~xrrtr de <br />r <br />m <br />es <br />1 <br />' <br />OFFlCE <br />T AREA <br /> •„a, <br />,e <br />. <br />w.Nt <br />,.. <br />.w <br />F <br />M" ~, <br />R OR AU <br />HORIZED AOEM CODE NUMBER YEAR MO DAY <br />y.:'1"iLi•:ai:Lt ":Lii•': LI'`:.T1' d?PLI.:S GF:LY IF <= lU-Y?r 24-!if: ~F:£."Tr^ F.VF.NT Ii C!.',I!1=~`. 1" ":. :."' !. [,;'~~I~'p ;-.'+ <br />n .: C:L, I'S:i F I'd '." !.IC.I'1'S ii I1.L !!DT :iE FPPLIr'.D TO 2F.PnIiT}:D :a f. ASIIDEMF. (:T°--'.i ~F,' T.9.1 d, "" " <br />.. ,.. . 16, +;. <br />~PA~Forrn 20-1'108-951 Previous editions Ivey bd'lised. ~ ' (REPLACES EPA FORM TAO WHICH MAY NOT BE USED./ PAGE OF <br />