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PERMITTEE NAMr~"IDRESS llnelude Ll~iliry Name/LB[ Vf di!lerenll NAME_h~lr~rl-l--c ~.~-f st'T`..(.r. !,~L--__ ADDRESS ..~~.~~t~µ_ _______ --~~F'Jr1-5-'1 A-7~i~I-I+~~~L-I-------- FACILITY LOCATION ___________________ r FT~'llh l74 L. RTr f4':r rl NOTIONAL POLLUTAIr 'GCHApGE ELIMINATION SYSTEM (NYUL.S f •' DISG}iARG 9NITORING REPORT (DAfR1 Il-Ifil f1719) ~J III I~Ii I! r ~ _ For A roved. PERMIT NUMBER Pracx cr xuzleex I k' I tI {z L OMB No. 2040-0004 Ll i; S i i i'1' ~ ,rpppro a ~expi to ]OAal1L9 5 CFIA MONITORING PERIOD r ~ L g YEAR MO DAY YEAR MO DAY {~~ FROM ~,J I14 r.j TO `l4 1[. ~r~ +z+[+° NO hISCIt9p.cE efC8lri #0~ r ~o~Jn („-J.n r++-s1 rla~?n /'8-?9) Goan NOTE: Read instructions befor Dieting this form. (7 Card Onl}') QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION PARAMETER (~h-S.iJ li!-6U (78-J51 (ab-5.7) (546/) NO. FREIXIENOT SAMPLE (7?~i7) EX ANA~SIS TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS I J (p L ) (bC6g1 (EY-l0) I SAMPLE is r: l,. /z, '. :.:./:?. z;::e .. ~ .. // 1 ~) MEASUREMENT 1 - . lr tJ 1 L' J PERMIT 0#4#+/:: +u:f04a=>u~ v/ ::;rr: `.5 :;a>,a:;,;: 9.G ' EEKLY RAH L I ~ 1_ I REQUIREMENT s. ~r.I IJ _,, ('l1'I AI. SAMPLE ,: rj z.:f ;L;: :: rj ~:{: {:.f :+(y t: ;;I ;[.;, ( 7~) I.,; r; l11rLD MEASUREMENT r•--.U .7 r n PERMIT QYt {r'./r}Y/ IQ rP90~{I {[ :~:: [: rt t71 Qt4z'F~ e 3J n 7V q NC. 4:/ RAH ~ I REQUIREMENT r. '[~I: :: M ,LIUJ, ~1:TTLiiAFL° SAMPLE ±'z.r+z}C+:I :i:I:S:i:Y/ z;zgi;::rl; ': l:{:.}r;::: ~ 25) MEASUREMENT 1 1115 7 !1 t) PERMIT OG000{+ 000000 p '::}h r,'Y/Or~l r/0 ~4i[OOfi V•5 NCE/ RAB REQUIREMENT JL ANG GREASE SAMPLE A;:t/~l is r'I Y; :j '~I ~: (z .} z;: {I :;: {r;}:;: yT (.:It:};c± i 1(~) .I %l;N F%tR-GAAV MF.TR MEASUREMENT , J Sib 1 O O PERMIT 00400b 411[9004 101 .i4 Ip00040 OOOOOa1l 10 ONT3M de- R ~"=' REQUIREMENT . . ~ r ,IUII, YOTAL SAMPLE 9vg04~ ~: •Y+7ply0 ;i:y {: jr~4 ( ly) (AS FE) MEASUREMENT ~'~ 111115 1 0 Q PERMIT 000400 000004 4 Lt{T K*04400 3.5 7GU NC~i '/~t ~1#rB~ r REQUIREMENT // I;1 zY , ry r ..' o i.Jll', Ih CONDUIT OR SAMPLE ( Gj) (I LI Sz4+k ai #4#rjl:jp 144Ya#04 I II (l ll T6EATRFNT PLANT MEASUREMENT ~ "~ 1050 1 0 n 0P1'IONAL AEPORT 000440 400040 0#001010 {100 EEKLY ~tlSA ':Y REQUIREMENT n •~0LiD5, TOT'.L SAMPLE :}Y,i4+}{z{: i/jlytf/iF{z Mrf##z}C: :}li"J:'IAJ{z ( 19) ISSOLVF.D MEASUREMENT - i J 2'~ i 1 G O PERMIT 40007tr 1Yr/0000 0 /firs #YY01?00 0[}R400 REPORT TR1,T RAB REQUIREMENT F C r f ~ NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY oc LAw THAT I HnvE PERSONALLY Ea AMINED TELEPHONE D A T E AMJ AM FPMILIAR WItH THE INFORMATION SUBMITTED HEREIN: AND BASED ATKINSON R:G ON MV INQUIRY OF TFQSE INDIVIDUALS IMMEDIATELY RESPJN9BLE FOR OBTPINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATrON IS ' 303.8244451 9~ ~ ~ . TRUE 4000RATE AND COMPLETE I 4M AWARE THAT THERE ARE F C G _ VP LAND/ENVIRONMENTALAFFAIRc SIGNIFICANT PENALTIES FOR SUBMITTING FALSE IN ORMATION IN LUDIN THE POSSIBILItV OF FINE PNO IMPpr50NMENT SEE IB USC f I(bl AND 1 P ni J h d J I ' SIGNATURE OF PRINCIPAL E%ECUTIVE » uSC rn:r rz un Or r aar ar wrrz mul n u a rma uP m 119 I ' AREA TYPED OR PRINTED f IOpY! un/ nr muinrum urrpriaunmem o! hnx'rrn D mnnnu •nJ f 1'nn.1 OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY COMMENT AND EXPLANATION OF ANY VIOLATIONS (Re@rcntt all a(laehmenls here/ . ~l'7LCAbLE 501.715 I,T"I7 AY['LTFS r11;LY II <= 1('i-Yrt, G11-iih Fh":i.:;E' F:YF.N'T 75 CLAIII~U. TF CL?T11 AI'F'$OVED BY , ~•:L, T55 E IRC1N L1`IITS rILI, hl1T bii ;,1'HLIEL il.l RF.t' •~hTh.ll MFA';111:~: 012`:2S--5F.L I.H.iA, PG ll AYII 7.H.1D, PG 6. EPA FOrm 3320.1 (RSV. 9•BB) PYBVIO(IS adl7l0/IS Tay DQ usBd. (REPLACES EPA FORM T-AO WHICH MAY NOT BE USED.) PAGE OF 1:.I' /')~'i 1. `1-1 Tll