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I'ERMITTEE NkMf/ADDRE^o517ne?rfr FaedtgNa.YLeruraw r/D(?wiwi) NATIONAL POLLUTANT OISCHAROE FLININATION SYSTEM /INPDFSJ <br />NAME (_1sY l l-L- DISCHARGE MONITORING REPORT IDMR/ <br />ADORESSSANDORN _; _Il <br />0. BOX 535 PERMIT NUMBER GE NUMBER <br />SOMERSET r_< T _ <br />FACILITY :APdbI±R IV CRt,. L.LK Cr;r, :11 ILA MONITORING PERIOD <br />VAT"f--OMERSET CO 814 ; i YEAR 0 DA YE R Pd0 D Y <br />FROM TO <br />JAMES T. '-:OOF'ER, EXEC t,'. P. <br />Form Approved I <br />MINOR `0,10-0004 <br />(SU13R ! <br />F - FIf • <br />SURFAC a r;t_?• _ , . <br />NOTE: Read Irmtru tione before completing We form. <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br /> <br />EX <br />FREQUENCY <br />OF <br />SAMPLE <br /> <br />TYP <br /> ANALfSIS E <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />-7 L _ SAMPLE <br />I ' MEASUREMENT <br /> <br /> <br />:40t 0 O <br />PERMIT 'Al It- It W 7r -r if <br />FFLk-!;-r•'.. ;ROSS T <br />- REQUIREMENT INST NAX J MrJiVTN <br />, SAMPLE <br />I MEASOREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLF- <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElT1TtE PRINCIPAL EXECUTIVE OFFICER 1 fet11lf ° Iaw that thh document and all altechr <br />prepared under my dlre•rtlon or supereyon In acrorttanre with ne nts we" <br />a system designed TELEPHONE DATE <br /> <br />- '- - 1 to aneurt lh.l qualllled perwnnel property 9.1h., the lofnrmallon <br />mbmllled 6aacd on m• Inquiry of the person or perwww who manage the f <br />flem <br /> , <br />] <br />V7 <br />- <br />i <br /> <br />r <br />- or those perenrv dlrxlle rr,pomlbk for ralhMng the Info-don, the Information ` i <br />1 - r 1 <br />?_ i,F'! <br />' I-•; - ?; l /n <br />' submitted h, to the best of ,ny knowledge and belle(. true, accvnir. and compkte. <br />e are st <br />nflleant <br />I <br />m <br />n that (he <br />en <br />lties for mbmlltin <br />false Inf <br />rmHl <br />• IONATURE OF MIINCt?AL EXECUTWE <br /> g <br />p <br />a <br />r <br />t <br />o <br />on• <br />.w. <br />a - AREA <br />TYPED OR PRINTED lnrw,mn= the peradblIlty of fine and Imprlson"m for knowing .lolsuons OFFICER OR AUTHORIZED AGENT CODE NV M6ER YEAR MO DAY <br />COMMENTS AND EXPL.ANA I Wfv yr AMT vlvLA I IUN5 f/foference an •rracnmenra neref <br />I t1? I_1 La! FASLE SOL.2DS I_MT APP! IFD FOR - =10; 24HP PREC IP E!'rNT: <br />L- : I ? MA), L-3!-- i ? =NT-SEE 1. A. 1 c <br />EPA Form 3320-1 (Rev. 3/99) Prt aous editions may be used This is a 4-Dan, E@RTI. PAGE OF