1992-02-05_REPORT - C1981008 ‎(3)‎

• Permit No: C1981008
• IBM Index Class Name: Report
• Doc Date: 2/5/1992
• Doc Name: 1991 Annual Hydrology Report Appendix B ‎(Part 3 of 6)‎
• Annual Report Year: 1991
• Permit Index Doc Type: HYDROLOGY REPORT
• Media Type: D
• Archive: No

PEAMITTEE NAME/ SS(Include NATIONAL POLLUTA HARGE ELIMINATION SYSTEM(NPDES)
' ".a';; N„. , DISCHAI NITORING REPORT(DMR)
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ADDRESS 13.U_50jb_j&JE_ -- �: 1, ;:_.._ + ACUTE HET TESTING FOR OU_TFA_LL
PERMIT NUMBER - �r DISCHARGE NUMBER
FACILITY .� MONITORING PERIOD
J YEAR MO DAY YEAR MO DAY
LOCATION FROM t i J MINOR (5UHR ''4G)y MOTHS
— ..._
A T T h • DENNIS--STEVENSON* P R E S1 D E N-T (20-21) (22-23) (24-25) (26-27) (28-29) 130-31) NOTE:Read Instructions before completing this form.
(3 Card Only) QUANTITY OR LOADING (4CardOnly) QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE
PARAMETER r46.53) (54-61) (38-45)- (46-53) (54-61) i EX OF
TYPE
(32-37) r AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS
(62-63) (64-68) (69-70)
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NAME(TITLEPRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED -,� TELEPHONE DATE
AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN,AND BASED
-Br t w„ T v� Qe ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
LJ OBTAINING THE INFORMATION. I BEUEVE THE SUBMITTED INFORMATION
IS TRUE, ACCURATE-AND COMPLETE, I AM AWARE THAT THERE-ARE SIG, 1
Mqf.� NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING ���� )
J es WSTHE POSSIBILITY OF FINE AND IMPRISONMENT.SEE 18 U.S C. ; 1001 AND SIGNATURE OF PRINCIPAL EX UTIVE
33 U.S.C. } 1319.(Pena/Iles under these statutes may Include finer up to $10,000
TYPEDORPRINTED and or maximum hnp'bonmtntofbetween6months and Jyears.) ~OFFICEROR AUTHORIZED AGENT EA NUMBER - YEAR MO DAY
COMMENT AND EXPLANATION OF ANY VIOLATIONS(Referenaeallattachmemshere)
i
Str£ PART I.3: GF PERMIT FOR. DE?AILS OF TEST PROCEDURE, REPORT RESULTS OF IWC TEST —AS "CINIMUi" AND 50',;
IMORTALITY TEST AS "f AXIMUM" AND-"ATTACH ACUTE TOXICITY TEST REPORT ' FORC TO DNR.', COPIES OF ALL INFORrIATItit•
y tR P/@Y OUr�edll/0nS maybe t18Br/ (REPLACES EPA FORM T•40 WHICH MAY NOT BE USED.)
PAGE 0F
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