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PERMITTEE NAM S (include NATIONAL POLLUTANT DI RGE ELIMINATION SYSTEM (NPDES) f0 roved <br /> Fanlily Name/Lacco rent) DISCHARGE M BRING REPORT (D)WR) Ot 2040-"4 <br /> NAME--PEAV �Y UL� CD—ACN"-AI [�NE1 --- (1-16) 17-19) Expires2-29-84 <br /> ADDRESS—IDdZ5 E dA .p-V-AU--AYE 4 <br /> L Q0--- <br /> �. ------- PERMIT NUMBER DISCHARGE NUMBER <br /> ----��� 1------- ------- MONITORING PERIOD <br /> FACILITY ———————————————————— YEAR MO DAY YEAR MO DAY <br /> LOCATION --------------- _ FROM 8 01 O1 TO S•Y Q 1 <br /> (20-21) (22-13) (24-23) ( 6 / ) (28-29) (30-31) NOTE:Read Instructions before completing this torn. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (54-61) (38-45) (46-53) (54.61) NO. FREOOUtENCY SAMPLE <br /> (32-37) ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62.63) (64.68) (69-70) <br /> r� cc SAMPLE <br /> tLO�I CE FLJEI,,T� MEASUREMENT No Dtscharge �r� * t + •t t t * k elr <br /> - �•}' • ,..5• - 7' _!� • ���'�.' r 1.5•�Y�S�'�a�Y� z:��, ���'.,•Ni7v e!.ew•iL'' 1'W D:• .. �.»WOK�,•�}ii Ni�. T,'�= T'A.'�',•��...'1 k (I , <br /> tin A REQCfIRE1�ENF . 4 y n £ h.t+ Aleed#�wry�Y' :i•,�e �'"'.waT .fr?;`s. i <br /> SAMPLE <br /> j'G• T,j TA L ,!IUQO MEASUREMENT <br /> 4 * i <br /> t;FFLIJE"Ti PER#4IT LB/DA �G/L <br /> REQUIREMENT <br /> '1 .CZ: * w 4 * * I& * 711 <br /> e� T SAMPLE <br /> I ZL! Tn i I MEASUREMENT * { <br /> PERMIT LS/DA G/L <br /> /\a REQUIREMENT * T rZ # <br /> SAMPLE N <br /> T MEASUREMENT I <br /> 5..5 <br /> PERMIT S U <br /> 00400 v. _ _ RBQtIEREMENT .* - <br /> ... . .... _., 1 ' - • ,ji •• .r•V.'..- -ti. �r r:', - ��r_:`' �V.ram'Y'!w���'.•T .. :- :�y jT. -A.�;J�M ♦VT'^v`}yy.'f•r <br /> SAMPLE - <br /> IL p GREAS 6E <br /> MEASUREMENT * t * * t <br /> VI9L,4L PERMIT MG/L <br /> :.•' tl•t REQUIREMENT ,y -M •Y *• Tr '�" • 11' 1M '.k !1< 4 W 'Y w'Z <br /> SAMPLE <br /> r IJJ-Tjy;ITY e, MEASUREMENT <br /> f E F ! .T) PERMIT <br /> REQIREM7 ' 9 t V; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED i TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> James S. Lunan ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION <br /> Manager Permits IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG <br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE 18 USC T tool And SIGNATURE OF PRINCIPAL EXECUTIVE 602 774-5253 87 04 24 <br /> 33 USC it1319 !Penalties under them ■tatutes may include fin- up to Elul <br /> TYPED OR PRINTED and or maximum Impnsnnmento/hetuwn 6 months and.5 vear%t / OFFICER OR AUTHORIZED AGENT AREAJ NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> 1F I�i.' - =� _�C' ,. _ F I . c T. G i=r" T_ ZE UT u - /?$y1�n�te GE It <br /> I � <br /> EPA Form 3320-1 (RSV. 10-79)PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 1 PAGE OF <br /> UNTIL SUPPLY 19 EXHAUSTED <br />