ML20134E265
| ML20134E265 | |
| Person / Time | |
|---|---|
| Site: | Beaver Valley |
| Issue date: | 09/30/1996 |
| From: | Noonan T, Orndorf D DUQUESNE LIGHT CO. |
| To: | NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM) |
| References | |
| NPD3VPO:0535, NPD3VPO:535, NUDOCS 9611010087 | |
| Download: ML20134E265 (63) | |
Text
{{#Wiki_filter:. . . . . . . . - - - _ . . . . -__ ~ =, -. - . s O a i* y Valley Power Station Shippingport, PA 15077 0004 THOMAS P. NOONAN (412) 393-7622 DMalon Vice President Fax (412) 393-4905 Nuclear Operations October 25, 1996 NPD3VPO: 0535
- Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555 NPDES Monthly Report. EPA Permit No. PA0025615
SUBJECT:
Beaver Valley Power Station, Unit No. 1 and No. 2
- BV-1 Docket No. 50-334, License No. DPR-66 BV-2 Docket No. 50-412, License No. NPF-73 4
Dear Sir:
i Enclosed is a copy of the NPDES Monthly Report as submitted to the Pennsylvania Department of Environmental Protection. 4
- Sincerely, ff T. P.
pp,= = J oonan , Division Vice President Nuclear Operations DNH/trs cc: D. A. Orndorf J. A. Cool i R. K. Brosi Central File - [* g~ ' f
! 9611010087 960930 j PDR ADOCK 05000334 DELWERING R PDR QUAlliV ENERGV i
i
. . _ . ~-- - . - _ _ . ~ . . . .. - - - - _ ..
- s. k aver Valley Power Station SNppinport, PA 15077-0004 i
s THOMAS P. NOONAN (412) 393 7622 DMalon Vice President Fax (412) 393-4905 Nuclear Operations i October 25, 1996 . j NPD3VPO: 0536 i S United States Environmental Protection Agency Region III, Pennsylvania (3WM53) ,
- Water Permits Branch Water Management Division 841 Chestnut Street
, Philadelphia, PA 19107 NPDES Monthly Report. EPA Permit No. PA0025615
Dear Sir:
This letter forwards a copy of our NPDES Monthly Report as submitted to the Pennsylvania Department of Environmental Resources, Bureau of Water Quality Management Sincerely, I T. P. Noonan Division Vice President Nuclear Operations DNH/trs Attachment
- cc
- D. A. Orndorf J. A. Cool DEbVERING R. K. Brosi Central File Q1 A LW E'N E R G V 1
t **
- aver Valley Power Station g' Shippingport, PA 15077-0004 l THOMAS P. NOONAN (412) 393 7622 DMalon Vice President Fax (412) 393 4905 Nuclear Operations October 25, 1996 NPD3VPO
- 0534 Attention: "DMR Clerk" l Department of Environmental Protection
. Bureau of Water Quality Management lJ 400 Waterfront Drive l Pittsburgh, PA 15222 FPDES Monthly Reoort, EPA Permit Number PA0025615 Gentlemen:
NPDES Monthly Report for Duquesne Light Company, Beaver Valley Power Station for September 1996 is submitted for your consideration. Sincerely, f T. P. Noonan
.;;u= J Division Vice President Nuclear Operations DNH/tra Enclosure cc: D. A. Orndorf J. A. Cool R. K. Brosi Central File QU Alli?
ENEIGY
_ . _ _ _ .______..______..___..._..__..._____._______.m___._ _ _ _ _ _ _ . . _ . _ _ _ . _ _ DISCHARGE MONITORING REPORT SUPPLEMENTAL SEWAGE SLUDGE REPORT Nonth: $m772,./
'Instructicns: Year: jyg
- 1. Complete monthly and submit with c2ch Opst. Attach addittenal l sh:sts and comments as nuded fcr completeness and clarity.
- 2. Sludge production infonnation will be used to evaluate plant Permittee: M/QUESN6 L/dW7To*N/ )' / r perfonnance. Report only sludge which has been removed from Plant: 66WEX V4ue r' th/t:st safat w E !
digesters and other solids which have been permanently removed NPDES: M4 oozSe:S Municipality: sen m n e ca r m .4 c u c ir ! from the treatment process. Do not include sludge from other County: f,5AvJg plants which is processed at your fac111ty. ' i
- 3. In the disposal site section, report all sludge leaving your For sludge that is incinerated:
fact 11ty for disposal. If another plant processes and disposes Pre-incineration weight = dry tons ! of your sludge, just provide the name of that plant. If you Post-incineration weight = ~ ~~~ dry tons dispose of sludge from other plants, include their tonnage in the l disposal site section and provioe Oeir names and individual dry ! tonnage on the back of this fenn.
- 4. If no sludge was removed, note un fone.
SLUDGE PRODUCTION INFORMATION forlor to incineration) l HAULED A5 LIQUID 5LLM 5 HAULED A5 DEMArtRED SLLN-E i (Conversion (Tons of , (Ga11ons) X (1 Solids) X Factor) = Dry Tons Dewatered SI=$!s) X (1 Solids) X (.01) = Dry Tons
/r.,cov a M. . "" 17 /,5 3
.01 j i
i i TOTAL = TOTAL e i DISPOSAL SITE INFORMATION: List all sites, even if not used this month Stie 1 Site 2 Site 3 Site 4 ; softo n 99 W ist o k 4c A Name: SE.*%G reEArMertw1 i Permit No.: /M vo 2of:t 5 Dry Tons Disposed: /,3 3 f Type: (check one) Landfill Agr. Utilization . Other (specify) , County: aE4/a. / _ _ 1 l CHGfnlSTRY htenRGER j 35W Ql),-313-$ll3 (SSR-1 3/21/91) 'STgn&fure l Title DaMr / Telephone
DISCHARGE MONITORING REPORT SUPPLENENTAL SEWAGE SLUDGE REPORT Month: SephJe #
~1nstructicns: Year: /992,
- 1. Complete monthly and sutait with cach DD5t.- Attach additicnal sheets and comments as needed for completeness and clarity. Permittee: R/QUESN6 L/G/7Te6// / r '
- 2. Sludge production information will be used to evaluate plant Plant: @wgx v4my' f bfgx m7,ut r I j perfonnance. Report only sludge which has been removed from NPDES: fA coz5eis digesters and other solids which have been pennanently removed Municipality: sevnar,/aca r f$cx- ve r/ -
from the treatment process. Do not include sludge from other County: n gAi/Jg. . plants which is processed at your factitty. '
- 3. In the disposal site section, report all sludge leaving your For sludge that is incinerated:
facility for disposal. If another plant processes and disposes Pre-incineration weight = dry tons of your sludge, just provide the name of that plant. If you Post-incineration weight = ~ ~ dry tons dispose of sludge from other plants, include their tonnage in the disposal site section and provide their names and individual dry tonnage on the back of this form.
- 4. If no sludge was removed, note on form.
SLUDGE PRODUCTION INFORMATION (prior to incineration)
!"2ED A5 LIQUID SLL"E HAULED A5 DEWAltRED SLLWiE (Conversion (Tons of (Gallons) X (1 Solids) X Factor) = Dry Tons Dewetered Sit e ) X (5 Solids) X (.01) = Dry Tons soco az "/, .GGGG417 o,.2 fa
.01 i i
i i t
- TOTAL =
TOTAL = DISPOSAL SITE INFORMATION: List all sites, even if not used this month 4 Site 1 Site 2 Site 3 Site 4
- eattomeeor w w4cA Name
- sG.*%G regarno'rtw1 Permit No.: M4 oo 2 0/2*5 Dry Tons Disposed: 0,/ ro M: (check one) -
Landfill l agr. Utilization Other (specify) County: BF4mA / 1 l m CAGfniSTRY ht4WKER lebth 'li2-313-5~ll3 (SSR-1 3/21/91) '3fgna ture
-{ _ --
Title Dafe // Telephone
t' PERMITTEE NAME/ ADDRESS duMar%No e Larna tfth.Lerpow! aW.TIONAL POLLUTANT DSCHARGE EUMmATION SYSTEM (MPDES! Form Approved. = N y NN MT fD 1 NME 3g3ygp yg(ggy ppggp g7g7;3y t7 33y7 7 gggg7 y No.2O N 4 ApoREss P. 3. rn y is -o a ' 4 e c. t c 3** = (3g3p y,) MT*8),'7s os-31-c3 ; ETTV; 9A710 D h k S O '? r PERMIT NUMBER DSCHARGE NUMSE3 y . p{gg{ , SHIPP!dG D 3T FA 15977 MTN PEN 0dO2 FACtLITY n,g ; y g g 7;g-jy pgggg q 7 ; 7 y 3,g LOCA N FROM eo (14 ,1 TO 46 Ju j; ?CC '90 UT p Ap ;g g g cco
*TTN: DA413 3P4D3Mi (20'211 122-23) 124-25) 126-271 128-29) 130u31; NOM Reed M W Y [ ting 1No form.
13 Cerd onyl QUANTITY OR LOADING (4 Cent on&7 QUANTITY OR CONCENTRATION NO. FREouENcv SAMPLE
- PARAMETER 146-531 (54-619 130-451 146-539 (54-619 OF (32-37; EX ANuyss TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS , sus, gg,_687 16 2 ou SAMPLE cs c h e n t e M e c c: coccce MEASUREMENT 7g/ 7_c 7
( 12) C /!/ 6,4
;)'a ? C 1 ) O PERMIT cceete o ceWee ' t. 30e 3,q ccoceg g3 y Ly ;gg.
??vt,UrMr j47r ' Vilg; REQUIREMENT gg ,gpyygg - g g p g ., - ey
'Li*TeGL ~f-1, TOTAL SAMPLE ocet^+ hececs eseco$ A
( 19) gg7gg MEASUREMENT A - T1251 1 ) O PERMIT C O 3 *r 3 0 6e p c'1 e hvc ccc00$ 3 3. , ig y g - . OMP U 1rrLD'N' d ' 4 !. V A T.0 s REQUIREMENT 3 c 3.., g1 gy; :p3gy ggy ,, g j ( gg
'L16, i ts C -) *i D U I I' 04 SAMPLE
( n 3) $ ? o,0 c m cocc00 cccone / e T440 I t ? !. T r, N T P L t P ': MEASUREMENT O,(CR ,7, g f . ; O- / phg i O % r) 1 ? g PERMIT gypprv Ptene. . ecoce
, c Nc M cr 4c$0c4 goc ggg;y g43gt ;
REQUIREMENT q gn; yg goeg SPFLO'$? 7d751 V n L u i- p g y 7,7 ,qp
? H L D E T N 2'. , I J T *. L SAMPLE eccie ca^dOO r cecoct O, O C, ()
( 1 43 ) O /4 , ( r y (, gq7pg4g MEASUREMENT //
- ' ; Q '); q 1 o q PERMIT C00000 enecee ? ito o c c c o .
- : 7, 5 1,25, g g(Y . un
' r e t't r .e * , p a s s y a Lf; REQUIREMENT yerm M9 A PO TNM'NEX NG/t cecco; T ii t 7 it [ F F , F 4 C. SAMPLE MCSM n e i ^ S ^. ( 19) O 3 y 3 7 g g g ,. MEASUREMENT O.O' fU f[e[ 6 p [,
30064 1
^ y PERMIT 9606?& seceSo e Mc ?r e
- M o ') .1 J.5 s EEKLt '
. ri~A9;
~ "' t' L !' i M T 3 .' J.h Y A L 1 i. REQUIREMENT w e .y gypqgp yyyg wg/g SAMPLE MEASUREMENT i
, PERMIT i REQUIREMENT i SAMPLE MEASUREMENT ! I PERMIT 1 REQUIREMENT , NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER e CtRTiFv tuotR PENALTY OF LAW THAT 1 MAVE PERSON ALLv EKAMINED AND TELEPHONE DATE AM FAMtuAR WITH THE INFORMATIOne SUOMITTED HEREm: AND SASED ON MY INOUmV OF THOSE 8NDIVIDUALS IMMEDIATELY RESPON98LE FOR d.ey e f David Orndorf OSMNmG WE WFORMAN t SELIEVE WE SUBMtTTED INFORMATION IS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE j , t'; . f , j y
's%{' t Chemistr7 Manager SWMCANT PENALTIES FOR SUBMITTWG FALSE WFORMAN. WCtVDmG THE POS994.ITY OF FmE AND tMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 se0 NATURE OF PRNGCIPAL EXECUTIVE
* ,i" 10 M 113
' - - 46
- IO ~ l8ve ,
TYPED OR PRINTED .u.S.c. i tSte.== w .r man reassnes
- . e uMrerstese.s.eems e.ew. a .mns.wmay beause s , snes ras se ne s to. coo OFFICER OR AUTHORIZED AGE 9ET 4 NUMBER YEAR MO DAY CODE ,
COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# ettschments herel , F N F r t 'i " 3AILY M A X I m' M F D I- DET* 0"-? 2Nr" N i C C i! A R G l *M (24 M $' . C3"?.) : MC/L. (TMF L Di!T IS MN i
~/L % :~ A PIILi 54%.) ,
EPA Form 3320-1 106-95) Previous editions may be uSed. (REPLACES EPA FORM T 40 WHICH MAY NOT BE USED.) PAGE OF
, M 0 5 u / 4 6 0 6 1 e. 'M 0 3 1 ;
Paperwork Reduction Act Notice Public reporting burden for thir, collection of information is estirmteJ to vary from a range of 10 hours as an
, average per responw for some minor facilities, to 110 hours as an averup per response fur some major facilities, l with a weighted average for rnajor and minor facdities of 18 hours per imponu, including time for reviewing ,
f .instructiorn, seuddng existing data source, pthcong and rainbining N data nuded, and completing and {
; reviewing the co!!ection c,f informmion. Send comments regarding the h den eatimate or any other aspect of }
l this to!!cction of infonration, including luggestions fi reducing this be.!cn, to Chief, Information Policy l i Bran,.h, PM-223, U.S. Envirorurental Protation Agency, 401 M Street, SW hhington, DC 2tWO; and to the ! l Office of information and Regulatory Af fairs, Of fice of Management and Hudget, Washington. DC 20503. l i I General Instructions L If form has been partially completed by preprinting, disreprd instructions directed at entry of that information aheady preprinted.
- 2. Enter "Permutec Name A/ading Addren (and facihty .name/localmn, if ddTerem)," Termit Number," and "Docharge Number" w here indicated ( A separate fann Is required for each dischargc.)
- 3. Enter dates beginning and endmp "Alonitoring Permd" cc2 ered by form w here ind:cated.
- 4. Emer em:h " Parameter" as r.peuf:cd in n cmtering requiremems of permit. ,
i Untr "&vnp/c Ucc ,uremer <" dm fu ca;h pmamcter under "Ourmnte" and "t hudar" in units specified in permit.
"Averg" is amma!!) anthmetic average tgcometric average fof bacterial parameters) of all sample measurements fa each pammete: obtained dunng "?lanaurmg PermI, "3 /camud ,md "Almi en,m" are normally enreme high and low meatmen nts obtained during "3/mimring Persd." (Note ta municipal ( mth secondary ucatment l FC'jukrLH10m. EnlOr D"d3) MCrR Of ' Lup!C rNa5HreW.Cmd lm.}Cr "li c/Wff," and eme' thailmum 7-dirt aVCragC of Lunple meamremenu obtained during monitarmg pctn! under "3/aumum *) ,
I ti. Enter "!'erma !?op.ucm:nt" for cach parameter under "puantm' and "Gaalay" aa specified m pctmit l 1
- 7. ( ?nder NO /'[X" cMer number Of '.alupl0 WC "ivrnh/nl5 dMring thonitoring period that execcd maximum (anJ/or I minimum er 7 d4 average as apprepnnic) penmt regaian. cat for each paramet;r. If ncne, enter "0"
- 8. Emer "Ibjueny of Aalym both as " b np! Alcawrv.ent" (auual frequency of sampling and analpis used i during mcmtoring penod) and as "itrum Rguircincm* npecified in permit. (c g., Erder " Cent " for contmuous monitoring. "/J"im one in per wed. "1 m" fer one day per manth. "le" for one day per gaaner, etcJ
- 9. Ente: "&mple '!)pe" both : '
misc Akesuremm!" (acm.d s.uople type used during monimrmg periad) and as Termir Repirementf (eg. !!. met "Grob" for indwidxd s:unplc, ".N/IC" for 21-hour composde W.:" far cantmuoas momtoring, etc.) 10 Where Viobilgns OI }Xrnut rCfnKmChis are r0p0&d. di Ch a bnCI 5p!:Waudh to 25chhe c30 sC 3ud cOfrCCliic EliOns Liken, md rCfehdCC CdCh ',iUIahun h) dalC
- 11. If "no dis harge" occun during ma dormg paiad, ent r "Xo Dxhg , " , non foun a pbre of data cuty U Enl r " Yaw. Tide' of } W Gj;;d UCG!we Olt:NT " U tih W.UUrr vl ?rmrf a! l$ :MnT ($h !
G d tHhCr V:$
' gent * 'icicphme Numhcr." ar.d "Dat? nt bottun of form
- 13. M.JI sq.".ed liepwt to Chfire(s; b) dr.:ts) spe.:ifitd in pa m;t. P.ttnn copy for yous records
- 14. Mm c detukd t* Imcaens for use of tbs !A ;iaj:c 3! e e la;mrt r!E/10 fcim m i be d tdmd ham Odicds)
-pxilied in permd Legal Notice n-n & s , n, w m m e eu m m eme mo-u %mo re mn ro uit in Gd pN @ , n A la t fro ;
'.'U. N O p r b y 0!- , h. m m C, t ,
< rn h en J DlO'M pa d.o
. Of YN !bth' , C f b f %1i i ? JIit k! '
C IHUrt i' d i J ) x 9 T, ! W biY j (N n *
. \e . . ' "
. . . _ -~ . . . . + ~ . . - ~- . . - . ~ ,- - - ~~uu ~ e .- ~ < n-r s . ... -~ . e - . - - - - - - -,-
PERMITTEE NAME//LOORESS(7 rweFaceerName.Leestaan(fDefnnff M*.TTONAL POLLUTANT OfSCHARGE ElfMMATION SYSTEM (NPDES 1 Form Approved. f
. DISCHARGE MONITORING REPORT (DMR1 "A" 9P&VTP J A L L F. Y POk30 iTETIl- (?-t si tr 7-rs! jNT"3 l t, 2 C O O LG . M% 2M
~
9'073"A1- FO' APP" N'", ADORESS P. 3. 3 ") 1 4 ' (SUBR SS) - ATTN; D1VID D 2 N D 3 'q y . PERMIT NUMBER DISCHARGE NUMSER y ,, y gg e aege +. pt r. i4 oyn.
-1 -.
r^ 2
' g' '* v MONITORING PERIOD
.. ^ Jy^'
'e
+
FACILITY ;p4yg3 yg(;gy p3geg 3y7y{g3 LOCATION FROM 9 t. +
!1 TO f5 '+ 3! CCC vG b1SCHAFGE { l uCC
& " P! 1 T' A T I 9 T' 7 D M P (20271 (22-23/ (2+251 i 126-27/ (28-2s/ (30'371 NOTE: Reed instructions before ~c&npleting this form.
PARAMETER f3 cerd On&s CUANTITY OR LOADING I4 cent on&s QUANTITY OR CONCENTRATION NO. FREoUENCY SAMPLE 146-531 (5+61I (30-459 (46-531 (54-619 oF (J2-371 EX ANALYSIS TYPE AVERAGE MA XtMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 18N t6&681 In72 3 SAMPLE c o n :r n e cent 00 e300); *7 k~ MEASUREMENT
- .s
/ , ,/ [, , . .
gny C ff
-r p(
i')!t a l ; 7 n PERMIT coca$c h e-> c e c + toe 1 , 0 eco no. g.p gqty pp
/rL1 qr -atn V A L ;t REQUIREMENT mes ,,; 7 y T ;) .3 rgy;,g, ;g SAMPLE c o e $ e: S ne^ts ce36A'
?ITPO3r* , i",93NI4 t ( i r} } //
<f T
qTAL ( t '; N) MEASUREMENT (f C) // 4g l 19 <,10 }, :) D PERMIT e00een Oce%e o ice 000000 rpm jgpggy EggLy yp , cryLgt 97 ;37;+ vgtg, REQUIREMENT yeo9 e g73 7, p p g y ' g y ynfg ;
; L A M T !! O L !!-1, I O ! '! f SAMPLE cee$eo encen^ $?cota ( 19}
9g ey MEASUREMENT g[M ,_
?
'1251 1 ] p PERMIT nearnes 016934 ( 103 ce23c0 ) 'y gfn. Mp24 rrL3ru- aatn /;Ly. REQUIREMENT ucy g gyg g 7gy f ygf7 gy gg
'LN, IG C 3 . ) U I -- 93 SAMPLE ( C J) 993900 eC00cc $ 3 c 0 W e,
*R61 ?9EK"N r ? L A ?.1 MEASUREMENT p7/ 77 m/ M h,h (g 1 3061 1 3 O PERMIT 3rpw" F D') rs 7 occcc$ cecScy ecoon - oen g;;y~ .3g7{g pety: : p qqa3, y3; y: REQUIREMENT 99 g- ngrTy.wy .n 90en t qLqn;%", pi?gL SAMPLE u fr W 60ec0c c o c er c.o ( J 9) f iy;Tgy;L MEASUREMENT () , (1 ( ; (.1 [) / g y,
, m p; G 1 ') :) PERMIT ccaneo e e"h o '
)^$ 0%$00 7.5 1. 3 ggLy' Ji n
' e r t t! ' u ! Sous~ v i t.y ;. REQUIREMENT m a .., %n- 4yg g37 33 y ggf,
?if LO M N C, # r L SAMPLE ecetet S e e: $ 3 ) 00000S ( l '))
gg.7gL7 MEASUREMENT gau ()./ O (r Q,.gg,
; 0 0 6 t, i n r; PERMIT cocebc S Me^ c o rW1 erc?"O* ;.? 3. 5 . 4 ?!!II N CORDE , ' r f L 1 d e, T ,>355 V .*( L U: REQUIREMENT y e. c g g :p g g g g r 347[gg=: s e; / I, ggg3s
( TD O A 2 [9] SAMPLE O c e+ t " A f- #- 0 0 ) 40007 ( 19) l MEASUREMENT C C d I[ [g(
}} 31 3 1 0 C PERMIT c%C06 ***NG ^ N OSOCOP } } i EfM L y 93 'F ? LU1 N T '3];S VALdr REQUIREMENT wr oc seg Ayg 9g11y pr 9 :;/ L NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER 1 CERTWY UNDER PEN ALTY OF LAW THAT t HAVE PERSONARY EXAMINED AND ^ TELEPHONE DATE AM FAMluAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY INQUIRY OF THOSE INDIVIDUALS tMMEDIATELY RESPON98LE FOR I' /
DUid blgU OSTAINING THE INFORMATION. I SELIEVE THE SUButTTED INFORMATION t$ TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE '/ (((F g Ef ~1 t
/J aY -
PENALTIES FOR SUSMITTING FALSE INFORMATION. INCLUDtNG C mnistiy Mamagt;r SIG,NIFICA,N,T,UTY ry pos OF FINE AND IMPRISOMMENT. SEE is U.S.C. 91001 AND 33 12 ,l 9 3- 5113 96 10 14. u.s.C. s tais. # Pease e samw mese aman.e mey sieAm aw, w so sto. coo SiONATURE OF MtINCIPAL EXECUTIVE AREA TYPED OR PRINTED sad or man
- men : - .: or aerween 8 awmms sad 5 rearaJ OFFICER OR AUTHORIZED AOtNT CODE NUMBER YEAR MO DAY t COMMENTS ANO EXPLANATION OF ANY VIOLATIONS (Reference s# ettechments heref
'- ? ? 9 % ". I N E t. 4 0 AN4011? lt M I ? 3 E I N G M e M1 ? "" TN; i: E 910 0 f 0 F WET L) YUP.4EPDET THE Ut iLY MAlin95 F01 D E T ". D I-1 wnFN n ! 3 Cli f. h ; I s ' (h i t. C P. P . ) : M ;/ L. (!HE LT*IT IS 35 9 ; / f. e. 3 A DAILY FAY.)
EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
)
Papenvork Reduction Act Notice Pob' lic reporting burden for this collection of information is estimated to vary from a range of 10 hours as an aveinge per response for some minor facilities, to 110 hours as an average per response for some major facilities, with a weighted average for nuijor and minor facilities of 18 hours per response, including time for reviewing , instructions, searching existing data snarec<, gathenng and naintaining the data needed, and completing and j reviewing the co!!ection of information. Send comments regarding the burden estimate or any other aspect of j this ce!!ection of infonrationi including suggestions for reducing this burden, to Chief, Information Policy { 4 Branch, PM-223, U.S. Emironmental Protection Agency,401 M Street, SW Washington, DC 20460, and to the - Office ofInformation and Regulatory Aff' airs. Office of Management and Budget, Washington, DC 20503.
-.._..-..-....=.----._-.-..-.._-.--_-----.._.-.a . General Instructions j 1 If form has been partially completed by preprinting, disregard instructions directed at entry of that infonnation
, already preprinted.
- 2. Enter "Permitive Name' Mailing Address (and facility name/ location, if different)," " Permit Number " and "Dbcharge Number" where indicated ( A separate form is required for cach discharge.)
i 3. Enter dates beginning and ending "AfonitoNng Period" covered by form u here indicated. ) 4. Enter cach " Parameter" as specified in momtenng requirements of permit.
- 5. Emer "Samp!< Mewement" data for each parameter under "guanif 0" and "Qualitf in units spxified in permit
" Average" n nonnally anthmetic average (geometnc average for bacterial parameters) of a!! sam;:le measurements 4 for each panuncter dtained danng "Alon:toring Penod"; "Madnn.m" and "Mennmm" are normal!) extreme high l and kw me tsurements obtained during "Mmnormy Permd " (Now to nmnicipals woh secondary treatment >
requirement- Enter 30-day averace of s:unp!c rocasurements ur.dct "Arerage," and enter maximum 7-day average of sample measuremems obtained danng monitoring period under "Maumus ") 6 Enter "Per nil Reymemert" for each parameter una r *Gmmitty" and "Guahn:" as specified in permit.
- 7. Under #No Fr" emer number of sample measurmenu durmg monitoring period that excced maximum (and/or minimum or 7@y aserage as approprote) penuit reqsement for cach parameter, if none, enter "0" t
A. Enter "Frrgmuy q/ Ana/nir" both as "Samr/c Akamrmmt" (acmal frcquency of sampling and analpis used ' daring momtering period) and as " Permit Paparement" specified in pennit le g., Enter "Om/? for continuous l monitoring, "/m for one day per ucck "1<.k ' fer one day per nwnth *1 WP for one day per quarter, etc.)
- 9. Enter "Samp!c ')pe"
/ bsh as " Nam;Je Ucmurement" (actual samp!c type used during monitoring period) and as "firnnr Reg:.irement." (e.g , Enter "Grah" for individnal sample. "24HC" for 24-hour composite, "NT for continuous rnonitoring, etc.)
- 10. Where violations of penmt requiremer.ts rue reponed, attach a brief explanation to dsenbe cause and corrective actios taAcn, and re!crence each violation bs date.
1
- 11. If"no dischayc" ocars during rnenitoong period, enter *No D schn r" ac rnu form m plaec cf data entr3 l l
- 12. Enter %une *Inlc of Pena r;w! Fucant rM, c?" mth "S:gnature of Pr :: pal Exe:wtive @ccr <f tua/ized Agent l "Tciephone Nwnberl and "DaV at bunn of form
- 13. Mail <.igned Report to Omce(O by da:e(s) specified m permit Retam copy for )oor zecords i l
- 14. More detaikd instructio 9 fa me of this !wharge Msnown,e Rc/wt (DM") fenn mae be utndned f:om Omce(s) specified in permit 1
Legal Notice ; This rp.rt is requi red hv 1m (33 U S.C.13 !F . M C f . R.125 2 7 ble la yrt er f alue ta npnt truth!cuy c.a { twdt in dvii pernks rot ta en cd Y iDM ra ev of s i.M m 4.nnunal pMne; n > m me<J 525 000 per da of violeon, or by umpricorumnt for mt m o than er , ym, ca by h,ih. EPA For m 33 20-1 (Rev. CH-M)
PERMITTEE NAME15.DDRESS anewe keer As e Larsman @gmari Form Approved. ! N?.MONAL POLLUTANT CFCHARGE EUMtNATION SYZTEM (NPDES) NAME N MMM NT (D .. g g gQyo,2040-0003
;g4y.g -f3g(gy p 3 ;4 g 3 5 7 g 7 ; -) s .
t? IN? AK5 SCk AooREss P . p . m4 " 7 1 " ". i n 'n' F (SUPR q5) APP' k
- Y **,05 6 AT!M* 9%VIO Ofi*DGEp PERMIT NUMBER - c;SCHARGE NUM8ER p . p{ yg{ y 7 0 ! P P f.4 ; P a k ! PA 15377 *WE MONITORING PERIOD FACIUTY s 7)yr9 yg((g7 pgge p ;77< 73y
~
LocATm FROM f r, .t v >; TO 9 t3 '< 3: 600 ha PIS~gAhGE l (20u21) (22-231 124-251 (26-27) 128-291 (30 311 NOTE: Reed inetructione beforeuT:^;[ coc thie form. x T Y : ntV n 3Y HY7 13 Cerci on&f QUANTITY OR LOADING I4 Card Onlyt QUANTITY OR CONCENTRAN NO. FREQUENCY gg g PARAMETER I46-531 154-61) 138-451 I46-531 154-69) CF (32-371 EX Analysis TYPE AVERAGE MAXIMUM UNITS MINtMUM AVERAGE MAXIMUM UNITS iss.,3, gg4_,,, ,g7g ; 4 04, IN C3NDOIT Ti SAMPLE ( tg conen- ;ccrte occagg / P ti D ?! TRFA!9'N? 1 LAM; 3 A C. COG ACM C -7 4T 53050 l 0 g PERMIT qq qp= p yy y o pgen- ceccce cocpoc cca ggy ;gg i p o r, ti p e - ;: 1i /tL9, REQUIREMENT pg 7 p r. n,77y 37 <n mn SAMPLE MEASUREMENT . I PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT A REQUIR5 MENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE I MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT L SAMPLE MEASUREMENT PERMIT L REQUIREMENT [ NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT t HAVE PERSONALLY EFAMINED ANO TELEPHONE DATE I AM FAMlUAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON s f ' f I MY INQUIR) OF THOSE INDIVtDUALS IMMEDIATELY RESPONSIBLE FOR : l
/ 'fy,j
.j(('1-[, ~
/ a gggg g g gy' OBTAINING THE INFORMATION, 8 BEUEVE THE SUBMITTED INFORMATION IS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE 1[ , , 'c -j JM h/ i che:aist ry Manager SIGNmCANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE POSStBIUTY OF FINE AND IMPRISONMENT. SEE 10 U.S.C. I 1001 AND 33 4 ,,5 { J p g
- 4 U.S.C. 9131s. sFwnernes ariser Wwse semanes my hiewe nnes se so tro,opo SiONATURE OF PRMCIPAL EXE ARE A TYPED OR PRINTED amtor - nmen n ' .: or6erw e a menses and s r rs.i OFFICEi OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# strechments herel EPA Form 3320-1 (OP-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE
- OF I O'lO3b/uo 9 f l e - 0 9 ') 3 t .
, Paperwork Reduction Act Notice Public reporting burden for this collection of informatica is estimated to vary from a range of 10 hours as an avenge per response for some minor facilities, to 110 houn; as an average per response for some major facilities, with a weighted average for major and minor facilities of 18 hours per respenw, includmg time for reviewing - ' f - mstructionsi searching existing data sources, gathering and maintaining the data needed, and completing and j i reviewing the collection of information. Send commems regarding the burden estiiMe or any' other aspect of {
;' this collection of information, including suggestions for redu:ing this burden, to Chiif, In!brmation Policy j Branch, PM-223, U.S. Environment:d Pmtecticm Agency. 401 M Stroet, SW hhington, DC 20460; anJ to the
- l Office ofInfornution and Regulatory Affairs, OfGee of Management and Dudget, Washington, DC 2050L j
_ - - _ _ . _ _ _ . _ . . _ -_ __ ..._ _ . _ __ J I General Instructions
- 1. If form has hun partially completed by preprinting, disregard instructions directed at entry of that infonnation already prepnnted.
4 2. Enter "Permince Name 3/m/ing / i!ress (and facility name/ location, if different)," " Permit Number " and .
"Dacharge Number" where indicated (A separate form is required for exh discharge.)
2
- 3. Enter datas beginning and ending "Afonitoring Permd"cmered by fonn when indicated.
j 4. Enter each " Parameter" as speerned in monitoring requirements of permit.
- 5. Enter "Sampic A/eawrement" data for each parameter under "Guantity" and "Caality" in units specified in permit.
! Wernee" is nonnaby arithmetic average (geometnc aurage for bacteria! parameters; of all sampic measurements - for each parameter obtained during "A!ormoring I'ermd', "Alaaimum" and "Atmem m" are normaHy extreme high and !ow measurements obtained during "Alomtormg Perimt" (Note to municipals with secondary treatment requirement: Enta 30-dav average of sarnple ucasurements under Werogr " and enter maximum 7 day average 3
. of samph measurements obtained dating monitonng period under "Alarimum ")
- 6. Enter " Permit Pequirement" for each parameter under "Gwmtity" and "Gunhty" as specified in permit. :
- 7. Under "Nb &" enter numbct of sample measunuents danng mar itoring pcnod that exceed muimum (and/or minimum or 7-day aserage as apprepnate) penuit requirement for exh parameter. U none, enta "0".
R Emer " Frequency of Analysd" both as "Namp/c A/cosurmnt" (actual frequency of campiing and an:dyris used
. during monitoring period) and as "Permi! Rcquircment" spccified in penuit. (c g., Emu "umt
- for ccminuous momtorins "/V" for one day per weck. "/M for cue day per momh, "I 90" fer one day per quarter, ch..)
i , i
- 9EEmer " Sample 7yty" both as 'Wup!c A/rawremen!' (actual sample t)pe und dtaing mondonng penud) and as j
- " Permit Reymrcerent/ (c g., Enter "Grah ' for indwidaal sample, *.N/IC" for 24-hour (.omposite, "E!" for coCilnnous IOonitonng, Ctc. ) l i l 10.. Mhere viciauuns of pcrnut wqunements are reported, attach a bnef explanatmn to derube catse and wrrective I
. actions taken and refaence each nolation by date. 1 ll. Lf"no discharge" occurs dunng menimring period, entu Xu Daharxe" across form in placc of data entry.
12, Entat "Vame Tule of Prmapa! Erautwe QMcf with "sparure of'Prmcipai bearwe U)]h er of' iw%ri:vd . Agent," "7'elephone Number," and "Date" at Louom of Tunn i 13,. ' Mail signed Repan to Ofhce(s) by ducy) sreciGed m pennit Retain copy for your records. I
- 14. More d:taded instructions far tx of this lasc harge A Am.. a ny Rrpmt (!d!R; forrn may be obtained from 03icen) 4 specified in p-rmit Legal Notice Thk repart h requirrd by law (33 !! 'i.C.131% 40 C 1 P 125 rij. F'.diure h trpmt or f.uhuo o rg.m nu6fouy 6 xn re.uk in md pmita s nat w enwd $10.060 ps &y -t mham, u - ma! p rdti;s rd tu ace! E'5.0W y d.cy M siem, or by irgriw v r.t for not mor thm om yc r, er by bMh.
~
4 EPA Form U20-1 (Rev. OMS)
PERMITTEE NAME/ ADDRESS J=ede Farery N == Lacer.w @@wur) SW:.TKWAl POLLUTANT DISCHARGE EUMINADON SYSTEM (NPOESJ Form Approved. NAME 3 y jt y p r y g ;(3,, pgggg ,53. yay N%jp MRNG RNT (og ttr 0 U CQ , TA ,I NA ,y, OMS No.20 N 2e-ADDRESS i> . O , J7% !{ " 3 31 ' V 7 4 M1 - ('i'in 0 S) ^#**k 'N!**, 5-31-Es
*T*N;
. DAVIG O R N ?> 0 g y PERMIT NUMBER c sCHARGE 80 UMBER p . p{qg{ ,"
S3IPPIMJPOO? Ei 15377 MONITORING PERIOD FACILITY > g 7 y .g y y q {, t, g pgy p-; 3pge;3r LOCATION FROM O9 i TO 9a m J* e00 NP OI5C3AEGC c00 9 t. s l- c&n[pleting NOTE: Reed instructions before tNa form. A *M: D5VTD D9MO37 (20'271 (22-231 f24-251 (26-271 (28-2s> (30'371 (3 Cent ONy/ CUANTITY OR LOADING (4 Conf only) QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE PARAMETER (46-531 (54-61) (30451 146-53) 154-611 OF (32-37/ EX ANALYSIS TYPE , AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS W-88 (6+6ef tsS70s
'L'Mi, I4 07V031T J is SAMPLE
( 63) M9coc 9ecy34 co@yce y
" d WI i; EAT 5'.4! ? L .* ': I MEASUREMENT O,pfg 0, c.g (, O '4 . . rG r i[ Aid 1 0 0 PERMIT - qrpsy tcppe; :s e c o c t Modu cucwr Mc gycc/ g;3) e q(t : Np ; 7 ; ., y g ! ** r REQUIREMENT y, pyy - y7yp yz 4 p eoeg mg7p SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT ,
PERMIT REQUIREMENT : SAMPLE MEASUREMENT
, ' PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICEn I CERTIFY UNDER PENALTY OF LAW THAT I H AVE PERSON ALLY EXAMINED AND / A. TELEPHONE DATE AM FAMBUAR WITH THE INFORMATION SUBMtTTED HEREIN: AND BASED ON MY INQUIRY OF THOSE INDIVfDUALS IMMEDIATELY RESPONSIBL E FOR OBTAINING THE INFORMATION, t BEUEVE THE SUBMITTED INFORMAT'ON IS -
4 %
/ ,
fy7 pd 7 ^- ggg gggg.[ TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE /, ' ' }, SPGNtHCANT PENALTTES FOR SUBMITTING FALSE th*rORMATION. INComG 412 393-5113 14 Chim{f:CrV M '1 n ;l re e r THE POSSIB4UTY OF FINE ANO IMPRISONMENT. SEE le U.S.C. 91001 AND 33 9 fi 10 U.S.C. t 13 e_ rrea mes easer eiese esams mer *icAde nrwe se so s70.000 -SiONATURE OF PRINCIPAL EXEM AREA TYPED OR PRINTED and ar mensmsw : .- .: er 6eeween a mantes amt 5 yearms OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMEN's S AND EXPLANATION OF ANY VIOLATIONS (Reference s# ettschments herof EPA Form 3320-1108-951 Previous editions may be used. ' (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) q , PAGE OF
' r Paperwork Reduction Act Notice t
Pubhc regerting burden for this collection of information is estinuted to vary from a range of 10 hours as an j average per response for some miner facilities, to 110 hours as an averge per response for some major facilities, j with a weightal nerap for major and runor facihtics of 18 hours per respcme, including time for reviewing
- i instructions, searching existing data sources, gathering and nuintaining the dau needed, and completing and ,
! ! reviewing the collection of information. Send ctmuments regarding the burden estirnate or any other arpect of l { this coUecuen of infornution, including suggestions for reducing this burden, to chief, Infonnation Policy . l Bran;b, PM-223, U.S. Environmental Pavtection Agency,401 M Street, SW Washington, DC 20460; and t > the ! Ofike of Infornution and Regulatory Affairs. Of fice of Management and Budget, Washington, DC 20503. General Instructions
- 1. If form hu twen partially completed by preprinting, disregard instructions directed at entry of that information already preprinted.
r
- 2. Enter
- Permittee Narne'3 fading Address (and facility namellocation, if differcut)," " Permit Nwnber," and
'" Discharge Nwnber" where indicated. ( A separate form is required for each discharge.)
i 3, Enter dates beginning and ending "Afonitormg Permd" covered by fann where indmated. )
- 4. Enter each "Pornmcler" as specified in momtoring requirements of pernut ,
- 5. Emer " Sample Afrawemem" data for cach par uneter under "puantsy" md "Quahte" in units speciDed in permit. .
"Arcrage" is normally aritlunetic average (geometnc average for bach ru? parameters) of all sample measurements for each paramcrer ohmined dunng "3/omformg Perimf' 'Aianmmn" md "Ainnennn" ase normally extrerne high and low me:Aremems obtained during 7/or!!ormy Periv./" (Nate to municipals with secondary treatment requirem:n!: Enter 10-day average of sample measurements under %crage," and enter mmrman 7-day aserage of sampje measaruuents c5 mined dunng monitoring period under "3/arimmn. ")
- 6. Emer " Permit Rnparement" for ear:b p:uameter under "(hunnty" and " Quality" as spccined in permit.
- 7. Under "W Ex" enter number of sample measunnems daring mondonng pened that exceed maumum (and/or l muumum or rday merage as apprepnafe) pcnuit equirement fer esh parameter if none, enter "(/"
- 8. Enter "Frcpency of Analps" both as "f amj>le 3/casurmem" (actual f equency of sampling and analysis used during monitoring period) and as "Pernu! Re.purcment" speci6cd in penmt le g , Enter " Cont," for condnuous moni@ ring. *1J" for one day per week, "/M for ac da3 per month, "lJu" for one day per quarter, etc ) l
- 9. Enter "Sc nple 71re" bath as %yle A!cawrement" (actual s tmple type used during monite> ring penod) and as
"!% rmn Re<pu ementf (e.g , Emer "Grah" for individual sample, "2,f//C" for 24-hour componte, "N'A" for ctmbnuous monitonng, etc.)
10, $herc violations of pennit requiremems are reported, attach a brief explanation to desenbe cause and corrective xtions inhn. and reference cach violation by date. I1. If"no discharge" occurs dunny taenhoring period, enter % Drharre" across fonn in place of data entrv
- 12. Enter "Nanc 7)!!c of Penwi;ial lhecutwe CWcr" with "St enature of Pnciud Exet utive OEin r cf.lurksned Agent," "Telepimor Number, and *Date" at bottom of fonu
- 13. Mail signed Report to Offictfs) by d.uc(s) specined in pennit Pstain copy for your Nccids
- 14. More dxdled instrudions for use of this Dinha ye 3!omtormp Report (DA!R) form may be obt nK4 fro u OfGcen) specified in pennit.
Legal Notice I l This report W sequad by- law (31 U S.C 1318.40 C f.R. !? NJ. Tiilu > to wyn or fdure to repert trutLMiy an j re ult m a d pendtia nat tn en ed $ 10,000 pt r day of i an,n, m in e nm tal p :uhus not v. cxwd 125.9% pc J,y ( Pf %iCI3oOD, or bit krnprimmDQi [Jr r4Di rea! c lh m iP : yw tr Ly Ivd). I I l ( EPA form 3320-1 (Rev. 0845)
PERMITTEE N *.ME/ ADDRESS a=rwe Fecer,Nea Loreaea afLN.$brser) NATIONAL POLLUTANT DISCHARGE EUMINATION SYSTEM (MPDf8/ Form Appf0Ved. , f DISCHARGE MONITORING REPORT (OMRf N.,ME D F K V L li VALLEI PQkRF 3 ?A 7 [1M (?- 76/ f f 7-791 ON{T CNf C ;,10 L C T OM Nog ; ADDRESS y , 3, D3f a **4"<' 9^" * ( $ t,t a a 0 5)
^# 'N",65-31-98 )
i AT?4; Da?10 ODDO?" PERMIT NUMBER otSCHARGE NuMg 7 . 77ggg ,- RIpp[2 PGRI D: 13077 MONITORING PERIOD A
- EEAVEl 7 ALLEY F3WE3 1TATI3N YEAR MO DAY YEAR MO DAY >
LOCATION FROM 9 >, ,a ei TO 'f 6 av i~ M9 9O a I s c 3 A t C j' [j ccm
\**V* B4yvn *M i9cr (20'271 (22-231 (24-25! (26-277 (28-2SJ (30-377 NOTE: Reed instructions before 'c'Gnpleting tNo form.
'3 C"'d Ontvf OUANTITY OR LOADING (4 Card Onrys QUANTITY OR CONCENTRATION NO. FRtouENCY $ AMPLE PARAMETER (46-531 154-671 (30-45) (46-531 154 611 0F (32-371 EX ANAtySiS TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,s3,3, (64-681 (6S 7ap
{ wg SAMPLE esece eeno - ceOcco i 12) MEASUREMENT M it 0 0 1 ) ) PERMtT g e r.p ne-ereoc e syn , , g) cucpo. 9,9 g ygy ;egp ~ a' '. ? 3 3 9 y t REQUIREMENT p,e n w y y y ., g . y y y r g g ., 3p irPLO L'f r
'L0s, f5 "?NDOI? 3p SAMPLE Ab
( S t} "-000'5 ea$c3e 0 ;r p e o l
. M 9 '? I d F ? T 1 L F1 T P +. 7 N I #
O Nd
,3350 i .! C PERMIT gyp
- orp3ry e?cce9 MOMO eccage o&n ggggy g g p p.
l
; r t tJ r :i v ~MS;, y g r, y < REQUIREMENT ,g 4y. p377, yg ,- n m9
" L O 'i ! w E , TOTAL SAMPLE 99~9*- *enN$ scene;
{ lo) o , ? D a, n, L MEASUREMENT i ') p .; q [ 7 a PERMIT geeNa n e c a- t < yce . c o c on.. 3,5 1,73 g g yg y g g g,
- ? T i, 0 t 's ? 107i~ ? ; Ty REQUIREMENT : o c c- 90 yy7 rq3; 3eg we/t -
.PLqni.t, f ,g SAMPLE s t A *s e;
- M*ee0e n$ee se ( ;g)
..AI.,,Le, MEASUREMENT
- t. s a 536 %4 1 ) O PERMIT . c o m ac rt e t e r: e t e t c: c ccocco ),7 S,9 ugggy :349
;- r ( C r e v .71 :: - y 1 f, q : REQUIREMENT 39o- 3yy3gc gggpgy ,q ;
SAMPLE [ MEASUREMENT > F PERMIT REQUIREMENT SAMPLE MEASUREMENT i PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT ! NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER 4 CERTIFY UNDER PENALTY OF LAW TH AT I MAVE PERSON ALLY EX AMINED AND TELEPHONE Ot.TE AM FAMiUAR WITH THE INFORMATION SUBMITTED MEREIN; ANO BASED ON f^, .
/ i MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSISLE FOR /
UdV[d OrIM')rf / i OSTAINING THE INFORMATION. I BEUEVE THE SUBMITTED INFORM ATION IS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE fL{f s/g M j < /,J/// g ? '_ e ChenisLry Manager SIGNMCANT PENALTIES FOR SUBMITTING FALSE esFORMATION. INCLUDING THE POSSIBIUTY OF FtNE AND IMPRISONMENT. SEE 10 U.S.C. 91001 AND 33 i 414. J, g93-5113' 9~ 6 10 m U.S.C. t 131e hiebwe saes se so s 70,000 SiONATURE OF PRff0CIPAL EXECUTNE TYPED OR PRINTED .aa er mannmn #Penomee.:emmer ewse raerw.e s.eems mer.mr a yeerts s monen. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY i CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# sFfechments here/ () (Scbar .) + i EPA Form 3320-1 (08-95) Previous edithns may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED l PAGE OF 0 0 9 4 2 / 7 6 0o151- 0 G 0 2 1
j- .
^
Paperwork Reduction Act Notice } Pubbe reporting burden for this collection of information is estimated to vary from a range of 10 hours as *n average per response for some minor facilities, to 110 hours as an average per response for some major facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing - l instructions, searching existing data sources,~ gathering and maintaining the data needed, and completing and f' reviewing the collectmn of infbrmation. Send conunems regarding the burden estimate or any other aspect of
- - ' this wilection 'of information, includinf.supgestions for reducing 'this burded, to Chief. Infurnution Policy
{. ' Branch, PM-223, U.S. Environmental Protxtion Agency,401 M Street, SW Washington, DC 20460; and to the l Office of inforLation and Regulatory Affairs. Of fice of Management and Budget, Washington, DC 20503. { . , i l General Instructions i 1.,1f form has been partially completed by preprinting, disregard instructions directed at entry of that information j already preprinted. i^ l s 2: Enter "Pernuttee Namealailing AJJress (and facility namellocation, if ditTerent)? ~ Permit Number,* and '
"Diacharge Number" u here indicated ( A separate form is required for cach discharge.)
l _ j 3, Enter dates beginning and ending "Mam/ormg Permd" covered by form where indicated ! 4.. Enter each " Parameter" as specified in monitoring requirements of permit. ( ) 5. Enter " Sample Men.surement data for each parameter under "Guantity" and "(!ucIny" in units specified in permit ! " Average" is normally anthmetic average (geometric merage for bacteri:d parameters) of all sample measurements I for each pammeter obtained during Monimrmy Permd"
- Mat! mum and "Minhnwn" are normally extreme high and low measurements obtained during "Momtoring Period" (Note to municipcis with secondary ticatment l .
retpiiretnenti Eruer 30-day aserage of sample measurements under " Average," and enter maximum 7-day average - l of sampic measurements obtained during monitonng period under "Manmmn."1
- 6. 2nter " Permit Requirement" for each parameter under " Quantity
- and " Qual:ty" as specified in pctmit, s
j- 7. Undpr "No Es" cmer numbu of sample measurtncnts during monitoring period that exceed neximum (and/or
- nummum or 7-day a crage as appropnatc) permit requirement for cach parameter. If nonc, enter "0".
SJ Eraer " Frequency of Analvsis" both as "Lm;>ie Measurment" (actual frequeng of sampling and analysis usad
- during monitoring period) and as "Pernut Requirement" specified in pennit (e g., Enter "Centf for continuous 1
. momtoring, "I 7" for one day per wcck "130" for one day per manth, "F90" fer onc day per quater, etc )
i '9JEnter "Sar:ple 7)pe" both as "Lmp!c Mcamrement' (actual sample type ussd during monitoring peried) and as
- '" Permit'/kquirementf (e.g.. Enter " Grab" fbr individual samp
- e. "aflR'" for 24-hour composite. "N'A" far l continuous inonitormg, etc.)
I p 4
- 10. :Where violabens of pertmt requirements are reported, mtach a brief explanation 'o describe c.mse and corrective
- acdons taken and reference exh violation by date.
- 11. If"no dsharge" occurs during monitanng period, enter "No Ducharge" across form in p!xe of data entry.
- 12. Entet "Namemtle of Prinap:1 Executne Ollicer" with " Signa:ure of Prinap<d Czecunvc Opicer af Authori:cd Agent," ' Telephone Number.~ nad "Datc" at bottom of form
?
- 13. hbil signid Report to Ohice(s) by date(sj specided in' pennit .Retam copy for ymd records,
- 14. More detailbd instructions for bse of this Diuharge Man.tarmy Report (DVR) form may be obtained from Office (s)
, specified in pet tnit Legal Notice ThN rapart ix requned by law D3 U..S.C.1318; 40 C.F.IL 125.27). Failure to reintt or fuhr to report truthfully can result in ciGI penfta not to excad $10$0 pr day of viulaion: or in niminal psdnes nd o cueeJ $23JOJ pr day of violation, or by imprimnment for rht more than one y c.tr, or by both.
EPA Form 3323-1 (P.n. 0845) a-
PERMITTEE NAME/ADORESS (F=eMaceryN=== Lacerrea ifDufirearl NATION AL PcLLUTANT DSCH ARGE ElfMIN'. TION SYFTEM (NPDES / Form Apgiroved. 7
- 4 NAME eEAY", VALLEY PH E9 $TRIIa? 6 ff 7 t il t l f ! 4 f. i 3CREENO% ^ %$
"'"'b'# 'O ADORESS P . 3 ?)( 4 '
(53D? O$) 4'$ AIIF; 9 A if LD 3?ND0EP PERMIT NUMBER DSCHARGE NUMBER y ,, e{qg{, i4IPP1P3PO27 9A 15 0 M MONITORING PERIOD 'S3% FActITY p y 4 g, g y3Lgyy pgggp 3+y-*33 LOCATION 'r $ t >3 D 1 C C tt.g 9 C 7 FROM e (, s" 'i TO / t. > 3* NOTE: Reed instructions l~ c&nlpleting tNo form before 900
% ? ? $. : h 4 'J T r '1 h s oO7i (2&2f/ (22-23/ (24-251 f26-271 (28-291 (3&371 PARAMETER r3 Cerd ontr/ CUANTITY OR LOADING I4 Card on/r/ QUANTITY OR CONCENTRATION N O. FP.EQUENCY SAMPLE 146-639 164-671- (3e-4SA (46-631 164-691 OF (32-37/ EX ANAtyms TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS *N31 (64-6e/ (6.9 7m SAMPLE cao6ve c a c g r> c
" L Ti , rh 2 3 *i p 'j ! T 04 ( e- 3 )
% ': 0 3 c //
"a W [ R F l '" * * ( T . 45!
MEASUREMENT Qgp- , f ,j g C /J g'g-- j ') M O 1 .) n PERMIT g g p q r4 - prpop; c a re r., n e A ce t;:0 :: c r:q $ p o ne0 6%LT 5 TINA ' r r(p' N y ne?"5 y A f; 9 J REQUIREMENT y g7- n.3yy yz .;3 enc SAMP;E MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT , s PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT ; SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER i CERTIFY UNDER PENALTY OF LAW THAT 4 MAVE PERSON ALLY EXAMINED AND . TELEPHONE DATE AM FAMBUAR WITH THE INFORMATION SUSMITTED HEREIN; AND BASED ON MY INOUIRY OF THOSE INDivtOUALS IMMEDIATELY RESPONSISLE FOR f
. ./ j - - , ;
/
David Orndor OSTAWWG THE WFOMADON. I BWEVE THE SUWITTED INFORMATION IS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE g t-T l_ f ,#
.h' i , d }u'-
SIGMFICANT PENALMS FOR SUBMIN FALSE WFOWAN. WCLUDNG gg Chemist.ry Manager THE POSSIBILITY OF FINE ANO IMPRISONMENT. SEE 10 U.S.C. 91001 AND 33 , ~~~ *g'9jg}.3J{}
-' [G [4 ;
u.S.C. e 131o. PenmNee wer wiese eensive mey became am up ne a70,000 SiONATURE OF P'RWICIPAL EXf'CUTIVE TYPED OR PRINTED w or manw-a c oraerwoon s mamns w s yearms AREA NUMBER OFFICER OR AUTHORIZED AOENT CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# errechments here/ EPA Form 3320-1 108-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF 3 ,
I Paperwork Reduction Act Notice
~
Public reporting burden for this coLction of infermation is estirnated to vary from a range of 10 hours as an j j average per response for wme minor facilities, to 110 hours as an average per response for some major facihties, l l with a wdighted average for major and minor faciuties of 18 hours per rePoose, including time for reviewing ! - I l indructiotr<, searching existmg data nources, gathering and m.tintaining the data needed, rmd comp!rting and l reviewing the collett:on of information. Send tom:nents re;prding the barden estimate or any other m-pect of
! this cohetion of infernution, im.luding suggotiom for reducing this burden, to Chief, Infornution Policy . ) Branch, PM-223, U.S. Environnen*al Proidion Agency,401 M Street, SW Wrhiagion, DC 20E0; nad to the !
Off% e of infernution and Regutatory Aff airs, Of Gee of Management md Budget, Wa..hington, DC 20503. L.-..-,., f l
.__......_.,_..__--_..m. ~ . ~ . _ . . . . _ . . . . . . . - - , . . . . _ - _ - . _ - - - - _ - - - - -s1 1 General Instructions
- 1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted.
- 2. Enter "Perimitec Na+nedlads.a A&lress (and fx:dity nann: location. if di& rent)," "Permet Number," and "Ducharge Number" where ind:cated. ( A separate form is required for each discharge] ;
1 3, Erter dates beguming and ending "Atomroring Perm # emcred by form where indicated. ' t 4. Enter each " Parameter" as speciDed in momtoring requ:remerits of permit. S. Emcr "Lmp!c M amermen!" data far each parameter under "Gua nity" and "pvaluy" in units specified in p;rmit ,
'Awrm:r" is normany anthmeti; aterare (geometri: awrac for bm rial parameteru of aM sample measurements '
for exh parametcr chtaintd during " Mon.turuT l'crim/L "\ form:m" and "Afmomm" are nonnaHy extreme high and low menwmenn obtained during "t!mnormx Pernwi'~ (tsca to municipals with secondary treaunent runnrement Enter M-day averm;c of sampic m;",uremer:ts under Wrage," and enter maxunum /-day averaf? Uf 5/Mup}0 InCaWrtments obCunOd duriDC nWildring punod und r "\[Grimum. ")
- 6. Enter " Perna! Ragsenu nt" far eac h parameter un&r "Ouantay" and "Gus/5" as rpccified in permit, 7 Under "No /Y c:dcr nuruber of 2 npk m wurmems during monitoring period that exceed mnimum (and.'er j m;uimum or 76y aware w apprepnate) perma requiremst fer erb parameter !f r one, erm.r *0" l
j 8. Enter % eem f + s A caly'.ia" bcah as S!mr:pic t! cow at" (actmd frequena of sampling and ana!pis used ! ! daring rnenneng periuS and r c Pe~ nit Reyk rcemm" spedfied in perm!! (e g . Enter "Gmrf for cenunuous ; l l momterint "l'" har ene day per w cek, "I W" fbr one cia per month. "/4'0" for on: day per quar 1ct, etc) J l
- v. Emer wy '!ve" wh n " sam!c st- e m" uctmd sample rme uwd during monitarmg pcriod) and as i
"!Pr.na Re pare ncnt/ (e.g, Enter Wah" for inJhidual s mpk "J.#!C" for Rhour comporte, "Gt" far I copunuous mmutonng. ete )
i l 10. .When; vichtens of pnuit requirements am reported.1 m:h a Micf apbnanon to d s;nbe cause and coneaiw ; l xlions taken, and refeience each m!ation by date i t l l 11, If *n0 disch3Igt" DGur? dunng 1900, OMnf perd Cn!0f "U /Mrh?gt " 3CmM fCTm m p!nec of data ently l t
- 12. Enter "':ame 7t!!c of Pr:m igu! Fw utn e Wicer" w nh ' sxare :lPn atm! Crei :twe (Tj.cer 91 lu;h. .:cd l l Agent " "Telejkne Num! er ' und "Date" at bonum of tarm l l
l 13 Mail signed ihpart to Ofnec(s) be duM :pecified in pennit Retain cepy for)our hcords i l l 14. Mure dakd imuuctim icr use of this /w;m:e mn<mg i <wt sim fe,n mm be oi 6na fmm 0:ncem i
'pccified in permit. I Leoal n Notice '
i This :enoit n irqua d 1, he U3 U.S C.13!F: M C.F. 12D D. F _dme to rqport < N oc u :epen ::u:hh;!h un ! re.u!! in dvd pendtm , rot i , + r $10 M tO er 9 W min v or n , r dg W s > ,1 : 'e u j M f M per day l of if a.orbyimpn m r. . b r.; ' newc lim ( >w, e r by bo i l l EPA Form 33 20-1 (hv. O.Ni$)
. _ . . _ _.- m . , _ . . . _ _ - . . . _ . _ _ . _m.. _. .
PERMITTEE NAME/ ADDRESS (FarweFeedwNe=e Lorene=(D@wer) NATIONAL POLLUTANT DISCHARGE EUM%ATION SYSTEM (NPDESI Form App'rsved. ,'" N3ME OtSCHARGE MONITORING REPORT (OMRf
'i t 17 f R (ALLET PM D 7; TAT!JN t ?-F 61 197-19/ #i lt X . 1974Ed $ Y S T T.OM8 No* 2040-0004 *
^P ' 1 ADDRESS P . 3. 33X 1: " * ' ' ~ 14A1' 'M '
(3$2E 26) I t?TN; DAVIJ 015D0FF PERMIT NUMBER OtKHARGE NUMBER y , p 7 ,; ,. L 7
. H T P ? ! 1 G P O ii ? M 15 0 *f 7 MONITORING PERIOD " A IM FACTUTY t 947 g VALLty POWgg 3thtJ7) g qq g g qq g LOCATION FROM vu d- Jt TO 7% ,1 << 0% P n O [ c.c 3 a g r p [ oco aT=n: r- n. y i n 3 u *: n 1 u r 12w2ti t22-23) 124-251 12s-271 (28-291 13o 311 NM R**d ine& Wo** ~5[% % foM.
13 Ced ontyt QUANTITY OR LOADING I4 cam ontyt QUANTITY OR CONCENTRAN N O. FREQUENCY SAMPLE PARAMETER 146-539 154-619 1394 59 146-531 154-619 OF (32-37; EX ANALYss TYPE : AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,,2.es, fg,.ggf f,3 7g sg SAMPLE conee^ *:etecy Ocecco ( 12} MEASUREMENT 3 t :; g a } 7, a PERMIT a rg e n e co m o r wy 3,g o cc Mr c 9,0 gggy . p,g g
; :- Q > .i e ~vSan y;La: REQUIREMENT MCC 4!9790"- "AXTMUM CM
-Lna, I :s TM00!T Tt SAMPLE MEASUREMENT Mg ( 93) a c c o c e. cc00Sc ce$4c:
r :t e n s '? t A r n o '.
- ELAN t-/ ,,j
;1053 1 3 7 PERMIT - H ypr o+ proner epecco 000000 cce%c c e r- [ gly $TJes
' p r L y i. % - ;,,,< y q r, g REQUIREMENT yn 3y y 7 7y ., y ,gp ee e
. . .. : ; i3 e. e. > ,., a , + g '.
--. A SAMPLE o a n e r. * -e>se> cet &; ta 4
zp. ;g g g MEASUREMENT
- S P, $ () 1
, ; PERMIT neccce e c e n e r- c 'it re c o c c e '>,5 1, 2 <3 pe gg .ggg
*cr ,q p v . v i e, ; vgtp, REQUIREMENT :)Se gg g y .- 7 z e,7 g,z o,g
~ 3 L 3 3
- i, F , cr.t SAMPLE MEASUREMENT eve $ e r- F e 6 *: c . .shccet ( 19) g.g ,e y g g g 7 i q 3 G i3 PERMIT 000&ec e e Me" * *^^ ^$0000 a g [,
1 1 0 ?.2 7.5 2ny
; e r L O .c p -e' ;3 y A Lg7 REQUIREMENT cea r. y r y 4 g r 3 A;[gn e yL SAMPLE !
MEASUREMENT PERMIT r REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT - NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW TH AT I MAVE PERSON ALLY EXAMINED AND TELEPHONE DATE i AM FAMtuAR WITH THE INFORMATION SUButTTED HEREIN; AND SASED ON A a " MY INQUIRY OF THOSE INDIVIOUALS IMMEDIATELY RESPO498LE FOR OSTAINING THE INFORMATION. t BEUEVE THE SUBMITTED INFORMATION t$ l7 / W i
,d aV id O Uh;O T l- TRUE, ACCURATE AND COMPLETE. 6 AM AWARE THAT THERE ARE /f .// 3r-h y / p'j'p t ,' y 9GNIFICANT PENALTtES FOR SUBMITTING FALSE INFORMATION. INCLUDING --
- ; 9 *1 .
- i f * ' d U 1 * *a l i
THE u.S.C.POS984UTY OF enser t isia. sRenames FINE enese AND IMPRISONMENT. seams mera cose snee SEE.18 se toU.S.C. s70.00091001 AND 33 800 NATURE OF PRINCIPAL EXECUTfvE g TYPED OR PRINTED sav er manenw= _ _1 - :ormerwe e s mearAs emr s roers.# OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s// strechments herof [
" "> J I T J P ! P ' P31 C L O '* , Fyri Att;L ;Lr r' 9 7. " ' T V : ' , A NI TOTAL :CSIPUAL C M L ; '? ' t > AEL k Z j ij i k T D ONLi ') O i I N G T MU lt ;
i-2[95J ') P S I '; C H A 9 "; " [ O ' ?Mt ; L T r o *' ,t
- 5- P ! S '1 P A 'i 17' THf APA"TOH P L i *i ! RIVr3 V A ? i. :t 3Y3TEF.
No hrscheee< , EPA Form 3320-1 (08-95) Previous editions may t>e used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE t*SEDJ PAGE OF q 7, q
. _ _ _ _ . - _ _ _ _ - _ _ _ _ - - - - _ _ _ . - _ _ _ _ - _ - . _ _ - _ _ _ _ _ - _ _ - - _ _ _ _ _ _ _ _ _ _ _ - . _ ~ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ - _ _ - _ _ - _ _ - . . - . _ . . _ _ _ _ _ - _ _ _ - _ _ . - _ _ _ _ . _ _ _ _-
I r ' Paperwork Reduction Act Notice 1 Pubhc reportmg burden for this collection of informatwn is estmated to vary from a range of 10 hours as an average per response for some minor facilities, to 110 hours as an average per responw for some nujor faciliues, j with a weighted aserage for nujar ed minor faciliacs of 18 hours per reAponse, including time for reviewing "
~
instrwtions, searching existing data sources; gathering and mainudning the dat.a needed, and completing and { l reviewing the coMeetion of information. Send cornments regardmg the burden estimate or any other aspect of ! l tids coNction of information, including suggestions for inbcing this burden, to Chief, Information Policy 3 Branch, PM-223, U.S. Emiromnental Protection Agency. 401 M Street, SW hhington, DC 2040; and to the OfGee ofInformation and Regulatory Af fairs, Of f5ce of Managenent and Budget, Washington, DC 20503. _ _ - . . _ _ _ _ ~ . _ _. m _ . _ J General Instructions - l l< If fann has tun partially completed by preprinting, diurgard instructions directed at entry of that information already preprinted.
- 2. Enter " Permittee Namestadmg Address (and facility nameAacation, if ditTerent)," " Permit Number l and ,
"Dischargc Number" w here indicated (A separate funn is required for cach discharge.)
- 3. Enter dates beginning and ending "Afonnoring Penod" covered by fann where indicated 4, Enter cach " Parameter" as specificd in monitoring requirements of permit.
5 Enter " Sample Afemrement" data for each parameter under "Ouantit/ and "Quahry' in units specified in permit. ,
"berage" n normaH) arithmetic as crar igeomeuie aserage for bacterial parameters) of au sample measurements for cach parametcr obtained durmg "A, moring Permd": "3/ammma" and "3hmmum" are normally estreme high and hm measmements 'obtained during "mmtarmx Permd" (Note to municipak with second;uy treaunent regidrement: Enter 30 &y aserage of umple measuremtats under "Acrare," and enter maximum 7-day nerage of sampic measurements cMained dwing monitanng period under "A/admum.")
i G. [ntbr "Perrm! Rnjutrcmwr" for ca:h paramCteT UndCr "Quanitty" and "QualI!y" as Spec 10:d in PCDltit. I
- 7. Under "No Et" enter number of suuple measurments durmg monitoring period that exceed rnaximum (and/or I minimum or 7-day as crag; as approprbte) pernut requ:rement for cach parameter. If none. enter "0".
- 8. Enter "Freewnce of Analyn" both as " Sam;Ve 3! carmen /" (acical frequena of samphng and analysis.used durinj; rncnitoring paiod) and : s "Permir Rafwrement" quaiGed m permit. (e g_ Enter %nt " for continuous monitoring "/?" tor one day per weci, "u3(r fc4r one day per month. "!J10" for one day per quarter, etc )
- 9. Enter "Nample 'if;v" bc:h as %ple Afaremmt" (actual sample type used during moni:cring penod) and as "Permir Regmrement/ (e g, Enter " Grab" for inhdual samplc, W!!C" for 2&houi com;,esite, "NT for conunuous inonironng, ete )
- 10. Where dotatmns of permit requiremenh are rq>orted. attxb a brief explanation to desenbe cause and corrective
.acuons taken. and reference cach violatma 1n, dec.
I1. If no discharge" occurs during cmnitormg penod, enRr " A o Dwlorge" acron farm in place of data enuy l?. Enter ."NQt?)ll) C < s[ PrmClpQl }hCtuttW Qllh CY' with "S!gnd!ut? ef P/'incipa! }UtTDitVC l}f/h t'r o[ AkihortlCd Agenll "Telephrme Number," and "Date" at knam of form. 13, Mail siped Repon to Officc(s) by dateB) spedGed in perant Retain cupy for your recorda i
- 14. More detn!cd imaru; tens far use of thh D:,er;ge mnaormg Report (IE/RJ form may be oWiued from OHice(s) '
specified in permit. l Legal Notice I i b4 br1 is rqu, 2 by lu 03 U.S C 131R @ i' F R 12S.2 /n Nimt to reiut <n khm to qut uuthloMy ear, ; I result in enii r-enahio not m emxd $1090 pc sy of u - tea, m m ( sim vi p r & ot : m 3 d 123.0% pa day
! cf violathm. or by impo v arrnf for nu more than one p a by huh.
t i l EPA Form 3320-1 t' Ret OLS) I i
PERMITTEE NAME/ADDRES3 a=4Je Forde=N =.'Lorereon til@rmer) NATION AL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES / Form Approved. *
- MCH NAME ap4933 gg((gy g 3gg 37g773g t MNm RNT (Dh tty UN1i t raaLJg; 7g M No. M M ;y EE "
ADDRESS P . 3. B )T 4 0*4i?Ef1# __994 E (3U3i OS) ATTU; P A 710 0Pw302F PERMIT NUMBER EKCHARGE NUM6ER y . p}qg{ . 9 't I i> P I N O T- 3 H T P4 15C77 MONITORING PERIOD A FACILITY nzgyyq g4-gyy p 3 y g r; t7g7{9g LOCA DON FRoy yn # 91 70 9n ,,j ,3 , C .0 9 e, g 3 { $ [ }} *,3 3 y g g 3$6 ! RTT1: 15 V T ', 3 H a il3R V (20'21) (22-23) (24-251 (26-27) (28-2.99 (30-31) NN %*O I"* W O'* NN *- (3 Card On&A CUANTITY OR LOADING (4 conf ontyl QUANTITY OR CONCENTRATION NO. FREQUENCY
$ AMPLE PARAMETER (46-531 (64-691 (30-451 (46-539 154-619 CF (32-371 EX mysis TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,sms fs4_ ass fagyar SAMPLE occeeS ^ *- c e t t.
,o
" 92eewe ( 173 O ,
MEASUREMENT 7 pg 7 f[ Q 44 1 P 't O G ( n 3 PERMIT M96&t o c e: e e 4 0 Sec 3 . f3 cocate- 9.0 gICg/ pgg-yaLy REQUIREMENT m3 3;47 m .: n ,, n g r r t, g ; ,- 3 ; p y q,, 17 L i n :;, ??f;( SAMPLE 9poeca e ** ^ e s tocon) ( ) g) , , ,
; g .:; p e s p r 9 MEASUREMENT /),7 /pp Q % Q4 19$30 g 3 3 PERMtT ' 0 0 :> e e 6 eche$$ y o r- e n o :rc e 30 (90 gIC3/ .n&g s t- e t !; t %* ; ,3 ; - yyg,- REQUIREMENT 33cy .y3 gyn npf[7 p , ;f t gyg if L qup q3s;;y SAMPLE ccenc% nece > , gg ( 14) O,
;7
,g3g q ;. 7 q g n y q g. 7 c MEASUREMENT <3 _
g g, 2, fg Qg
}q956 1 3 ? PERMIT coccec 6 6Mc @ c we [3 20 3 (} .
y;cg/ Ah retL,'N- -t191 y t Lil: REQUIREMENT ,; r . y gyg 94777 qq yygy yz g ,, g f ( gy79 a.on g s g q p ,. ,
; ' LOW, IN TJiCUIT Of SAMPLE ( n z) eg3e33 p / '
4 373 7 7 p g 7 3 ;, y 7 eg9; MEASUREMENT g g . 5D059 1 0 0 PERMIT qqphp? prpnpc ggwg mgy ,3 gm , 33p s J# ,,
"' i
- r P ', g r v ,- 7rqqq y p t ri ; REQUIREMENT gg 3 p ,. ng77y y g. , p &
SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE , MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVF OFFICER t CERTIFY UNDER PEN ALTY OF LAW THAT I HAVE PERSON ALLY EXAM!NED AND TELEPHONE DATE AM FAMlUAR wtTH THE INFORMATION SUBMITTED HEREIN; AND BASED ON *, / MY INQUIRY OF THOSE INOlvtDUALS IMMEDIATELY RESPONSsBLE FOR /' ' f d'- l David Orndorf OBMNING M INFORMATION. I BEUEVE THE SUBMITTED INFORMATION IS ij ,g Cliemia L r Manaeer TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE StGNIFICANT PENALTIES FOR SUBMtTTING FALSE INFORMATION, INCLUDING k i - [ M -f
- O THE POS$1BlUTY OF FIN u.S.C. s late. rease.E,ANOwMIMPRIS.ONMENT. SEE 18 U.S.C.
- 4,12 393-5113 96 U r me. esen,t mer *ien,sie smen 51001 ANOcoo se sto, 33 sIONATURE OF PfuNCIPAL EXEhlTWE AREA TYPED OR PRINTED emt er msnmana : _ : er aerw.we s means eaar s years.s OFFICER OR AUTHORIZED AOENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# ettschments here/
\ i
<p EPA Form 3320-1 108-951 Prevtout editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.I g, ,
PAGE OF
'8 4
, Paperwork Reduction Act Notice Public reporting burden for this co!!ectiou of information is estimated to vary from a range of 10 hours as an average per response for some minor facilities, to 110 hours as an average per response for some major facilities, with, a weighted average for major and minor 4cilities of 18 hours per response, induding time for reviewing e instructions; scarching existirg data sources, gathering and nuintaining the data needed, and completing and -l reviewing the collection of information. Send comments regarding the burden estimate er any other aspect of l
this, collection of information, imluding suggestions for reducing this' burdea, to Chief, Infornution Policy i Branch, PM 223, U.S. Enwronmental Protection Agency,401 M Street, SW Washington, DC 2030; and ta the { Office of Information and Reguhtory Affairs, Office of Management and Budget, Washington, DC 20503. j
. - . _ - - -- . -. i i
General Instructions l
- 1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted, i
2c Enter " Permittee Name&failing Addrest (and facility name/ location, if di1Terent)," " Permit Numbce," and
" Discharge Number" w here indicated (A separate form is required for each discharge.) l 1
' 3, Enter dates beginning and ending "Afonitoring Period" covered by form where indicated. I l
- 4. Enter each " Parameter" as specified in nwnitoring requirements of permit.
)
- 5. Enter " Sample Afcasurement" data for each parameter under " Quantity" and " Quality" in units specified in permiti l "Averace" is nermally anthmetic average (geometric merage for bacterial paramercis) of all sample measurements i for cad parameter chulined durin;; "3/vmtoring Period"; " Maximum" and "Afintmwn" are normally extreme high I mid low measurements obtained during "Ahmitoring Period." (Note to municipals with secondary treatment 1 rcquirement: Emer hday average of sample measur:ments under "Awrage " and enter maximum 7-day average of samp!: measurements obtained during monitoring period under "Afarimum,")
1
' 6. Enter "Perdnt Rujuirement" for each parameter under "(; .antity" and "Gualitr as specified in pennit. j
)
- 7. Under "No Er" enter number of sample measunnents during monitoring period that exceed maximum (and/or !
~ minimum or 7-day avemge as appropriate) permit requirement for each parameter. If none, enter "0". l 8..Emer "Frequemy of Anaksis" both as "Namfr/e Aicasurmen!" (actual frequeng of sampling and analysis used during memtoring period) and at " Permit Retjuirement" specified in permit. (e g., Enter "Conr," for continuous monitornig, "/9" for one day per week. "130" for one day per nwnthc "uM" for one day per quarter, etc )
1
- 9. Enter " Sample 7)pe" bah as "Sami de Afcasurement" (actual sample type used duriv monitoring period) and as
*Permir. Requ:rement," (e.g., Enter "Grah" for indindual sample, "N!!C" for .24-hour ' compos te, "N'A" for j continuous monitoring, etc ) 6 10 Where viobtions of pernut requirements are reported, attach a brief exphnation to describe cause and corrective adicas taken, and reference each violation by date.
1IL if"no dischmge" occurs durmg monitoring period, enter "Yo Discharge" across form in place of data entry
- 12. Enter "NameTitle of Principal Emutin: @icsr" witt, 7lknature q Prmcipal Executive Qtfiter of tuthori:ed Agent," "Telephane Number." and "Date" at bollom of form- ;
t
- 13. Mail signed Report to Omce(s) by date(s) specified m permit. . Retain copy for pur record-1 1.4l Nore detaikd instructions for use of this Discharge Monimring Report (BIR) form may be obtained from Omce(s) l specified in permit Legai Notice Thi; report is required by law (33 ti.S.C.1318; 40 C.F.R.125.27). i%ilme to m;urt or radur.: to report trmhfully m ~
result ih chd gr.atties not to exceed $10,tXM per day of vio!Aion; or in tsiminal pena! tin ent to euced $25.000 per day of viobtion, or by imprisonment for not more the one yar, or by both. f EPA Form 33204 (Rev. 03-95) i
, a - - . , . - , . - . _ - , , ,,
PERuiTTEE NAME/ ADDRESS trace.* hhW Lorenes s/D@wer) NADONAL PCMUTANT OtSCHARGE EUMINXWON SYSTEM (NPOES) Form Apgiroved. DISCHARGE MONITORING REPORT (DMRJ , , . , , , , . 7. -, ,. , , . . NAME - r .xV :< - :-, i L n Y P O s .. p y e -g. - +1 (?- t 6i (7 7-7:.1 v . i a e. r 2 . o c . OMB No.2040..0004
/.DORESS P . 3 e >)I il '99'~\"35 )l
- i ( 3 4 Il F 78 5 ) ([ . -
DE7!D UT s COH; PERMIT NUMBER ceSCHARGE EUMBEA p . p{gg( [ l A T
- i.1
.:~o r p p .e , . p a. n
" y on
*" *Og77 MONITORING PERIOD we*)
FActLITY 4 r; g g y , y;(g7y p3jp ; 7 g 7 y y sn LOCATON FROM uo iu . TO v0 i* .i : "*C hC 3 I 5 - M 5 r ^, l }. 000 (26-27/ (28-291 (30-311 NOTE: Reed instructions before~coinpleting this form. j
- U;V[n 3 ;' : O .) A F #20'271 (22-231 (24-251 (3 Card on47 CUANTITY OR LOADING (4 Card on41 OUANTITY OR CONCENTRATION NO. FP.EQUENCY SAMPLE l
PARAMETER 946-531 (54-619 (38-451 146-531 (54-691 or (32-37; EX ANALYSrs TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <ss.es; (64-681 tem
^ r , yg , ;q y a 3 9 7 -- a: SAMPLE ( n )) $$i390 9$3007 ceccet ,/ /
4 qr ,y v; y7ye9p -e: ; .1
; MEASUREMENT g, .c., ,j ,7 . . . y C /~7 f. , 7
; 30;n I J q PERMIT irp377 t' eneT 'tchoca $dOSci COOnte :3' CL GY 5?T93
. r g g : >; - ~ ag jf igt REQUIREMENT on g7e ngity 37 ;, nec SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER i CERDFY UNDER PEN ALTY OF LAW THAT i MAVE PERSONALLY EXAMINED AND '_ TELEPHONE DATE AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON -% -
/
MP1d W M OT[ MY INQUIRY OF THOSE INDIVtDUALS IMMEDIATELY RESPONSidLE FOR OSTAINING THE INFORMATICN. I BEUEVE THE SUBMITTED INFORMATION IS I AM AWARE THAT TMERE ARE J
/// ', ./
TRdE. ACCURATE AND COMPLETE. er // # / '. ';-' ,y
- f g(; }3 Churlifil! " Mana ?Co 1- SIGNtFICANT PENALTIES FOR SUeMITTING FALSE INFORMATION. INCLUDtNG 4[2 J@.3 j, }J
} {,)
/ THE POSSIBIUTY OF FINE ANO IMPRISONMENT. SEE 18 U.S.C. I 1001 AND 33 U.S.C. e 131e. rFeasses anser emse sneeurse nwy sicauwe mies se to s 70,000 510 NATURE OF PRINCIPAL EXECUTIVE ew ormeeemen: .
ARu NUMBER YEAR MO DAY TYPED OR PRINTED _ .: eraerween a memns ow a resral OFFICER OR AUTHORIZED AGENT CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference al/ strechments hers/ EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) g g 7 .) PAGE OF
3 e. Paperwork Reduction Act Notice
\
Pub!ic reporting burden for this collection of infonration is estinuted to vary frorn a range of to hours as an average per response for some minor facilities, to 110 hours as an average per response for some inajor facilities, with a weighted hverage for major and inmor facilitit~s of 18 hours p r response, inchiding time for nsiewing l - ; histructions, searching existieg data sources, gathering and maintaining the data needed, and completing and reviewing the cohecuen of information. Send conunents regarding the burden estinute or any other aspect of ; this coheetion of infornudien, induding suggestions for ~ reducing this burdeni to Chief, Infonnation Policy l Branch, PM-223. U S Envirnernental Protection Agency,401 M Street, SW Wuhington, DC 20#0, and to the l
! Office ofInformation and Regulatory Affairs. Offiee of Management and Budget, Washington. DC 20503.
- b. _.._ _ , - - _ _ _
I General Instructions i l 1; if form has been partially completed by pieprinting, disregard instnetions directed at entry of that information {
> already preprinted.
J! l
- 2. Enter "Permittec Name/A! ailing Address (and facility name/k> cation, if di1Terent)," " Permit Number " and i "Dirharge Number" where indicated. (A separate form is required for each discharge.) !
l
- 3. Enter dates beginnimt and ending "Afomtormg Period" cmered by fonn where indicated.
l
- 4. Enter each "?aramcier" as speci0ed in momicring requirements of perndt.
- 5. Enter "Lmple A!casuremem" data for each parameter under "Qumility" and "Guahty" in units speciGed in permit.
" Average" is normally arithmetic mcrage (geometric average for bacterial parameters) of all sample mensuremems for each parameter obt:uned dunng "Alonilvring Perhh "Afarmmm" and " Minimum" are normally extreme high and low measurements obtained during "Afrmduring Pcem!" (Note to municipals with secondary treatment i nuluirement: Enter 34 day average of sample measurements under "herage." and enter maximum 7-day avera, cirsampic meamrements obtairied during monitoring penod under "Afe "r ") '
- 6. Enter "Permu Reaairement" for each parameter under "Ouantity" and "(p4
- as specified in permit.
- 7. Under "No in" cmer number of samph measurments during monitonng penod that exceed maximum (;md'or minimum or 7: day a ernge as apprepriate) ;ierunt requnement for each parameter.. If none, emer "0".
- 8. Enter " Frequency q/ Analyuf both as %ple Alcu3arment" (actual ficquency of sunphng and analysis used ;
dtui_ng memtoring period) and as " Permit Requimmem" specified in pennit. (e g, Enter " Cont
- for continuous j rnomtoring. "!d" for one day per veck. "!W for one day per manth. "140" for one day per quarter, etc.) l
- 9. Enter "Scmj!c ?);e" both as hj'le 1/cawement" (actual sample type used daring monitoring period) and as
% rmn Rapirementf (e g , Enter "Genb" for indiv! dual sample, ".Nf //C" for.2& hour composite, "N/A" for -
continuous monitoring, etc ) i
.10. Where vm!Ihom of pennit recpiremenM arc icrated, attxh a brief Op!anatieu to dcoibe umse and correcnvc abrions taken, and reference each violatma by date q
- 11. If"no dischaige" occurs during monitaring pcnod cater "Yo Dacharge" across form in place of data enin l i
- 12. E tCr me b?fi' ofl r0liifn$ EXUU$iVi' Qll5ref" W5th EddtllU?** Lf l'f!'lil] d heCHlltf 5:Yr Uf ,1 UibiO *'!Nd Agent," "Telejdwne Nwnberl and "Date" at bottom of fucm D. Mail signed Report to Omce(s) by date(s) specified m pennit htdn copy for your records.
a
- 14. MUTc de135Ied Ithtrudtio3S fM 16e of thiS OMharge A!Cni!Dring Nefort (!)A((l)[orm ma) [4 oDCdbed from Office (<t j sgcified in p.rmit. .
Legal Notice ! l Tids rervut n reqeded ley !ew (33 U.S.C. DIF; 40 C F.R.12L27). FA c to rtpmt a fihue to rep rt authfully na I result in ;ivd p-naities not to ex > M $10.W per day of mW ; or in rmnain A 4mitam O $25,000 per day ! cf vichti(m, m by imptiwmna t for not rwre thio one 3rm, or by hsh ! l l FPA Form 33241 Wev. 08-95) i l i
s PERMITTEE NOME /CDDRESS(farWeFerrA#yNameLacerme((Ddirono ICTIONAL POLLUTANT DISCH ARGE EUMINATION SYOTEM (NPDES) Form App' roved. . NAME nc4y33 gggggy pgggy 3 7 g 7 7 9.9 DisCHAR,GE gy. gj MONITORING REPORT (DMR,A fyy 73 gLgwggyg pggx p n - OM, .B, N,o., NN, , -
* ^P '*
CDDRESS F . O . iD s 4 D'#'9" (SOB' 0S) e
~
ATiN; D&VED 0%DC1r PERMIT NUMBEQ DecrHARGE NUMSM p ., y{g{ 5 NIPP iN 3 PO ET PE 15077 MONITORING PERIOD ' FACILITY ){,ygp yqg({y p:34 gg 37g,773g YEAR MO DAY YEAR MO DAY LOCATION s a cdc A0 DIScy AFCF { FROM 99 0s ut To vn i { MO h * *' U 3hY1D 3 u a 9 3 2 (* (20u21) (22-23) (24-25) 126-27) (28-29) (M31) NN R*U N W W NM' 13 cord Onsys QUANTITY OR LOADING I4 Card Onlyi OUANTITY OR CONCENTRATION I NO. mEQUENCY SAMPLE PARAMETER 146-53) (54-671 (3e-45I 146-531 (54-611 OF (32-37; # EX ANALYSIS TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 4 2., 81 (64-681 16S7a SAMPLE 3 c e e *: 3 acceno gn33,
'M MEASUREMENT g +1 3
? g. / 3 - I "!
[
, !c Gu g.
33370 ( 3 f) PERMIT cuocce O c e ey am e : s e: ,,3- nuee 9,9 gy .g g g
;rFLOS N" ',' A S $ S 7 a L O ;. REQUIREMENT me my97ggy ,, p 7 7 ., 7, m q ,, ,g
' {,0 J , fe ^ ? 1 P 'J I T 03 SAMPLE ( g 3) e$ecte %ccee -3 3 c o n e ff
! 4 i:9 f;E3IMMN1 PLAN: MEASUREMENT () , cg > / O. g7,f C /,3o k T[
3 l} % ^ 1 ') O PERMIT ypng* Ptprpy c00t03 coe ne. occee 90s ; gg- .5 TINE F F T l' E N T :J1SS Y A L 't f REQUIREMENT gg gg n3 y; y gg $gn u c r- qqgg SAMPLE MEASUREMENT
' PERMIT REQUIREMENT SAMPLE MEASUREMENT
- PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAMEITITLE PRINCIPAL EXECUTIVE OFFICER t CERTIFY UNDER PENALTY OF LAW THAT t HAVE PERSONALLY EXAMINED AND p. . / TELEPHONE DATE AM FAM: LIAR WITH THE INFORMATION SUBMITTED HEREIN; ANG BASED ON g ;
David, Orndori-
. MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON95LE FOR j -,
r (44 - /;/ . OsTAmiNG THE iNFORMATiON. i eEuEvE THE SueMiTTED iNFORMATiON is -, - Cten atry ianager TRUE, ACCUGATE AND COMPLETE. I AM AWARE THAT THERE ARE /
' f SIGNiFiCANT PENALTIES FOR SUeMITTING FALSE INFORMATION. INCLUDfNG n -
- THE POSSBluTY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. t 1001 AND 33 #* 9b u.S.C. e 131o. seenemes easer en se essaires mer *wasse skies se so s 70,000 SiONATURE OF PRINCIPAL EXECUTIVE g TYPED OR PRINTED and or menemen :_ _ :_ _ -.: oreerween a menees aaa s roeras OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLAN ATION OF ANY VIOLATIONS (Reference a# strechments here)
EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) , PAGE OF
- s a
.L Papenvork Reduction Act Notice
. Pubhc reportmg burden for this collection of infornation is estimated to vary from a range of 10 hours as an hverage per response for some minor fac'ilities, to 110 hours as an average per response for some major facilitics, ,
with a weighted average for cujor and minor facilities of 18 hours per reeponse, including time for reviewing '! im4 ructions, searching existing data r,ources, gathering and maintaining the' data needed, 'and completing and j > reviewing the ce!!ection of infonnation . Send canunents regarding the burden estimate or any other aspect of l' this! collection of information,' including suggaticas for redu;ing diis burden, to Chiet Information Policy i Pns.o:h, PM-223, U.S. Ennroomental Protection Ageney,401 M Stret, SW Washington, DC 2WO; and to the i OfGce ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
' j L- _ _ . . _ _ . _ _ _ _ -
General Instructions ! 1)If' fonn has been padially completed by preprinting, disregard imtmctions directed at entry of that infornution . j- : already preprinted. l 2yEnter " Permittee Name4 falling Address (and facility name/ location, if ditTerent)," " Permit Numberf and
~
- Discharge Number" wh"re indicated. ( A separate form is required for each discharge.)
3, Enter dates beginning and ending "Afonitoring Period"coscred by fann where indicated,
-4. Enter each " Parameter" as specified in monitoring requirements of permit.
i
- - 5. Ents " Sample AIJanrement" data fbr exh parameter under "Quannly" and "(Juality" in t nits specified ia perrsit, j " Ave. ige" is normaH) anthmetic average (geometric aserage for bacterial paramctc.rs) of a'l sample measurements
] for each parameter obtained during "Alamtormg Pam:P; "Alnumum" and "Ahmmum" are coimally extreme high ' and low measur,ements obtained during "Afom!ormg Permd" (Note to municipals with tecondary treatment requirement; Enter 30-day aserage of sample measurements under %cragef and emer mammum 7-day average } of sampic measurements obtained during monitonng period under "Alanmum."f 1 - 3- 6. Emcr " Permit Per/mrement" for each parameter under "Guantity" and " Quality" as specified in permit.
- 7. Under "No Er" ewer number of sample measurments during monitoring period that exceed' maximum ;and/or minimum or 7-day averagc as appropriate) pennir requirement for cach parameter. If nonc, enter "0".
e 2- . 8. Emer " Frequency of Analysis" bath as
- Nam;2/c Afeasurment" tactual frequency of sampling and analysis used j . durink momtoring pericni) and as " Permit Rchmeemen!" specified in permit. (e.g, Enter "Gmt? foi continuous menneringl"lo" for one day per weck, "/do" for one day per month, "/M far one day pcr quarter, etc.)
i { 9. Enter " Sample npe" both as "Sumph Alcasurement" (actual samp!c type used during rnonitoring period) and as
"?ctmu Requirement? (e.g , Enter " Grab" for individual Anuple, .N//C" for 24-hour composite, "Nd" for continoons monitoring, etc.)
- 10. WIIere piointiens of permit requirements are reported. adach a brief explanation to descriN cause and corrective actions taken and reference cach violation by duc ;
i1. If "no discharge" occms during monitoring period, enter "No lhscharge" across funn in plaec of data entry.
- 12. Enter "Name Ti:le of Pnnti;>al Executwe Oficer" wsth " Signature of Pnnapa: Gewt:ye Q1ilcer of Authoriced Agen! " "Tel; phone Number: ared "Date" at bonom of form
~
.13; Mad signed Report sc OGcds) by due(s) specified in pe:mit. Retain copy far your records; IL More detailed instructions fer use cf this Discharge Atomranng Report fDA/RJ fccm nay be obtained ficm OtTicets).
specified in permitc Legal Notice rhineyn %umny sw3 e s.cwm a c.u.tm. rau-pm er unwnporunnhfuny an inuh in civil pcmi!!u not te newJ i!O.000 per day of viciotim; or in crimina! penaith s no! to need $25,MO pa day of Wolation, or by imprisonant im rat more thw one year. or by both, 4 EPA Foero 3320-1 (Rev. fM5)
-Am. - _
PERMITTEE NAME/ ADDRESS (J=rweFordisvNeerterenes((Pafsrust) NATIONAL POLLUTANT DISCHARGE ELIMtNATION SYSTEM (NPOES/ Form ApprIved. NAME ;ggyp < y g {,(g y pg g ;z S7g777p NHy- t M m m m R M (D t7 3 gg; 13 OMB No. 20N4 '
'P7?)# %TG Si 1 * (SUBn O 2,) ^EE'" * #**
ADORESS P . 3. H3X 4 ) A T T ti ; OAV13 3MNOO3g PERMIT NUMBER DcSCHARGE NUMBE3 y . p{gg{ , SMI PPIN O PC RI PA 150"'7 MONITORING PERIOD
' C l '** # E YALLbI PM C M UIIIl3U YEAR MO DAY YEAR MO DAY -
LOCATION FROM TO ) -r ?*S 0** 4 n c9 at in h 5s tD LIZ5!JRGf {_l
*TT%: ^tVED 3 itN D 3 9 V f20'211 122-231 92'-251 426-271 128-292 430 311 O W Reed k & W oro s @ % % M m.
(3 cerd Onry; CUANTITY OR LOADING (4 Cerd On#1 QUANTITY OR CONCENTRATION N O. FREQUENCY SAMPLE PARAMETER 146-531 15+611 (30-451 (46-531 (Sosti oF (32-37/ EX ANALYSrs TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,ss.e f,4,,, fgg7o,
> q' SAMPLE c0odet t?ted? 070000 ( 12) /
MEASUREMENT h, t! 1 h/6 6 7 Mh
^
g g g g r) 1 *) - PERMIT 060cce B &cM y 0 203 ..Q 00c000' 3.0 ifRLY -dAF
- p e p; t *; 7 ,; 3 2 y z g ;i y REQUIREMENT meg 97ptgg 9 4 y 7 8,1 % n
' L '11, !F C]h03[I 3p SAMPLE
( 93) 0 $ c a ce 9aceno c o o c t: $ ff c u e; r wa r t (ci pLari MEASUREMENT gn( g -jf C /7 g ,T iS050 1 7,
^
PERMIT - grppam >cpOp! c30500 c m 3C 6009c0 + cc9 S g y,L Y S T I n. ;
- r e i e, - 47 7 o ic 3 v3Ly, REQUIREMENT qg yyg myyy gy .,--r, cer
'aLOTIVr, r !) ; ii. SAMPLE n % ': 6 c 9 neocc: nc3ces ( ;o) y i L g I S u r,1, MEASUREMENT 4 r/ { [ r -- n /30 gg,l
;9C. ) 1 0 ,) PERMIT 00c600 e cheen , c loe C c C 3 0 r: SUDR* 9Epco; VICg/ A LC; t,
'P r f.U U ; ? , ' 15 .; i ,* L n y REQUIREMENT top % pn .3 7; 79q7 ggg em 3ggyg SAMPLE a .
h _: 7 I h * ,1+ MEASUREMENT g g, f <gg < ci, f () fp p 44 PERMIT REQUIREMENT pg/g SAMPLE ,/ MEASUREMENT <g,p_ 4c ,.; 4.3, ; g 37 (.;y ex..46, ., tv e a- PERMIT REQUIREMENT ,,, j SAMPLE MEASUREMENT 4 c, c ; < g, P I <OIa ('e T [m4 sy a 1d * ,
/ c T es i PERMIT REQUIREMENT jyg.g SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THATI HAVE PERSONALLY EXAMINED AND TELEPHONE DATE AM FAMILIAR WITH THE INFORMATION SUSMITTED HEREIN; AND BASED ON . m o MY INOUIRY OF THOSE INOlVIOUALS IMMEDIATELY RESPONS18LE FOR , f OBTAINING THE INFORMATION, t BELIEVE THE SUSMITTED INFO *MATION t$ c .
[ V DdVid Orndorf TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT PENALitES FOR SUBMITTING FALSE INFORMATION, INCLUDING p M" s/, p' p ',-p ; Chenistry Manager THE POSSIBILITY OF FINE ANO IMPRISONMENT. SEE 15 U.S.C. 91001 AND 33
- 412 m. 4113 <> d 1U 13 u.S.C. 131o. sesaemu enMer mese seenme mer *wwe time e, so sto, coo 800 NATURE OF PRINCIPAL EXECUTNE g TYPED OR PRINTED amtormammsw L __ z er between a mones sw e years.J OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# ettechments here) i ti C O. F SMALL "J - 'I D ^13CMt. .- QF f' L O * I M T 99t*n~ 3? VIS[dLP T 1 A *' IN O T d r ^- P i .t N T Sii C '. A NDU N T<.
EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.i PAGE OF
. gy7q g g,gggg
c Paperwork Reduction Act Notice
- 3 Pablic reporting burden for this co!'lection ,of information is estinnted to vary from a range of 10 hours as' an _ '
average per response for some minor (seilities, to 110 how ra an average per response for some major facilities, ' with a weighted average for major and mkm racilities of 18 hours per response, including time for reviewing - ! instructions, searching existing hta scureen, gathering and maintaining the data necded, and completing and i reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of infonuation,' including suggestions for reducing this burden, to Chief, Iriformation Policy , Branch, PM 223, U.S. Envimamental Protection Agency, 401 M Street, SW Washington, DC 20460; and.to the ! Office of Information and Reputatory Af fairs, Of fice of Management and Budget,. Washington, DC 20503. _ . _ _ ~ . - . . .
~-
_._..u_, _ General Instructions
- 1. lf form has been partially completed by preprinting, disregard instructions directed at entry of that ibformation t
already preprinted.
- 2. Enter " Permittee -Name/Ataihng Address (and facility name/ location, if different)," " Permit Number," and !
" Discharge Number" w here indicated (A separate form is required for each discharge.)
- 3. Enter dates begimting and ending "3/omforing Permd* covered by form where indicated.
t
- 4. Enter each " Parameter" as specified in momtoring reqmrements of permit.
. . i
- 5. Enter " Sample A/casurement* data for each parameter (mder " Quantity" and "Guality" in units specirted in, permit. .
"Aecrage" is normally anthmetic average (geometric average for bacterial parameters) of all sample measurements _
for each parameter obtained during "A/onitoring Period" "Marimum" and "Afinimum" are normally extreme high ; and low measurements obtamed during "Afomtormg Penod." (Note to inunicipals with secondary treatment - -l requiremer,t: Enter 30-day average of sample measurements under "Awrage." and enter maximem 7-day average ' of sample measurements obtained dunng momtonng period under "3/aximum ')'
- 6. Enter " Permit Regmrement" for exh parameter under "psomity" and *guahty" as specified in permit.
7.' Under "No &" enter number of anpk measurments during monitoring pened that exceed maximum (and%r mmimum'or 7-day average as appro xiate) permit requirement for each paramder. If none, enter "0". I
- 8. Enter "Frcqwney of Analysis" both as " Sam;h Aleasurment" (actual frequency of sampling and analysis used i during momtoring period) and as "?cemit Rcquirement" specified in pemnt. (e.g , Enter " Con / " for continuous !
monitoring. "IP fer one day per weck. "!a0" foi one day per month, "//90" for one cby per quarter, etc.) 1 9L Emet " Sample 7)pe" both as " Sample Measurement" (actual sample type used during monitoring period) and as "Perrmt Regaremcnt " . (c g., Enter " Grab" for individual sample, "24/K1 fbr 24-hour composite, "N'J" for - ; dontinuous motutoring, etc.) ' 10[ Wherc vichtions of pennit rcquirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference cach violation by date. j 1
- 11. If"no discharge" occurs during monitoring pcriod, enter "N> Discharge" across form m place of data cran i
- 12. Enter "Namh7'itic of Principal &cain e Oficer" wim " Signature qf Pnnapal &ecutoie @cer of Actinit:ed Agent " " Telephone Number," and *Date" at bottom of form.
- 13. Mail signed Report to OfDec(s) by date(s) speciDed in permit. Fdain copy for your 1ccords.
14; More detaikd istructions for t:sc of this Discharge Alonitoring Report (D3!R) form may be obtained from OIDeels) , spec ficd in permit. Legal Notice , J Thn report is redmrdd by law (33 U.S,C. 018; 40 C F.R i 5.27). Fa;hm: to rqort or f ailure to report tmthfully can ] muit in d il penedties not to exceed $iO,093 per day of no!atmn; or m crimma! p; ulties not ta ermd $25fMO per da ! of siebtionf er by impriwament for not more thw one year, or by both. ! l EPA Form 3M0-1 (Rew OMS) i
= - m - - + - . .%- w+9 m W .- 1
._m m - . _ __ ._. . .- - -__ _ . .
.
- w
'TRutTTEE NAME/ ADDRESS d=a eFaery%==Lorenes(D@uarf NATIONAL POLLUTANT DISCHARGE ELIMfNXTION SYTTEM /NPOES) Form Apprrved. ~
ISCH r NAME p g 4 y; . V AREY PO2ER 5'A' ION E MONITORING REPORT (DMM OMS $ 2 ADDRESS P , 3. p31 11 &*S'1469% 10i * ( 5 U l'S 3i) ^ PEW %**!
%TTU; &iVID 02,xD0ap PERMIT NUMBEn 0 SCHARGE NUMBER v . yyyg* [
>g*t ye T. r. 2 p p p e, t , 1 r,3 7 7 " *" J D "'
MONITORING PERIOD FActu n gpgygg ygnggy 73s3q 3p,7733 YEAR MO DAY YEAR MO DAY , , , , , LOCATION FROM 4 ;, ;a at TO 's t 9 000 "O DISCHAH;E j- 005 (20 271 (22-23/ (24-25J (26-27/ (28-2.91 (303ff NOTE: Reed instructions before coin lpleting this for A7*M* D%Vi) 34MD3G" (3 Cerd ontys CUANTITY OR LOADING I4 Card Onlyf QUANTITY OR CONCENTRATION NO. FREOuENCY SAMPLE PARAMETER I46-53) 154-611 136-45) (46-53) (54-619 OF (32-37/ EX ANaysis TYPE AVERAGE MAXtMUM UNITS M!NIMUM AVERAGE MAXIMUM UNITS ,s2-43> (64-68) (sm
,3 SAMPLE MEASUREMENT PERMIT -
occost o o p e ere fo r: e h o v e e n ^ rs c c ae y,g4 2001$0 400cc7 9.0 7G ( 12) O //[ n gY -,yD. gff 30'00 1 ? O ; , Q rr nypsp : aTg3 y;Lp, REQUIREMENT ,v a g 7 g g 7 . pe - 34(Iqna m 53LTD3, T 7 A L SAMPLE 90cNe9 eenec+
- n he c t ( 19) f O
,333..y y p MEASUREMENT 4 // 4 L[ [ hp y ') s ] q 1 3 A PERMIT c t o t N r- coenac e 10 0 0000c0 30 l fj 0 ' -g R L Y OMN 2 I tPLynst ; :qc : 735>p REQUIREMENT we sq ywy g3yty q ,rft
)T L A96 G 9 r, A S T SAMPLE $2cq^n ecre3; .g g 3 gg- g I ') / f
~J3% T E T :i-Gi: A Y dETp MEASUREMENT -
.- F to b '
10 5%. 1 9 O PERMIT occono ccenno e e- c <r e c 's e e 15 20 prgLy .qAs
;e P 10 4 * 'f1sc y 4Tjie REQUIREMENT yeoe . +g gyq p3ggy g 4cf( j
!!*" % tt, A N *" 0 N I X SAMPLE .- c o n e 'c^^0? S 0 r; n 0 0
( 19)
"3 1L (iS 4 MEASUREMENT N/A ~, _ , _
p
}961S I 3 4 PERMIT Chenen n900&O - 200 0')0000 ;i ? P 3 S T KDORT EKKL1 dab prggr1- , in i; y.Ly; REQUIREMENT son, p 3y3 pgygy-pg ;ft
'LM, IN J%CJIT 05 SAMPLE ( 03) C00003 WO00^ CW 3 c 9 i 21"4 T9EA!N YNT PLANT MEASUREMENT g,gjg g gg g C Ng { 7
^i ') P 5 9 1 P *
, PERMIT 9,EpnDT D*Pfw r Occ00C C ;4 0 0 OGoccc 3 ': 0 i AIL! ChTls re[P ;T , ; 7 r; ? Y z L 9 l' REQUIREMENT yr 4ya 937yy 3y ,33 cenn ,
,me" synEAm t;' SAMPLE *"$ c ' O ? 000073 ( 1%)
MEASUREMENT i1 31 ) 1 :) S PERMIT O '" d e t e n*A900 ^ !": OCS*C1 RPF38? REPOET :
#E%Li RAB
- P CLO' V T ~133" VELJ: REQUIREMENT yece 3 ,3 3g .p y gy ay- wgf; SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER FENALTY OF t AW THAT I HAVE PERSONALLY EXAM!NED ANO .
/ TELEPHONE DATE AM FAMILIAR WITH THE INFORMATION SUBMtTTED HERE!N: AND BASED ON /N i/O
/
/
MY INQUIRY OF THOSE INDIVIDUALS iMMEDIATELY RESPONSISLE FOR ' f ' David Orndorf OBTAINING THE INFORMATION. I BEUEVE THE SUSMITTED INFO 8tMATION IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE : /fr/ /
)k g y"j f StGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING ditd STEy hailQCr THE POSSIBILITY OF FtNE ANO IMPRISONMENT. SEE 18 U.S.C. 61001 AND 33 !.s 1 W J-%}l1 9 (> 1O
*~ 1R '
u.S C. t 13te. temenee anser an.se senms mer subae rhus se so s70,000 840 NATURE OF PRINCIPAL EXEckJTfVE g'l -- - TYPED OR PRINTED .aa er msnman v - _ er eer n e momns sma s y rsJ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# ettechments herel i f a ti A / I N F A: 3 a * *i O VI A '3NITJ4!JG TS PT5"Y '"-?NO carIO32 OF 1?T LAY'!P. EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) p g PAGE OF 7 ,
a-----------_._----,----_-------a---_____..------___-,----___----_---w-_--,__-_.---.--___------_-..-_u___-----.,--,-_s- - _ _ - - - . - . - - _ - , - - , _ - _ - - _ - - _ _ m__ - - - - - - - , - - - --_m- -
_' - - a m' -
L Paperwork Reduction' Act Notice Public reporting burden for this collection of information is estimaRd to vary from a range of 10 hours as an average per res;mnse for some minor facilities, to 110 hours as an average per response for some major facilitks, i with a weighted average for major and ndnor facilities of 18 hours per respoose, including time for reviewing - i I
' instructions, searching existing data sources, gathering and maintaining the data necded, and completing and :
reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of j this collection:of information,' including suggetions for reducing this burden; to Cidef, Information Policy ' Bramh, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Wahington, DC 20460; and to the Of6ce ofInforrtution and Regulatory Affairs, Office of Management and Budget, Wahington, DC 20503, ! k' General Instructions ! 1
- 1. If form has been partially completed by preprmting, disregard instructions directed at entry of that itformation already preprinted. '
2 Enter " Permittee Name4failing Address (and facility name/ location. if different)," " Permit Nmnber," and '
"Digharge Number" w here indicated. (A separate form is required for cach discharge.)
- 3. Enter dates beginning and ending "3/oniformy Period" covered by form where indicated. -
)
C Enter each " Parameter" as spcci6ed in inonitoring requirements of permit. j
- 5. Enter "Sampic Afeasurement" data for each parameter under "puanny" and "pcahty" in units specified in permit.- l' A mrage a norm;dly arithmeuc average (geometnc average for bactenal parameten.) of all sampic measurements for 'each parameter obtained during "Alonit9rmg PerhnP; "3/arimum" and "3/munum" are normally extreme high and low meamrements obtained during "Afomformy Permd " (Note to imudcipals with secodiary treatment i requirement; Enter 30-day average of sample measurements tmder " Average," and enter maximuin 7-day aerage i of sampic meamrements obtained during monitoring period under "Atarimum ") j
~
- 6. Enter "Penmt Requirement" for each parameter under " Quantity" and "puclity* as specified in permit.
7cUnder *No Ex" enter nwnber of mmple measunnents durini; monitoring period that exceed maximum (and/or ndnimum or 7-day average as appropriate) pernut requirement for each parameter If none, enter "0". a RJ Enter "Frel;hemy of Analysis" both as " Sample Akasurment" (actua! frequency of sampling and analysis.used; during merutoring period) and as " Permit Requirement" gecified in permit (e g., Enter " Con /," far continuous monitoring; "la" for one day per weck, "/ G0" for one day per month, "150" for one day pcr quarter, etc.) l
- 9. Enter "Samp/c ')pe"1 both as " Sample Measurement" (actual sample type used during monitoring periodrand as )
"l'ermit .Rgquirement " (e g. Enter " Grab" for individual sample, "N/r" for 24-hour composite, TA" for '
continuous monitoring, ete )
- 10. Where violations of permit icquirements are reported attach a bneruplanation to desenbe cause and corrective
' actions taken. and reference cach violation by date.
J IL ff"no discharge" occurs dwing monitoring period, ente: "% Discharge" across form in place of data entry.
- 12. Enter *Namditle o!Trincip:d l'ucutn e OBcer" with ' Sign 4 ure if Pnnci ud t Ezecutive Ofcer of Au;hxtred j
, Agent," " Telephone Number,* and "Datef ut bottom of form.
13, ' Mail signed Report to Office (s) hv date(s specified in permitz Retam copy for yoat accords. d
, it More detailed instructions for use of this Dacharge Aksitoring Report (DMR) form may be obtained from O!nce(s) ' j
- n. ecified in perns. i q
Legal Notice ; i Thh r6part is requiwd by law (33 U.S.C,1318; 40 C.F.R.125.27) Failme to rqort or felure to rep <at truthfully un result in civil penalties not to enced $10,000 per day of viof ahom or in erunmal penahies na to excetd $25.000 per d9 of violation, or by imprimnmeat for not more thaa one year, or by both EPA form 3320-1 (Rev, OL95)
4 e a PERMITTEE NAME/ ADDRESS dare,MererrN =s'Leersea trD@eary N7.TIONAL POLLUTANT C:SCHARGE EUMINATION SYSTEM (NPDE31 Form Approved. NWE N _gjE NORM REPORT<t /Dg -
- (4y; y3;ggy pggyq g7p7;3y 7 2 I y ? ;_ r C r, ", r gOMB No. 2040-0004 ADDRESS P . ? , d3X li "*""' E1' I '* F
( 3 ri g r p $) AWO 78 MW ~ 3 ;7;y; ;4yI< 33gn9t., PERMIT NUMBER oiscHARGE NUMsER p , p 7 g. g . saI?PI%3PJPI d' I507 MONITORING PERIOD Ft.CluTY ;r3yyq ygggey pg 7 y 37g7134 YEAR MO DAY YEAR MO DAY LOCAT M OGC 10 DI SC'i A D J T FROM *
/ ., TO ir r i .
l_] 00? NOTE: Reed instructions before completing this form. ((y;e r:. a g r :: 37NO95" s (2G2FJ (22-231 (24-25) (26-27/ (28-291 (30'371 r3 Cent onry; QUANTITY OR LOADING /4 Card ontyr QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE PARAMETER (46-531 (54-6r1 (38-459 (46-531 (54-691 OF (32-371 EX ANALYss TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS nes; gg4_gg; fgg7o, ip SAMPLE c:6*^* ?rSe3 $$9eac t1 (^ ) s MEASUREMENT 7, K / ,
/, / / O % (l y,{
31909 1 7 g PEP.M!T e ? A r- 6 n^neco t. P a c_ 3,9 t e? P e LO ,;I c g f :g A n
.. r o L n a
'a
; e n ., y*;3) REQUIREMENT , e. c ~ 7IhiMDs FAVTM1N 'n NW9
-'a?.rns r as ,
- J = .ta .r . SAMPLE cr e e * *, 5 e n e * *- ets5 - -
{ 1 g) ,f y ,2 . C.,
, , e n p ;p g MEASUREMENT / 4/ . 7 , /, f
/ gQ (
'^'^^-
10 < ? ? 1 : O PERMIT nee ^^^ ^ecetc ^^ 33 100 gigg/ 6Ag rer y r ., - *
, , y;L REQUIREMENT me, zn f7, p,7gy gg gm 3 g ,3 TT L lt i n Gy;> ;p SAMPLE ocet9^ e66677 cevcce , ( 19) O 2 , ,
-,<-,s ;x T [ . -, ;f 5;7; MEASUREMENT 4 $, 4 j> g Cy
! T ; T (, t 1 0 PERMIT occ0e* 06Sn^^ r 360 ucconc ( !, 2 f) ,1CE/ ,dpy 7 F t 'J '" ~, P 1 ; c t' A L g : REQUIREMENT 3ne- 30 (v0 DATLY PY <~/t
*Dhh s t, c a , 15 7 ,30Dg'* 3q SAMPLE ( " J) ectona i c ; 0 *t t 60c9tc y
.w r:syap 47 j ,; y - MEASUREMENT ('/, p/ p, pgj / M gf u k 7-
,gnqs 1
' o PERMIT r"DS9a trone- 030000 00^003 0*;0300 Sco 4ICt/ f!Iy?
, r. :. ; q ;, z,,,, y,ps REQUIREMENT a; zer n.T7v ,g
, ,7n ;ec qqg SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT t HAVE PERSON ALLY EKAMINED AND , ~ ~ TELEPHONE DATE AM FAMlUAR WITH THE INFORMATION SUBMITTED HEREIN; AND SASED ON ,.,s ;
MY INQUIRY OF THOSE INDIVIOUALS IMMEDIATELY RESPON98LE FOR ,, W OiW id OrIlGO r [
. OSTAINING THE INFORMATION. t BEUEVE THE SUBMITTED INFORMATION IS If #/- u/
TRUE. ACCURATE AND COM8 TETE. I AM AWARE THAT THERE ARE A j -[' d 43 7 f h' Chenisteryhnager "N'S*"sIuN"OENE H Eo fu"E* MENT '*s'EE'"is 0"s^c'.'S"iEi EoS - 912 393-5113 9 t> 10 lb SIGNATURE OF PRtNCIPAL EXECUTWE g TYPED OR PRINTED .u.s.c. aa eremenemna 131s. Pwasmes n _ anwar mese mures
- .reerw mernabeauc s m nes a r.e snes
.in sup me s70.000 OFFICER OM AUTHORIZED AGENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLAllONS (Reference elf attachments heref EPA Form 3320-1 (08-95) Previous editions may be used, (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF 7 , / -
03
Paperwork Reduction Act Notice Pubbe reporting burden for this collection of information is estimated to vary from a range of 10 hours as. an averuge per response for some minor facihtieN to 110 hours as an average per response for some major facilities, Wh a weighted aserage for nujor and rninor facilities of 18 hours per response, including time for reviewing - instructions, searching existing d.sta sources, gathering and maintaining the' data needed, and completing and reviewing the collection of infonnation. Send comments re2arding the burden entirnate or any other aspect of i this cou-tion of iriformation, includin~g suygestions for redming this burden, to Chief, Inf6rmation Policy Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Waabington, DC 20460; and to the Office ofinformation and Regulatory Affairs. Office of Management and Budget, Washington, DC 20503.
.i General Instructions 1.l1f fonn has been partially completed by prepriating, disregard instructions directed,at entry of that information
-already preprin:ed.
I
- 2. Enter "Permittec Name/Mailmg Address (and facility name/ location, if different)," "Pernut Number " and
" Discharge Number" where indicated. (A separate fonn is required for cach discharge.)
3J Enter dates beginning and ending "Monnoring Period" covered by farm where indica:nl
' 4. Enter each " Parameter" as speciDed in monitoring requirements of pennit
- 5. Enter "Nample Measurement" data for each parameter under "Guantay" and "Ghalay" in units specified in permitt
" Average" is nonnally anthmetic werar.e (geometric avempe for bacterial parameters) of all sampic measurements for each pammeter obtained during "Momformg Pmod"; " Minimum" and "Mmimum" are normally cN1reme high and low measurements obtamed during "Afonnoreng 19rimi" (Note to municipals with secondary treatment reqmrement: Enter 30-day average of samp!c measurements under "Acrage." and cmcr maximum 7-day average; of sample measurements obtained during monitoring period under "Manmum ")'
, 6. Entet " Permit Requirement
- for cach parameter under "Guantay" and "Gualay'* ar specified in pentat.
1 [ 7. Under "No Ex" enter number of sample measarments dmmg monitoring period that exceed rnaximum (and'or minimum or.7-day average as appropriare) permit requirement for each parameter If none, enter "0"
- 8. .Eser " Frequency of Analyns" both as " Sample Measurment" (actual frequency of sampling and analysis ~ used -
during monitoring period) and as "Permu Regwrement" specified in pennit (e g, Enter " Cont " for continuous monitoring, "1m for one day per weck, "Idp" for one day per month, "MU" for one day per quancr, etc )
- 9. Enter "Sampic Epe" both as " Sample Meawement' f actual sample tvpe used during monitoring period) and as "Pmnit Rnparement," (e.g., Enten " Grab" for individual sample, ."Mr'" for 24-hour. composite. "NF for continuous monitoring. etc )
10.-Where violatiom of pennit rcquiremena arc reported, attach a brief explanation to descobe cause and corrective acticas taken, and ref rence each violation by date. I h If"no discharge" occurs during monitoring period, enter "W Discharge" acron fonu in pbce of data entry . I2. Enter "Name-71tle of Principal Dewave OBher" with " Signature of Prindfal hecutive Qilicer of Authort:ed Agent;" "Teltphone Number," and "Date" at bottom of form 13, biali signed Report to Ornce(s) tr., date(s) specified in pcomt metain copy for your records.
- 14. More detailtd instmetions far use of this Discharge Emrermg Report (DAIRi fuim may be obtained from OfTrce(s) speciGed in pennit.
Legal Notice Thiirgott is required by bw (33 U.S.C.1318, 40 C.F.R.1252 /). Failure to rqvn or fdhare in rymrt truthfuMy can
. nsatt in citil peostics not to exceed $10.WO per day of violarbn; or in truninal patties nm tu ced $25,000 pu day of violation, or by imprimnrnent for not more than cue year, or by heth.
f EPdTtmm 3320J1 (itew 08-95)
__ __ . . . _ o. . m .- ~. . . .. . ._m _.
. 4 PERMITTEE NAMElaDDRESS f7ame Facehy Name-Imrereen (fW) NATIONAL POLLUTANT OF' CHARGE EUMINATION SYSTEM (NPDES) Form Appr;ved.
DISC NAME q7.gy3g q, p r,( g y p 4 3 g 4t qpq7;ga MONITORING REPORT (Dg D G "~. 3EI1L;y3 ; OMS No. 2040-0004 - ADORESS P . ;) e $3X 4 r. t n n ' 4 c ] 4 111 3 (g g pf p 93} APPM'(*Yf'. 05-AT!N; O A V ! *) OMU0?? PERMIT NUMBER DeSCHARGE euMsER y _ y7y4g EMIPPIi3PO9Y PA 15977 MONITORING PERIOD I FACILITY qggypg y g (; c y yy gg g;p73g LOCATION FROM 9n o o e1 TO an ay J.< 090 F0 DISCHEJGL j_{ eh NOTE: Reed inetructume before completing thie form. i
&7T4: DhYZD %% NDY ? t20211 (22-231424-251 t26-271 128-291 13&3r; PARAMETER !3 Card On&f CUANTITY OR LOADING I4 Cod On&A QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE 146-531 (54-691 (30-461 146-531 (54-619 OF (32-371 EX ,,3tys,s TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS oss, gg ,. ,,; fu a SAMPLE c: c eran~ ne**c0 r 993;Ja
( ^^) 5' , , MEASUREMENT ,( / ) %,/ /
~
C %j 4 4( 33300 [ O ') PERMIT c o o r. 9
- ee6ete c w o :' ,,0 cc90ce. ),0
- WI;g/ ;44 9 703,3 V A Lit t REQUIREMENT :en) 3 7 9 7 .s p n - u;7;gu - .j ggq7g
'rFLffe't?
'3L{On, 70*gL SAMPLE 0c&$^$ dento) 60e3c? ( 19) -
#[f f, 3 :1 $ 0 E n D ,, MEASUREMENT 27y y 2. y O NH( ,
10530 1 0 0 PERMIT C00cch e eeteco .c tot ecoc^c- 39 100 ggg/, Op;p)q c r e t,9 : er r;-s33 gatoj REQUIREMENT mee g,; ygg pgyg >p ngf; egpq PLO/, Ib "34001T 0: SAMPLE ( ? )) Oc49?c ^^23cc escuve j
* 't 'm 7% {1TnC NT P L 4 ',1 MEASUREMENT g yq C, ppi K O y/,2 O gy i
;1750 1 ') O PERMIT P C p p it '* r ?pm y CCnoco c0000u c o c c:'r e '; t o 4ICg/ GTyng
- " L ili 17 ': 1ss V A Uf 2 REQUIREMENT g g y e; MTTV *i 4 M *- 200* *:O N T H SAMPLE MEASUREMENT PERMIT.
REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT . , ! REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PfMALTY OF LAW THAT 4 HAVE PERSON ALLY EXAMINED AND TELEPHONE DATE AM FAMlUAR WITH THE !NFORMATION SUBMITTED HEREIN; AND BASED ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONStBLE FOR !~ I #. OSTAINING THE INFORMATION i SEUEVE THE SUBMITTED INFORMATION IS [f ./ -
/ -t David Orndorf TRUE. ACCURATE AND COM=LETE.
SIGNtFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING I AM AWARE THAT THERE ARE k /#4- #
'4 '
M' E j ' THE POSS'BIUTY OF RNE ANO IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 M*' M3 Oll3 46
- 10 la
SiONATURE OF PRINCIPAL EXECUTWE u.S.C. O iste. # Pensees amsse mese serame mey bcAnn naes se so s 70,000 AREA TYPED OR PRINTED eas er maremeC _ - _.: c eerween s mones saa s yseral OFFICER OR AUTHORIZED AGEftT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference o# strechments here/
EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE , OF 9 0 0 7.J /19 0 E 10 - 0,-- 0. _i, i
- _m _ . _ . . _ . _ _ _ _ . _ _ . _ _ _ . - . . _ _ . . _ _ _ - _ _ . . _ _ . . _ - . _ _ _ _ _ _ - _ - - _ . _ _ _ _ _ _ _ _ _ _ _ - _ _ _ . _ _ _ _ . _ _ _ . _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _-- -
a .a +m . _ m --
Paperwork' Reduction Act Notice ! Public reporting burden f$r this collection of information is estimated to vary from a range of 10 hours as an average per ' response for smne minor facilities, to 110 hours as an average per response for some major facilities, ; with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing - l
. instmctions, searching existing data sources, gathering and reaintaining the dats needed, and completing and !
reviewing the collection o' firtformatiorn Send comments regarding the burden estimate or any other aspeit of this collection 'of information, including suggestions for reducing this burden,to Chief, Information Policy Branth, PM-223, U.S. Environmenta! Protection Agency, 401 M Street, SW hhington, DC 20400; and to the Office ofInfornution and Regulatory Affairs Office of Management and Budget, Washington, DC 20503, General Instructions-
- 1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
. already preprinted.
- 2. Enter *Permitter Name'Alailing Address (and facility namcIlocation, if ditTerent)." " Permit Number," and
."Disdrarge Number" where indicated (A separate form is required for each discharge.)
t
- 3. Enter dates beginning and ending "A!nmtoring Period" covered by form where indicated.
4J E'nter each " Parameter' as specified in momtoring requirements of permit.
- 5. Enter " Sample A/casurement" data for each parameter under " Quantity" and "Quahty" in units specified in permit.
" Average" 1s normally arithmetic averag - (geomeinc average for bacterial parameters) of all sample measurements for cach pasameter cbtained dunng "Ahntoring Period' "Mawnum" und ." Minimum" are nonnally extreme high and low measurements obtained during "Afonitoring Paicd" - (Nete to municipals with secondary treatment
!. requirement: Enter 30-day average of sampic measurements under " Average," and enter maximum 7-day average of sampic measurements obtained during monitoring period under " Maximum. ") -
- 6. Enter "Permir Requrrement" for each parameter under " Quantity" and "guality" as specified in permit. -
- 7. Under "No !G" enter immber of sampic measurments during monitoring period that exceed maxinium (and/or minimum or 7-day average as appropnate) pennit requirement for each parameter. ;If none, enter "0". .
- 8. Enter "Fenjuency of Analm" both as *%imple A/casurcrent" (actu;d frequency of sampling and analvsis used j j daring monitoring period) and as ." Perm!/ Reymrement" specified in permit, (e.g., Enter " Con!" for continuous !
l morutoring, "l/7" for one day per u eck. *100" for one day per month, "/M0" for one day per quarter, etc.) l 9.' Enter "Swnple Trpe" both as " Sample Meawrement" (actual sampic type used during inonitoring period) and as j "Pcrmit Requirement," (c g, Enter *Grah" for individual sample, "241/C" for 24-hour composite, "NM" for - j eentinuous monitoring. etc.) l l 10 .Where violations of permit tequirements me reported, attach a brief explanation to describe cause and corrective -! actions taken, and refacnce cach violation by date. Il. lf"r[o dihcharge" occurs during monitoring period, enter "No Di.scharge" across form in place a of dat' entry. l
- 12. Enten "Nameniti of Pr ncipal Executwe Ol]icer" uith "Signatsre bfl'rmeipal Executwe Oj)icer of iuihari:ed j itgent," ? Telephone Number," and "Date" at bottom of form. ~
- 13. Mail signed Report to Office (s) by d.tte(s) specified in permN Retain copy for y our records.
I4. More d: tailed instructwns for use of this luharge Monitoring Report (DMR) harm may be obtained from Omce(s) specified in permit. ! Legal Notice ) t .l i' This report is required by la (33 U SL .1318; 40 C.F.R.12527). Fadure to srport or falure to report umbfully an
/
} iesult in civil pena!hes not to cdeed $10.000 per day of viobti4m; or in erinuntd penahies not to eneed $25,000 per day j of viobtion, or by imprisonment for not more than one yar, or by both, s EPA Form JMO--I (Rev. 0845) ' i 4 i. i ! se * -p--g W -
, t .
PERMITTEE NAME/ADORESS g=Me F=en he twenes g(D@wac NATIONAL POLLUTANT DISCHARGE EUMtNATION SYSTEM (NPOES/ Form Approved.
,s 3 OM8 No. 2040-DOO4a r NAME : eig < g y;L{gy gy s 5y-.[n3 DISC . E MONITORING REPORT (0 /] , , y
^EE *
- I,DORES3 2 e0e h3X fi ^F"CC7h ? ?* * ( 5 f;; ' ^ S} ,
PERMIT NUMBER DISCHARGE NUMBE;t i ztyp. 7;iiD 0; * [ ]e p _ yyqgL
- o. A e a- - -a r 4 s ,n v-
.. , ng i v. 7, . ., 3 "3 -
t t MONITORING PERIOD FACIUW g zg y: - .,. 3 ( ( y y p,) j p 4 q 7 ., 7 7 s y MO DAY YEAR MO DAY YEAR LOCATON FROM s- Ua .* TO .. 4 3 003 NOTE:
't 3 Read D instructions 3Cri Gi lbefore N_ c6in)pleting ece this form.
- f.
- T &
- D *s V T
- 5 i 4 D r; e F (2&211 (22-23J 124-251 126-27J (28-291 (30'3,,
'j 13 Cerd Onlyt QUANTITY OR LOADING (4 Cerd Ontys QUANTITY OR CONCENTRATION N O. FREQUENCY SAMPLE PARAMETER 146-531 (64-619 138-451 (46-531 154-619 OF EX ANALYSIS TYPE (32-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAX l MUM UNITS 5243; (64-6ss (69-707 LOV, !N ~lif J i I' '>- SAMPLE , - ( *3) etc.ce* s'o c r : .t c 3 0
, a. . y.
., n ~r 't > ., -. , . , , ,, ., ; MEASUREMENT
.u. A.1_ /j o c. y -
? p % f) i J q PERMIT + ;pqr* Per^t; acc3cc occ633 00003c Se~ :M MY G T T P. 5 g n !. ;r N - ,,is y3t, REQUIREMENT 3 3 ,. - np,p , , ,, .; x SAMPLE MEASUREMENT PERMIT REQUIREMENT l
=
SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I H AVE PERSON ALLY EXAMINED AND TELEPHONE DATE pgid Orndg,3r { AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND B ASED ON MY INQUtRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON98tf FOR OBTAINING THE INFORMATION. I BEUEVE THE SUBMITTED INFORMATION IS
,f.
(f [f*f #'- / TRUE. ACCURATE AND COMPLETE. t AM AWARE THAT THERE ARE ( - - '/ . , [ 2 " j [i Chenistry llan0ger ?4GNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING ' ' q [2 fj3 d ((3 gby [O 16 THE POS95tuTY OF FtNE AND IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33
$1GNATURE OF PRINC3 PAL EXECUTIVE
.U.S.C. 9 1318.erwassamsar temastseeersoMer mese sceneres mer kwAme mes se to sto.ooo AREA TYPED OR PRINTED ad or menanien aerween a monms saa a yearsJ OFFICER OR AUTHORIZED AOENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e// strachments herof
- f. i < c V .
s e EPA Form 3320-1(08-95) Previous editions may be used. (REPLACET: EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE OF _7 p ,) ,q3 y
,8 J g
Paperwork Reduction, Act Notice - i Public reporting burden for this collection of infonnstion is estimated to vary from a range of 10 hours as an [ average per ' response for some minor facilities, to 110 hours as an average per response for some major facilities, with a weighted average for rnajor and minor facilities of 18 hours per response, including time fiTr reviewing I
' instructions, searching existing data source ., gathering and nuintaining'the ' data needed, and completing and ;
reviewing the collection of infonnation. ; Send comments regarding the burden estinute or any other aspect of E this collection 'of infonnation, including'~ suggestions 'for reducing this burden, to Chief, Infonnation Policy l Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Webington, DC 2040; and to the j Office of Information arn! Regubtory Affairs, O!! ice of Management and Dudget, Wuhmgton, DC 20503. !
\
General Instructions , l t
- 1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information !
. already preprinted. l
'l 2; Entec
- Permittee Name: Mailing Address (and facility namellocation, if different)," "Permd Number," and I "Di3 charge Number" w here indicated. (A separate form s required for each discharge,) :
- 3. Enter dates beginning and ending " Monitoring Period" covered by fonn where indicated i
- 4. Enter cach Yarameter" as specified in monitoring requirements of pennit.
S. ' Enter "Samp - Afcasurement" data for crh parameter tmdct "(?uantay" and "Quahtf in units specified in permit,
" Average" u nmmally arithmetic average (geometric merage for bacterial parameters) of a!! sample measurements for cach pan neier obtained during "Mondvemg Period"; "Manmum" and " Min / mom" are normally extreme high j and km m marements obtained during "Momrormg Permd." (Note to mumcipals mth secondary treatment i requirement: Enter 30-day average of sample measurement; under " Average." and enter maximum 7-day average l of sample me. urements obtained during monitoring period under " Maximum ")
6.. Enter " Perm.c equirement" for each panmeier under "Guantity" and " Quality" as spcafied in permitc 7_ Un;1cr ."No E. enter number of sample measurments during monitoring pcriod that exceed maxituum (and/or
, minimum or 7s 4 average as appropriate) penuit requirement for cach paramercr.. If none, enter "0".
- 8. Enter "Frequm of Analy.su" both as " Sample Mca;nrment" (actual frequency of sampling and nmdysis'used ,
' during moniton ; period) and as " Permit Requiremem" specified in pennit. (c g., Enter " Cont for continuous -
monitoring. "l? tar one day per u eck, "/M0" for one day per month. "l39" for one day per quader, cle.) i
- 9. Emer "Samp!c In # both as " Sample Measuremem" (actual sample type used during monitoring penod) and as Permij Requirement " (e.g., Enter " Grab" for individual sample, ."24/IP for 24-hou1 composite, "N A" for centinuous mordtering, cic )
- 10. jNhere vietations of permit requirements are reported, a9ach a brief explanation to destibe cause and corrective actions taken, and refe:ence cach violation by date.
' 11. If"no dischitrge" occurs during monitoring penod, enter "No Dncharge" across form in place of daIn entry.
- 12. Entcr "NameMale of Prmcipal Encurwe Otiscer" vith
- Signature of Prma;ial Encutwe Ofpcer qf Authori:ed Agent.' " Telephone Number," and "Date" at bottom of fann.
- 13. Mail signed Report to OmceM by date(9 geified in pernut. ;Recan copy for sour recordt 14, More detiled instructions for use of this Discharge Monitormg Report i DMR) fonn me be obtained from Omew I specified in, perrrut.- ]
Legal Notice l Tu report is required by im (33 U.S C !313, 40 (1FA 12S 27h Failure to repwt or felcre to report truthfuly can resuit in' civil peralties not to meed $10JOi per dsy cf viohtion; m in crinneml p.m!tm not to neced $23,Om pn by j of VkOlatiOrL Dr bf impOSGmndnt [Or dot MOre thM one year, or by both. EPA Form 332M (Rev. 0095) l I
. ~ - . . .
PERU TTEE NOME /ADORESS 0= cur Fersher Aa-. Lacerraa efLNf=ce=6 NATIONAL POLLUTANT C'SCHARGE ELMNCMON SYSTEM (/VPOES) Form Approved. DISCH, age MONITORING REPORT Dg! 3(L ,; y , . u g OMS, No. 2040-0004 NAME ,ggy-> 7 4 ;y,gy p3p7m ;y477 , ppr vel expires 05-3198 ADDRESS r e 3 e - }1 5 "**' *5i15 1I? ! (S 2I P % 'l $ )
- , y. y , y y <) S9 9 ypr PERMIT NUMBER c:$ CHARGE NUM8En g- ,
p g4{
~%=op'tt
*' ' pop, r..
" '. 3' '5 r 77 MONITORING PERIOD
~ ~,' i~ ~g ~r, " T FACILITY fgyci y ., { y7 p q, qq 57;y7gg LOCATION FROM n 1 TO ": ~ * * ' ' 'P ,
./ I 5 C H A ti G
- l_{ 00S
%""%* (2G2tf (22-23/ (24-251 (26-27/ (28-291 (M311 NOTE: Reed instructions before completing this form.
i A V i: ? 3KLSa4r (3 cent onry) QUANTITY OR LOADING I4 Card On/rf QUANTITY OR CONCENTRATION N O. FREQUENW SAMPLE PARAMETER (54-61) (36-459 (46-53) (54-619 OF
/ 146-531 EX TYPE (32-37) ANAtyss AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS re2e ( 4 681 (6 m 4 SAMPLE eno$+5 norm S S *- +->ge^ { y;g MEASUREMENT '~f, af nA .
7 j cs; f7/ ,~' ,f _ l' gag [ 3 PERMIT c n c e r e- a r c; 4 ^ & ;
.,9 cecec~ g,,, gggg .gp ngq;e ;r 3 REQUIREMENT 3o a y97yg3 ..
y 7. 3, ,g 33-
;3 L [9 ;, ; ') r r, [, SAMPLE > - e m em ';^nc ^^ccen l ( 19) Ac ,;q3, s979 , MEASUREMENT d' j'Q g c; I O / ,'7 Q4 S. 7 t, 3t i 3 0 . PERMIT e. e ^. ^ ichaN se^ 9%$@" e 100 '
Lg g g pi t3
, r, ,e v 7 y;- y37at REQUIREMENT .-- t 3 zy7 gy;g yy ,-fg
, y; r en g: :q: SAMPLE '-^*r"
. c or S' '
( [9) jj
<g
^ r. ' 9 % E; C-i ,i - t_ T F MEASUREMENT <g gf (,? /7 qg
)15;; I r. . PERMIT 5 .~. c N c- H$6^C9 2& 5 3G JC 5:qi ggp 7e,e sm ,, s
., g ., 3 .. REQUIREMENT e. m .yg nEyty .q y yyy. y3y *;f7
"[ iA, T! ? 3.17 ] I - r) 7 SAMPLE ( r 3) 9000 - e ~ ri s c h ; N :': e c g: "
3 g7a. ,v , ggt 5 MEASUREMENT 4 g,g C f g 7-
, 7 ^ ' , r. 1 ; F PERMIT " mm& **rper 9 0 6 t o fs m:* rt o e cr o c c c e >+n gqv st;y; i . , y r ,
3_- y3p REQUIREMENT g gy- nyv.7 3g . e g e: SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PEN ALTY OF LAW THAT B HAVE PERSONALLY EXAMMED AND TELEPHONE DATE AM FAMILIAR W!TH THE INFORMATION SUButTTED HEREIN; AND BASED ON MY INQUIRY OF THOSE INOlVfDUALS IMMEDIATELY RESPONSIBLE FOR g~s q
/ ,rt 133 yid Qrudor[ OBmNmG THE mFORMATION, t BEUEVE THE SUBMITTED INFORMATION 15 h TRUE, ACCURATE AND COMPLETE. t AM AWARE THAT THERE ARE
$1GNWtCANT PENALTIES FOR SUBMITTmG FALSE INFORMATION, INCLUDING -A ' 4}'f
. 1 f r,
-~
, ,- { 7 y e s -- I j,
6 G!iCT115 t r}' liittlagG r THE POSSIBillTY OF FtNE ANO IMeR!SONMENT, SEE 18 U.S.C. I 1001 AND 33
- 41. 393-$113 V6 1U 10 U.S.C. s 131e. frenenwe enser mese easeuves mey 6 enase staen se e sto,oco SIGNATURE OF PRINCIPAL EXECdJTIVE 3pg TYPED OR PRINTED mw or menemar c . . : or eerween s nicams and s rears.s OfTICER OR AUTHOR 12ED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference allerrechments here/
EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) .,
, ,g. PAGE OF
)7 ,
. s ,
l Paperwork Reduction Act Notice ; Public reporting burden for this collection of infcrmation is estimated to vary from a range of 10 hours as an ! average per response for some minor facilities, to 110 hours as an average per response for some major facilities, l with a weighted average for major and mir;or facilitien of 18 hours per responsei including time for reviewing
- 7 i instructions, searching existing data sourecs, gathering and mainttdning the data needed, and completing and
- reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
;. this collection of information, including suppstions fer reducing this' burden, to Chief, Infornution Policy ' } Bomch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the } Office of Infornation and Regulatory Affairs, OfGee of Management and Budget, Washington, DC 20503.
i- , . .
, .__ _ _ _ . _ _ 1 1
General Instructions , t elf form has been partially completed by preprinting, disregard instructions directed at entry of.that information already preprinted.
)
l
- 2. Enter " Permittee NamAfat/ing Address (and facility name/ location, if different)," " Permit Number," and
" Discharge Number" where indicated (A separate form is required for each discharge.)
- 3. Enter dates beginning and endmg "Afomforing Permd" covered by form where indicated.
- 4. Enter cach " Parameter" as specified in momtoring requirements of permit.
P 5/ Enter " Nam;>le afeasurement" data for ca:h parameter under " Quantity" and "Gunhty" in units specified in permit.
" Average" is normally anthmetic average (geometric aserage for bacterial parameters) of all sampic measurements for caeh parameter obtained during "Afomforing Period"; "Afaximum" and "A/immum" arc normally extreme high
' and low mesurernents obtained during "Afonitoring Period." (Note to municipals with secondary treatment
. requhemeri Enter 30 day average of sample measurements under " Average " and enter maximum 7-day average of sample measurements obtained during monitoring period under "3/arimum ") l 1
- 6. Enter " Permit Requirement" for each parameter mider "Guantity" and "Gunhty" as specified in ' permit j i
- 7. Under "Nu l&" enter number of nmple measurruents during monitoring period that c>.cced maximum (and/or j minimmn or 7-day average as apprcpriate) perma requirement for each parameter. If none, ente; "fr. '
l
- 8. Enter "Frerprency of Analysis" both as "Somple Afeasurment" (actual frequency of sampling and analysis used ,
during rnonitoring period) and as " Permit itcquirement" speciDed in permit. (e.g , Enter " Cont " for continuous- I n.cnitoring, "/J" for one day per weck. "/60" for one day per month. "lMa* for one day per quarter, etc.) l
- 9. Enter " Sample 7ke" both as "Na~iple Afcawrement" (actual sample type used during monitoring period) and as . l
" Permit Re<Juirement," -(e.g , Enter "Grah" for indmdual sample, "N!K" for 24-hour composite, "N A" for
~
conunuous monitoring, etc.) l 10, Wiiere violations of permit requirements are reported, attach a brief explanation to describe cause and corrective l abrions taken, and reference each violation by date. J t 1. If"no discharge" occurs during monitoring pcried, enter "Yo Dischargc" across form in place cf data entry
]
- 12. Enter *NamWDtle of Principal F&ecdiiN Qilicer" with *Sigrature of Prmci;>al Executive Oj)1cer of Amiwrced l Agent " " Telephone humber," and "Date" at bc,ttom of form. l l
- 13. Mad signed Rgort to OfGec(s) by date(s) speciGed in permd. Retam copy for your records.
- 14. More detulpd mstructions .for use of this Dncharge A/>mtormg Repo I(D3fR) ferm may be obtained frmn Ofnce(s) specified in permit. -
Legal Notice ! 4
'lhis rejort is regimJ by la c (33 U S C.13 t t 40 C.F.H.125.27L Faihue to seprt or fulure in repcrt truthfully caa rnalt in civil pena! tics not to oceed $10.fX0 per dy of violanon; or in crimimd peralties ret to cueed $25,000 per day of velatum, or by impriummera for not marc than one year, or by both.
FPA Form 3320-1 (Rev, OMS) ; y-- wwy-' v- y.--y- -+- --. u . p- y t .w-
PERMITTEE NAME/ADoRESS (r= hie Fecabrp Name Lorenen ((IN>earf NATION AL POLLUTANT DCOHARGE EUMIN'. TION SYSTEM (NPDES / Form Approved. . NAME DISCHARGE MONITORING REPORT (DMRf 3ggygg y4gggy pgggp $ 7 A T I ') N (?-t s) If 7-ts/ UNIT 2 $ U W & G fl t 't TOW No,2040-0004 g AooaEss P . 3. ma " mm s 5*' - (sonn ru) ^P $ N' 1', 5** A7IH; DAVIO 39%00gp PERMIT NUMBER DiSCHARot NuMeEn 7 , py3y 1EIOPI%PDR! OA 1. 9 M MONITORING PERIOD FAC:LITY gpgygp yg g y pg g p 3y.y3y YEAR MO DAY YEAR MO DAY _ LOCATION FROM TO cce 95 ty 9 4 i y t. ?1 i, cM NO pi ClALGV { ATTM: D%VT3 8 r, 0 % V (20211 122-231 124-259 426-271428-291 (30u311 NOTL Reed intmcuom Mton 2 {%& % form-43 Cerd on/rs QUANTITY OR LOADING I4 Card ontys QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE PARAMETER 146-53) 154-691 (30-459 146-53l 154-6 t1 oF (32-37; EX Analysis TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Me* (64-681 (6 M ar 23 i SAMPLE ucesce e r: s a: e e Macyn ( sy ., f MEASUREMENT h,[1 7d f
^
() 730 ggL
) % 9 f) [ ') g PERMIT rt n e t s: e S e e M: s e :: n n 2.0 cen*c 9.C WIce/ 1RrJ s ? P L i; ?-:51 GM7tq V A L:g r REQUIREMENT St0P MINT W MATIWM- W M 4'N r 3,1 g ,' e SAMPLE jf ">NDaO
~3*gg MEASUREMENT e4609' H&ect **CC30 _
AJJ Sb ,O { 17) cy b /.d pffg N 2s J 3[A in a nx
+
v 1 r a PERMIT ocWO?c- SM600 C to^ C Da*C 30 60 i' ICE / "0ME*' REQUIREMENT PrLU'n? TME V i t.1 : 3000 9 fi 47G DIILY M1 NG/I FMTU c L O V, IN CD400i! 03 SAMPLE ( ^3) DC?D^U **DMC ""' / my Tarstar.or 'Last MEASUREMENT C , />O V, 6. O/ ,') g ' M "" 5
'j 3 M Q 1 q r. PERMIT , ,043 prp-)py c c o: c c h c c c .at c & cocceo Occ g y, L y gm 3
P F L U E ^i ? 3d333 VALUm REQUIREMENT m 3 y r; n,77y gy og9 ynen 3LOPIMM, T D 7 ?i L SAMPLE :: S n e c e ce6?ct c c c c c. ~ ( T 4) . 2j [pqTgg4L MEASUREMENT C, ' ] j',ef 7 O /M h [, 19360 1 3 0 PERMIT .cccccc ceceeg r- acc cortcen l3p3pp. pgpggy - gy y .pgp. evelgsst v3gg y;u; REQUIREMENT .y c e gg ggn g p eg 34g qgfg g 7p 23L!T.?11, FECAL SAMPLE cce$e* c e * !'- e ? cocccc c u c c c <r ( 13) C g /
.; p g e a g g MEASUREMENT C p .Q (
J g ? S r, 1 ? O PERMIT cccccc -cenc70 % iho c c o a tt 200 cc00% / UCL/ RAS PrLU: v? .i?q3 y 41. f . REQUIREMENT ycc3 g gg33 ypop ygyyp f)?, ) M D 3 M A C LQ U 3 SAMPLE cocSoi nec^ca chocce { 19)
)$ 3AT, 20: MEASUREMENT /[ (( b, 4[2/ $/M
)Dng2 1 3 3 PERMIT eccet utece c w9 o c o c c ss JC r; j WIcgf 0MP-e REQUIREMENT MC7 EO AVG rFrLUp47 ;R?ss V1Liiv DAILI f* T HG/L M3MTP SAMPLE MEASUREMENT PERMIT REQUIREMENT NAMEmTLE PRINCIPAL EXECUTIVE OFFICER CERTIFY umoER PENALTY OF LAW THAT 1 HAVE PERSON ALLY EXAMINED AND / TELEPHONE DATE AM FAMIUAR WITH THE INFORMATION SUOMITTED MEREIN: AND BASED ON A MY tNQUIRY OF THOSE INDIVIOUALS IMMEDIATELY RESPONSIBLE FOR \
David UrndOr[ OSTANNG THE INFORMATION, I SEUEVE THE SU8MITTED INFORMATION IS
? /
e.l d ,/m. / ChCC11S t ry NOIMSU1' TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SLGNtFICANT PENALTtES FOR SUBMITTING FALSE INFORMATiON. INCLUDING
, {M,a. , ' ~,
/ -- e
{3 g(y {G
^
9 . {f THE U.S.C. POSSIBIUTY OF FINE,ANO e 131s. scenene masw IMPRISONMENT. SEE 18 u.S.C.,91001 mese asennes mermesume AND 33 sae w se s70,000 S40 NATURE OF PRINOPAL Eh AREA TYPED OR PRINTED maar ar man ==n= w : er eer-e a e maams ew 8 yearsJ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference att strechments here/ EPA Form 3320-1 (08-951 Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.I , PAGE OF
_i -
, s ,
Paperwork Reduction Act Notice
. i J
Pubhc reporting burden for this collection of information is estimated to vary from a range of 10 houts as an average fer renponse for some minor facilities, to 110 hours as an average periresponse for some major facdities, , with a weighted average for major and minor facilities of 18 hour.s per response, incluJmg tims for reviewing - instructions, r.carching uitting data sources, gathering and mam' taining the data needed, and completing and reviewing the collection of information. Sead comments regarding the burden estimate or any other aspect of this collection of infonnation, including suggestions for redating this burden, to Chief. Information Policy I TAranch, PM-223, U.S. Environnwntal Protection Agency, 401 M Street, SW Washington, DC 2N60, and to the Office ofInformation and Regulatory Affairs Of fice of Management and Budges, Washington, DC 20503. t__- . . _ . . _ _ . _ _ _ _ . _ _ _ _ _ _ . _ _ . __ . _ _ _ _ i General Instructions
- 1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
, 'stready preprinted, 2, Enter "Permittec Name Mading Address (and facility name/ location, if different)," " Permit Number," and , '" Discharge Nianber" w here indicated. (A separate form is reqmred for each discharge.) i 3.' Enter dates beginning and ending "3/vmrormg Period" cosered by fann where indicated l
- 4. Enter each " Parameter" as specified in monitoring requirements of pennit.
- 5. Enter " Sample Afeasurement" data for each parameter under "Guantity" and "Guality" in units specified in permit. ;
" Average" is normally arithmetic average (geometric average f or bacterial parameters) of all sample measurements I for each parameter obtained during " Monitoring Period"; "A/nximum" and "Afmimum" are normally extreme high J and low measurement:, obtained during "A/omtoring Period" tNote to mmdcipals with secondary treatment )
requinment: Enter 30-day average of sample measurements under "Arerage," and enter maximum 7-day aserage ' 4 of samp!c measurements obtained dming monitonng period under "Afartmum. ") d
- 6. Enter " Perma Requiement" for each parameter under "Gunnnty" and "Gualin " as specified in pennit.
- 7. Under "No. &" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriale) perunt requiument for each parameter. If none, enter "0"
- 8. Enter "Fecqueny of Analysis" both as " Sample Alcuxurment" (actual freqncocy of sampling and analysis used during nionitoring period) and at " Permit Regmremen!" specified in penmt. (c g., Enter " Cont." for continuous ,
- monitoring, "10" for one day per week. "!Go" fer one day per month, "140" for one day per quaner, ete ) l l
- 9. Enter " Sample 7)pe" both as "&nnf,le Afeusurement" (actual sample type used during monitoring period) and as
" Permit Regwrement " (e.g, Enter " Grab" for mdnidual sample, "24/IC" for 24-hour composite. "N'A" for contmuous momtormg, etc.)
)
i 10. Whcre violations of pernut requirements are reported, attach a bricf explanation to describe cause and corrective l actions taken, and re!crence cach violation by date. l 11. If"no discharge" occurs during nenitoring period, enter "No Dischar;ee" across form in place of data entry.
- 12. Enter "Name 'i'itle of Prmcipal hecutwe Q$cer" with "&gnature of'i*rincipal becutive QlJicer of Authorized Agent," " Telephone humber " and "Date' al bottom of form 1L Mail signed Report to Of rice (s) by dateo) specified in pernut Retain ecpy for your records. ;
, 14 More detailed instn.ctwns for use of this Dischage A!nnitoring Rcrort (DA(R) fann may be obtained (som Office (s) qweified in permit.
Legal Notice This tcpod is required by law (33 U.S.C 1318 40 C.F.R.125.27). Failure to rqort or f aine to report truthfully can reuk in civil pcmdtie s not to ewad 1:0,000 pur day of vioStion; m in ennunal penshies not to eneed $25,0N per day of violation, or by impriunwn! for not more than one year, or by both I FPA fum 33201 (Rev. OL95)
PERMITTEE NAME/ ADDRESS (1=rhds Fershav Am=e Lore see efPafpreet) NATIONAL POLLUTANT DISCHARGE RIMIN', TION SYSTEM (NPOES/ Form Approved. NJ.ME q*. <1- DISC OMS No. 2040-000 *, ' 4
,yy; , y4ggy pgyg , RGE MONITORING REPORT,f,0% 7 ;3; 3 7y 7 s
- 37 ADDRESS F. 3 e 71 't **"# h' PERMIT NUMBER
'*?
c:ScMARGE WMBE3 (lJ 0
%) #PP
- f3 mO
) r%; p 3 ti 1 y; 3p g g g c y . p{g4( .
- S. .t 1r^77 - 'a"' t ri "r 2 ,, p -. 1 <> a , ,. o * ,
<a -
MONITORING PERIOD FACILITY rgyy g3LLyy pgg o 3 p 3 7 7 )' YEAR MO DAY YEAR MO DAY __ LOCATION FROM ,, u TO i 4 06' r. D 1 ? C 9 .t ? ', ? Ml 32? nTTn: n3;Tn aa'qyuv (20'21) 122-231 v24-25I (26-271 128-291 (30-319 NOTE: Reed inetrnctione before completing thie form. PARAMETER (3 Card on&1 CUANTITY OR LOADING I4 Cerd on&f QUANTITY OR CONCENTRATION NO. movENCY SAMPLE l 146-531 (54-691 (36-451 146-539 tc*stl OF (32-37j EX ,,,tys,s TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS sm (64-681 16s-707 SAMPLE ':^' -
.a MEASUREMENT 00e?^^ eh?SC$ ( 12)
)qu a ) ! ' ,
PERMIT 7c0699 oneeSc c :r : ,,p oco365 J,5 W I-C g / qu p ; t, q -. :- ., e a 7 y * (;_ , REQUIREMENT .n; c q , c y q .3 - sq77vge ,p 3g7p
, "} L M. , ^ T *. ;, SAMPLE ahe"c wa cy te;u, ( ; gy
., y- ,
.u, ., MEASUREMENT f
,5< 13 1 y 0 PERMIT 0%*& ener:r-c c sa' neet% 13 19p gic-/ m l
->,n y q .fr t ;5 REQUIREMENT s99, .. gy- gygg7 g7 ,,; f 7 .. g y 7 37; q,, e at = - r SAMPLE oce^~ -
ee ts 3 :010o5 ( j 9)
~a-4 , cv _, 7 y y .,7p MEASUREMENT iS' .5 ; 3 6 PERMIT no ~ne ea^e*n i :~- $ 3 g e t- o ?- J ') gigg/ ,pgp
-rqn ;7 r ~ yf7;. REQUIREMENT . r. . y; gg73y .y 3 9 g 7 t,
_ 437
' I ' 12 , [4 T350U[ 3> SAMPLE ( ' ]) oc^^n: ->%n cact3'
- 3.n r - r g 7 s, .y7 pt. . MEASUREMENT 4 l ,.. , p 4, g spoq0 1 0 r PERMIT acp w q e m9 T 20c)70 ccePee O?e900 ao Wicr/ 377rp setyav7 , q :, , y; <,; REQUIREMENT ,9 4pq ng7;y yy ,4 n ,$33 ,,, g y 7 ,,
SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT h REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW TH AT I MAVE PERSONALLY EXAMINED AND ,-~ TELEPHONE DATE AM FAMtuAR WITH THE fMFORMATTON SUBMITTED HEREIN; AND BASED ON , . _ f MY INQUIRY OF THOSE INOlvtDUALS IMMEDIATELY RESPONSIBLE FOR / / ,, S / OSTAINING THE INFORMATION. I SEUEVE THE SUBMIMED INFORMATION TS jj .) ! / / / . f , . .# 1 David UI'ndOr[ TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUOtNG y f-d k j j> b 1', i .r=~bg{} qU - 1gg
'- }g (heminfTv '8 ' ' n n a" a' r.'- THE POSSIBluTY U.S.C. OF RNE seMer t 131s. spenomen ANO IMPRISONMENT. SEE 18 mese steam mer heam meeU.S.C.
i so tsro,
,1001cog AND 33 SIONATURE OF PR!NCIPAL EXE' CUmfE AREA TYPED OR PRINTED sader== w - : er aer-- s menran a w s rewas omCER oR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# strechments here)
- I </G-
) EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
.. .,. a,
. - 3 / .2 , n 51 a, - 0 4 0 'l t
. t
,s ~, ,
Paperwork Reduction Act Notice : Public reporting burden for this collection of infornution is estimated to vary from a range of 10 hours as an average per response for some minor facilities, to 110 hours as an average per response for mme major heilities, j with a weightal average for m:.jor and minor facilities of 18 hours per response, incladmg time for reviewing " instructionxt searching existirig data soureeg gathering and maintaining the data needed, and completing.and , reviewing the cohetion of information. . Serd comments regarding the burden estimate or any other aspedt of this;eoUection 'of itiformation, induding suggestions for reducing this burdenito Chief Information Pohey Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Waahington, DC 2040; atd to the {
. Office ofInfornution and Regubtory Affairs, Of 6ee of Management and Budget, Wehington, DC 20503. :
b._. , __.. _, _ _ _ . _ . _ _ _ . . . _ . _.n. _ _ _ _ _ t General Instructions I
- 1. If form bas.been partially completed by preprinting, disrqazd instnetions directed at entry of that infornution ;
. already preprinted.
i 2J Enter "Permittce. Nome /3/ ailing Address (and facdity name!!ocation, if ddTerent)," " Permit Number," and- ;
" Discharge Number" where indicated. (A separate farm is required for cach discharge.)
l t
- 3. Ecter dates beginning and endmg "Afoniturmg Permd" covered by form where indicated.
l
- 4. Enter each " Parameter" as specified in monnoring requirements of permit. ,
- 5. Enter "Sampic A/eaxurement" data for each parameter under "Gutmtity" and "Quahry" in units specified in perrnit. l "A wroge" is normaHy arithmetic average (geometric averare for bacterial paramete:s) of all sample measurements i for cach parameter obtained daring "Afomforing PerimP; ":Alartmum" and "Alinunum" are normally extreme high -{
nnd low measurements obtained during "Afon.toring Permd" (Note to municipals with secondary treatment t ttquirement: Enter 30-da) . average of umple rneasurements under "Astrage." and emer maximum Nay aserage j of empic measurements obtamed during nmnitoring penod tmder "Alaximmn. ") j 6, Enter " Permit Requirement" for each parameter under "Gunnt,'ty" and "puuht/ ar speci0ed in permit,
\
- 7. Under "No &" cnter number of ::tmple measnrments dunng mordtoring period that exceed maximum (and!cr !
j . minimum, or Nay ag erage as appre;;riate) permit regmrement far each parameter. If none, enter "0". ; tL Enter "Frequencv q/ Analysis" both as " Sam;,le Alvasurmem" (actual frequency of r,ampling miu analysis used staring menitoring period) and as " Permit Requirement" speafied in penmi (e g, Enter %nt " for continuous monitoring. /7 for one day per w eek, "b.iO" for one day per month. *l/90" for one day per quarter, etc.) i c
- o. Enter " Sam;>le Tire" both as "Senple Afeawremem' (actual sampfe type used during monitoring period) and as !
*Permir .ReqWrenn nt " (e g , Enter " Grab" far individual sampic. "N/IC" for 24-hour composzte, "N41" for )
continuous monitonng, etc.) ' 10f Where violations of pemut requirements are reported, attach a bnef explanation to describe c.mse and corrective I actwns taken. and reference cach violation by date. l l
- 11. If"no discharge" occurs during monkoring period enter "Xp Dischargc" across fann in place of data entry
- 12. Enter "NameTuleo 'f Principal Em utwe Ofker" with " Signature ./ Prwi;>al Secuing Oficer of Au:haced
' l Agent ' ' Telephone Number," and "Date" at bouom of form '
l
- 13. Mail smned Report to orrice(n by dat:(s) specined in p:nnit Retain copy for your seemds, j
- 14. Mom detaikd instmetion; for uw of this D.:a hne Emt<: ring Report (DJ/RJ form may be obtained fiom Omcea) speciEed in permit 1
Legal Notice '
. This report ix mquind by im (33 U.S.C.131s; 40 C.F R. !?5 24 FWime to wpat or f iha - to rrpon !nulfuUy cua ,
neult m avi! pera!hes mt ta exced $10 000 per day of viethm; m in an:r d per ab wr to cnted $25.003 per day j l . of violgtion, or by Unprimrn at for not more tha one year, m by both. rpA f'orm 3320-1 {Rev. (EM) ! l I
~. _
. , < +
PEnemTTEE NADAE/ ADDRESS &=64 F=Mewf.mr.o= @elb vM) NATIONM POLLUTANT DISCHARGE EUmmiDON SYSTEM (NPDES / Form Approved. I - Nigg NRCE MONITN REPORT (DW1 1Al s S u ; G r ; n POME No. N *
" =r . V E R VALLCf POW D STA;T)%
.. v2-t si rt 7-tsi Appro ADDRESS P ,3 , 6% 11 "*'S1M1% M7 s (y ig jres,05-31-98 ATIN; P i V l ') ORN009F PERMIT NUMBER DCCHARGE NUMSER y ,
7,,gL GHIPMnWO97 t a 1 % 'f 7 MONITORING PERIOD U# FACILITY ggg773 yg((gy pgg m ;g g3n p ; LOCATION FROM so ou OL TO n. <a c36 %3 OISCMATCP j *#0 6% l hTT%: n1YI% > ? & D '3 D C' 120"219 422-231 124-251 426-271 (28-29) 130-311 N M R**d kf* O N I***- t PARAMETER 13 cent orWs QUANTITY OR LOADING 14 Cent O W s QUANTITY OR CONCENTRATION NO. FREQUENCY SA W LE I 14 & 5 3? v54-st! 130-451 146 539 154-619 or ; (32-371 EX ANA(ymS TYPE ' AVERAGE MAXIMUM UNITS MtNtMUM AVERAGE MAXIMUM UNITS ,sm ,g4_se, fe,7a,
,3 SAMPLE ceeees tv e c t r c c o rr $ o n ( 12) ,,2, j i O
h,/ 2 MEASUREMENT 6, / A fjo (,.o 4, 39qgg ( 3 g PERMfT ecente . S eeeed < m3 ug rz w o o m -) ,1 ggggf -Qg ~ REQUIREMENT m .;. 3 ,,3 y 7 3 9 7- e, q 337p
'PrLUr47 3 R m V A lf r. ,, y g 7 , n ,
7") L { p 3 , ;7p;L SAMPLE H&ent ee6eco tf;occt ( 19) Aef 3gpppg MEASUREMENT / f.,() M, (, O /3o f/M 10 s ][i 1 3 q PERMIT 6McO& coceSo t :Se occecq 30 60 gig / pp, c 7
" r F ? :; F 4 T 13 3 T. q y rg L g t REQUIPEMENT g% g g73 . n(ru sy *1/t gm ,
-~L N , 13 ")U3UIT gr SAMPLE ( f;3) tm c c c 's anoano O c c o r: c / /
[ TH'u TREtrMExt P L t '; I MEASUREMENT t.6 gj y C , gg C M f.@ g 5-0050 1 3 p PERMIT 3,q23 nepng; co*Sco eceogg oc49eo- $20 gg ggpg ,
' f* P L ;1 r +17 7'419? */ A L E , REQUIREMENT o, n 3y. OPTU FY *"". O C 'M
'4 lod 1NE, TJTAL SAMPLE ceeent 6MSce coach ,
( 19) O y/ , Q, 6,m k
,ag;gp r, MEASUREMENT Od/ C.t// !
M60 1 0 $ PERMIT o c r: e q tececo e yee ,poge 3 7 3 % ., p .
" / ,A3 5
~7 '~~~[^ -IV y" ny .:
3 " f
- rrLws7 -
ess yggn; - REQUIREMENT s_,.
--- 17 -. . gcyt 3ng73 l
23LIFJ t, M AL SAMPLE mece weregg g .% " ~' I ,13) q ;ggenzL MEASUREMENT g C
- PERMIT .eccoc^ e e ec 9 cr c 3cg 99,333 yg n pg. , . p .
}
73055 1 3 0 ^ -
"?CLUPM* 7 R 7 5 ". Y a L:), REQUIREMENT 3)g ,
i 33D, C4993MACT30% SAMPLE corees er9 397393 I ,* I g
~
'S DAY, 20~ MEASUREMENT 13142 1 0 0 PERMIT cocche neeen r me 3a3g99 3r 3 g' WIC8/' 05P*O !
' r L IA r e ' 103%% Vgg g; -
REQUIREMENT ..,..a.
++ na \ ? ,, .
OAyLy n( , ,- / g
, = m. 3 SAMPLE I MEASUREMENT PERMIT REQUIREMENT 4
NAMERITLE PRINCIPAL EXECUTIVE OFFICER e CERDFY UNDER PENALTY OF LAW THATI HAVE PERSONALLY EXAMINED AND ' TELEPHONE DATE ; AM FAMlUAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON98LE FOR I . - /, " ORTAINING THE INFORMATION, I BEllEVE THE SUBMtTTED fMFORMAT10N IS TRUE, ACCURATE AND COMPLETE. 0 AM AWARE THAT THERE ARE f I; [
/ (f d;f ,, j ' .
y ' I David Orndorf 9GNIFICANT PENALTIES FOR SUSMITTING FALSE INFORMATION. 8NCLUDING ' - -- g 1
*12 393-5113 %
Chmi s t rv N no~cr THE POS99 UTY OF mFmE ANDmese IMPRISONMENT. SEE 10nn U.S.C 5,1001 AND 33 10 1 h. ; U.S.C. s iste. enww =Rn a=r eien.* . e io aro. coo SiONATURE OF PRINCIPAL EXECUTIVE TYPED OR PRINTED w er me-mna enen wimsar ere.ews.s s means ans s ms OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY ; COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# ettechments herof ; i k EPA Form 3320-1 108-95) Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE OF i M 3 0 5 / 9 6 %18-0 % 3 1 [ _ . . . _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ __ ___m _._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ . - _ _ . _ . - -_._._ ___ _ _ . . -
- l. j I
.. ~.,! .
Paperwork Reduction Act Notice l
- 4. ,
j' Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an $ average per respome for some Ininor facilities, to !!O hours es an average per response for some major facihties, : with a weighted average for ndjor and minor facilities of 18 hours per response, including time for reviewing
.imtructica$, t.earching'exirting data'sourcen gathering and maintaining the data needed, and completing and
-l
]
. reviewing the collection of infonnation. Send conunents regstding the burden utimate or any other aspect of p thir collection 'of informstion, includingiuggestions for reducing this burden, td Chief. Inforaation Policy l
- Branch,'PM-223, U.S. Environmental Protedian Agency. 401 M Street, SW Washington, DC 2040; and to the !
Office ofinfonnation red Regulatory Affairs, Office of Management and Budget, WaJiington, DC 20503. j
._a_._ __ _. _ . . i l
General Instructions i I. If form has been partially completed by preprinting, disregard instructions directed at entry of that information . ; , already preprinted. ! t-l s . 2. Enter " Permittee Namedfailing Addreas (and facility name/ location, if ddrerent)," " Permit Number," and l
- " Discharge Number" where indicated. (A separate form as regmred for cach discharge.) l l
3.; Enter dates beginning and ending "Afoniformg Period" covered by form where indicated. l l 4. Enter each "Purameter" as specified in monitoring requirements of permit. [ 4 l S. Enter " Sample A/easurement" data for each i mmeter under "Quaniity" and "guality" in units specified in permit, j "Averoxe" is norma!!v anthmetic average (geometric aserage for bacterial parameters) of all sarnple rucasurements i for each parameter obtained daring "Momforing Permd"; "Alsunmim" and "Mmimmn" are normally extreme high I and low measurements obtained during " Man /tormg Permd" (Note to municipals with secondary treatment , requirement; Enter 30-day average of sample measurements imdcr " Average." and enter mammum 7-day average ) l of sampic measurements obtained during monitoring period under "Maximumf/
- 6. Enter "Pernut Rcquirement" for each parameter under "Quanntf and "Quahry" as specified in permit.
7.:Under "No Er" entrr munber of sample measurments duririg monitoring period that exceed maximum (ard/or , minimum or.7-day average as appropriate) permit requirement for each parametcr. If none, enter "0". ' ;
- 8. Emer "Frcquency of Ana!.ms" both as " Sam;>le A/cawrment" (actual frequency of sampling and analysh used l ldoring monitoring period) and as " Permit Requirement" specified in penmt (e.g., Enter " Cent," for continuous l monitoring, "/C" for one day per week. "1/M" for one day per month "/NO" for one day per quarter, etc.) .
- l. . -
- 9. Enter " Sample 7)pe" both as " Sample lieusmcment" Octual sunple tipe used during monitoring period) and as
*Pcemit Requirement," (e.g., Entet "Grcb" for individual sample. "2MC" for 24-hour compostic, "N01" for r coctmnous momtormg. etc )
l
- 10. Where violations of pennit requirements are reported, attach a brief explaration to describe cause and corrective l actiens taken, and icference cach violation by date.
t IL If "no discharge" cccurs during monitoring period, emer "No Discharge" across form m place of data entry
- 12. Enter "Name Titic uf l'rnu ipal Ewcuore @ccr" mth "Swnature of Prmci;>al Executn e O)pcer pf Authori:ed Agcrt," " Telephone Nwnber " ar,d "Date" at bottom of form. l
- 13. Mail signed Report to OITsce(s) by dale (s) speedied m permit. Retain copy for your records.
14! More detaded instructions for use of this Discharj;c Ah mtomg Repmt (DUR) form may be obtained from OfTice(s) specified in permit. -
]
, Legal Notice 1 1 1 i Thig 'mport is xquind by hrA (33 U.S C.1318; 40 C.F R.125.27b Failure to report or failure to report truthfuUy can result in civil pendtv:a not to emd $10.000 per day of siohitian; or in cnminal pedtic not to cueed 125,000 per day j ' of VICl&l5Dn, of by Iluprii Onmcht [0f Ddf moIB lhin Ofte ye:Ir. Of by bulh. i EPA Form 332dd (Rev, @%) d i
PERMITTEE NOME /ADORESS 0=e,Medwyh Leem (ofwouU NOTION AL POLLUTANT OtSCHARGE EUMINCTION SYOTEM (NPDES / Form Approved. - C"E *V?1 ViLLCY P J .r "" W 7i *Iit ifNi itph /J1 ;O};i*, . .y - OMB No. 2040-0004 ADDRESS i . 3. .)i 4 P ' : E ' i ~ 'i' $ (9UEd ;:) AD P '_xpres, 05-31-9 8, 1 5 "'
- N ; O'VIO L5 0 q e- PERMIT NUMBER otSCHARGE NUMBER p , p7g4 ,a
- r) 7.. n. . , , . e L, e .+. .
,3
' 14p77
- er a j g t MONITOR!NG PERIOD ^ "
FACIUTY V11LLvY P;di' T ^* t ? I . ' AVf 3m m m um m m _ LOCATON *^u FROM i TO I- 4 4 OL; 8.' 1 ?[iCaAs?~ l~ c&n[pleting Reed instructions before this form.
;*7' ; DAVT? e 9 a 3 5 - (20Lgf) (2).f]) (24 Jgf (Jg 27) (Jg 2S) (JCLJf) NOTE:
(3 Cerd on&1 QUANTITY OR LCADING M Cerd on/yl QUANTITY OR CONCENTRATION N O. FREQUENCY SAMPLE PARAMETER 146-631 154-619 138-45) 146-53) 15a-619 OF (32-37f EX ANavs s TYPE AVERAGE MAXtMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ess; gg4.gg; gg m a SAMPLE 3 ; '; e r. moner e n e e. - *?) g j[/7 MEASUREMENT 7/ . ,f (, 'U , C e_ , s f
'9:2?1 ; -) PERMIT ' 3 r r ' '- o e c e: No-) ^
.3 7 0 c 9 e.: ) , r' rtr;y t3 E
.ceru :-. .
r ,.., , REQUIREMENT se- .* I P ! x 1 " M i. .t '& 9 "_ "
, 1Lieg, +
,rgu SAMPLE 3ce*+r ~^^&ac 1: -a.. ( ; 9) f<
3,,,vp-9 MEASUREMENT 4 t/ < g/ O ( ., j , at 33 1 5 PERMIT T i o ^ e *- A Pr .S r a e : :. : caee9e 3a ign cp (7 p p;
-4
- - yyL3 REQUIREMENT o r- 2 u, aj- n;2 g tg
'r q ; . e a -cfL 31< s es , s . - SAMPLE :nsSe~ ^^^*: <
1c)
je
, y _ ,ty - p, MEASUREMENT <{ < $ 4
{ C // q l73 ; 'i a PERMIT orm6ce ^5^^er r. -
's y' 30 g c gy p f, n ery *: v- . ,> 'e : L, REQUIREMENT sa s o x3 : y7 a erLy 7y 15 g + 43i ,g/t SAMPLE 3 cane ; w n ..
L'4, IN J J 3 L- j l ' 3: ( n 33 nc :3ng , 4 rg y c,7a , , p g ., - , MEASUREMENT g,gof g_ggf gj p[7 gs7 Tnnt 1 , PERMIT *-n'7" e"o-97 O Me c3 a O n u r- c: 9 0 c ci c 2. 0 } -Qr .',T I q ; 7 7 , t- - 37 , ;, g t REQUIREMENT =ye n. 7y s. j ,ap y9% SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT l NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PEN ALTY OF LAW THAT l MAVE PERSON ALLY EXAMINED AND TELEPHONE DATE AM FAMFUAR WITH THE INFORMATION SUBMtTTED HEREIN; AND BASED ON r MY INQUIRY OF THOSE fMOlVIOUALS IMMEDIATELY RESPONSIBLE FOR 4 M' y ,/ MVid UNOI.{ 08TAINING THE INFORMATION. I BEUEVE THE SUBMITTED INFORMATION 19 TRUE, ACCURATE AND COMPLETE. SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING I AM AWARE THAT THERE ARE '
/M k g' t
/# # dJ d
'A
*+ 12 393-5i13 6
9 t> 10 a lu ChCmi. S L r"1 M a na r.t= :- THE POSSIBluTY OF FtNE ANO IMPRISONMENT. SEE to U.S.C 91001 AND 33 U.S.C. 3 1319. bienne SIONATURE OF PRINCIPAL EXECUTIVE ggg TYPED OR PRINTED .avermen===resammes m ceniser ar eer.sweees.terure.e m mne mer.as re; s v.e.an s se so s r0,000 OFFICER OR AUTHORt2ED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY Vid. ATlONS (Reference e# etrachtnents here/ EPA Form 3320-1 108-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF q , ,
Paperwork Reduction Act Notice 1 Public reporting burden for this collection of information is e.stimated to vary from a range of 10 hours as an j average per re<:ponse for some minor facilities, to 110 hours as an average per respom.e for some major facilities, i with a weighted average for major and nunor facilitica of 18 hours per respon% including time for reviewing
- j inttructions; wrching exir; ting data sources, gathering and maintaining the data needed, and completing and j
i reviewing the wilection of information. Send comments regarding the burden estimate or any other arpxt of I this collection 'of inforrnation, including suggestions for redecing this burden, to Cidef, Information Policy ; Brinch, PM 223 U.S. Envirocnwntal Pmteerion Agency, 401 M Street. SW Washington, DC 20EO, and to the ! l Office of Information and Rgulatory Af fairs, Of Oce of Management and Budget, Washmpon, DC 20503. _ _ _ . . _ _ _ _ . _ _ _ _ . _ ___.__.__a l l General Instructions !
- 1. If form has been partially completed by preprintirig, disregard instructions directed at entry of that information
- j. ; already preprinted.
1 l 2. Enter "Permatce Anme>Afading Addre.u (and facility name/ location, if ditTerent)," " Permit Number," and
" Discharge Nmnber" w here indicated (A separate form is required for cach discharge.) {
l j ' i
- 3. Enter dates begimung and ending "3 fon/tarmg Pcemd" covered by form where indrcated.
l 1 l 4. Enter exh "Parometer" as specified in monitoring requnements of permit.
- 5. Enter "Fample Alcawrement" data for each parameter und:r "pucmlity" and "Quahty" in units specified in permit.
"Arnage" is norm:dh arithmetic average (sometric average far bactenal paramekrs) of all sample measurements for each parameter obbined during "3/omformg Permd", "Alaumum" and "Almimum" are normally extreme high and lew mesurements obtained dunng "3 f miloring Penod" (Note 10 municipals with secondar) treatment l rcquirement: Enter 30-day averme of s;miple measurements under "Awrage," and enter maximum 7-day aurage I of sample measurements chiamed during monitming penod under "A/arimmn ". I
- 6. Enter " Perma Requirrment" for each parameter under "Quantay" and *Gsuhty" as specified in permit.
l 7. Unkt "Na L" emer number of sample memanments dunn;; monhoring penod diat execed maxinmm (and/or : minimum or 7-day average as gpropriaR) pernut requaemem far each parameter sf none, emer "0".
- 8. Enter "Frc</uenry of Analpia" borb as " Sam;>le Alcawrmen!" (actual frequency cf sampling and analysis used 1
-daring mendonng pertod) and as " Perm:t Re<!virenrnt" spec:fied in permit. (e g., Enter "Contf for conunuous monitoring, "I ? for onc day per weck, "NO" for one day per month. "lw ror one day per quarter, etc )
- 9. Enter " Nam;)le lipe" tuth as "Sampic Afrasurement" (rtual sample type u<cd during monitoring penod) and as
" Perma Regmrement " (c g., Enter "Grah* for indmda:d sample, "2.///C" for 24-hour composite, "N'A" for cominuous monitonng etc.)
l l 10. Where siolations of pcrmit requnemems a:e reported. anach a brief esp!anation to desenbe cause and carrecuve l acimas taken, and reference cach siolation by date, I1,'If "no discharge" occurs during moniNnng period enNr "No D:schmge" across fann in place of data entn
- 12. Entet "NameTit!c of Prmopa! Frmaia qiliw?" wth %enature qi Preicipal Dautor Quicer of,tu,%n:ed
, Agent," 7elepfwne Number," and "i) ate" a bottom of form. t 13, M1!) Slgned Report to Office (s) by date(s) rpecified in lerudt Detain capy for 3our records 14; More detaded mstructions for use of this DmhuW / m;mrmg Ref+rr t/ 6fW fonn may be ebt2ied from OinceN speciDed in pennit. l Legal Notice m nyt m <eywy im m u s.c. n m un mn. nau m mem or amo mp mnnhuny - tralt in cisi! pndries not to owd $10,000 per by of s e ai,, - 3 nnu ma pamL ; r.ot u mw 5220 per dy or emn. m by immioma a not m,re thmn enc ><ar. or h> sun. F.PA Farm 3320-1 (Rew 00% l l l
FERMtTTEE NAME/ADORESS Garbde ForeryName Lerenes psArver; ' ~ EATIONAL POLLUTANT DISCHARGE EUMINtTION BYSTEM (tWPDESJ Form Approved NAME p y at y g 3 y 3 LL a;y p g ;; y y qpA773$
, [NN ff,07 puy7 3 gggg 7 g y g qOMS A 94 t' ADDREES P . 3. OX il "* ? ^ ^ * 6 ' C *17 * * * $'
{ *;y a E Q 5)
- i &70N; D37ID 3"!NOOV7 PERMIT NUMBER OtSCMARGE MuMsER 77ygg 7 ,,,
i11IPPI#3PO1T Pa iSP7' MONITORING PERIOD 1
- FAMW g p q g r, p yAL(gy p c3 y g > q f g 73 rjg YEAR MO DAY YEAR MO DAY LOCATION FROM y9 73 *I TO yN >. i> ?c$ A0 3f5NAMP E*vN: M iTn nun'tnnY v20u21s 122-231 c24-251 126-27s 12e-2s> 130usts NOTE R**d ine'ruc'ione >***** - lhl- 0 30*'ia f**m-13 M my QUANTITY M LOADING 'd Card mM OUANTITY OR CONCENTRATION mEOutwCy PARAMETER 146-53i 154-611 NO. SAMPLE 139-451 146-53t 154-611 OF (32-37; EX m y,3 TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ess, ,gg,, f,,. 7, q SAMPLE 30Aca A ce ? c : OcocoA ( 17)
MEASUREMENT 13 '2 0 n } $ 3 PERMIT c etr e n c coo ^te t ;y* gg. cc9$$9 9,p g yj g
- rrL9CHT lS$3 V A L,y: REQUIREMENT at .; y 7 qg q yygg, .ggy 7p 33 LID 5, ? ) f .t l SAMPLE ri c e ar e r h e e * *: ) c a rm o g MEASUREMENT ( 30) iUiPEMUED T ') $ 3 f) .. 1 .$ 9 - PERMIT oc9he+ eMeee c :ce caecoc 3r igg -
gygg ,p g REQUIREMENT
'F?LOPM! TR759 if A L 9 t e .3 g g ,g ; pz 7g g7 sqq g. 7 g T[L AND q ? E s. q g SAMPLE ocence coneck ocAses ( 19)
MEASUREMENT rF MF 9 Y T 'i - 3 it A V 5E7F 135;h 1 9 $ PERMIT c o c e de n e t:eerra G e anc ceteco [g 2 () g[gy q;p 1 F 5' L '.1 F 4 r ;4 t37 y g L .y p REQUIREMENT pg, wg ,yg y, y 34yg f., 7 ,, 7g
?LPW, IN C3NDUTI 3 ;< SAMPLE
( n )) etic 20 co ~c w 49c3ce rMU ' 4 5' A "' f ? N T PLAN! MEASUREMENT fy,j [ . i)S50 1 ; O PERMIT t< y p h p 'r a :* n rs e ; c406cb c :T6 3 ? % .7conco Acc i;r; q y 3773g I '"TLdt7 ? J9999 i A. U 7 REQUIREMENT y p; Spy 7, y7 p e e g e. SAMPLE I MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTNE OFFICER a cEnwy uNDEM PENALTY OF LAW THAT1 MAVE PERSON ALLY EXAMINED AlfD ' ~ AM FAMtUAR WITH THE mFORMATION SUDMITTED MEMEm; AND BASED ON
% /
TELEPHONE DATE MY INQUIRY OF THOSE mOfY0UALS IMMEDIATELY RESPON98LE FOR /
- Dayid Ortidorf OerAmmo THE mFOnMAriON, i eELifvE THE sueMtTTED iNFonMATiON iS W e/ 1 .%__.-
Chez::istry Manager TRUE, ACCtJMATE AND COMPLETE. 4 ANI AWARE THAT THERE ARE /1~ /
#. "'4 ,fil-Y SIGNtRCANT PENALTTES FOR SUOMiTTWG FALSE WFORMATION. mCLUDmo 413 D3*5113 THE POSStatOTY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 SIONATURE OF PRNOCIPAL ERECUTfvE 4- % 1O 18 u.S.C. s 13ie. speammme nr s==. sMam mer wwse # hee se M s 70,000 a e memns amr a youru AREA NUMBER TYPED OR PRINTED emt er maremn= b - : ef ter 0FFICER OR AUTHORIZED AGEIET CODE YEAR MO DAY COMMENTS AND EXPLANA'lON OF ANY VIOLATIONS (Reference e# effechments heref n l ( {^ ^ /' /* -4?
EPA Form 3320-1 108-95) Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 3 g 3 , .g PAGE OF i
. _ _ _ - _ _ _ _ _ _ _ _ _ - - . _ - ~ _ _ - _ . - - - ~ . -----,~-----------r - - - - - - .--s,-- -
Paperwork Reduction Act Notice i I t Public re;nrting' burden for this colbetion of information is estinated to vary from a range of 10 hours as an ; i average per response for some minor facilities, to 110 hours as an average per response for u.2me imjor facilities, i i l with a weighted average for major and rninor facilities of 18 houn, per responsc, including time for reviewing ., l l instructirms,.seanhing existing data sources, pthering and nuintaining the data needed, and cornpieting and q l reviewing the co!!cetion of information. Send comments regarding the burden estimate or any other aspect of , this co!!cetion of informatido, including <unge. tions for reducing this burdenL to Chiefi lofernution Policy , l . Dnmchl PM-223, U.S. Environmental Protection Agency,401 M Sucet, SW Washington DC 2040; and to the I Office of information and Repubtory Af fairs, Of fice of Management and Budget, Washington, DC 20503. l . _ _J t ' i General Instructions ; icif form has been partially completed by preprinting, disregard instructions directed at entry of that infonnation already preprinted. ( 2. Enter "Permince Namelfa!/mg Addre3s (and facility namc/ location, if dMerent)," "Perrmt Number," and
" Discharge Number" whcre indicated ( A separate form is required for each discharge )
- 3. Enter dates beginnmg and ending "Monimrmg Permd" covered by form where indicated.
- 4. Emer each " Parameter" as specined in rnonitoring requirements of permit L
r
- 5. Enict " Sample Mmuurement" data for each parameter under "Ouannly" and "Guality" in units specified in perm't. i l
">t wrage" is normally aritlunenc average (pomenic m erare for bacterial parameters) of all sample measurements !
!bt each parameb;r obtained during "Momtming i crd; "Msimum" and " Minimum" are nonnaMy extreme high and Imt m:asurements obtamed d.ning "Mondwing /WioJ * (Note to murdcipals with secondary treatment i requaement; Enter 30-day aurage of samp!c measurements under "Acrage," mid enter masinmm 7-day merage r of sample measurements obtained during rnoaitoting period under "Mmmum.")
l tic Entr "Pernut Rcqwrement" for each parameter under "Gwnno
- and " Quality" as speci6ed in permit. !
s 7 Under ,"No Er" enter number of sample measurments during menitoring period that exceed 'ruaximum (and'or ruinimum or 7-day average as appropnate) pernut rcquirement for each parameter. If none, cmer "0". 2 Enter "Frsjurmy of An/pv both as " Sam;@ Mea 3urment" (actual frequene) of sampling and analysis used f
'during monitoring pe:iod) and as "I*crmit I?cquircment" specified in pernut. (c g, Emer " Cont " for continuous momtoring "/J" for one day per wcck "lS/r for one day per month, "I W for one day per quarter, etc.)
- 9. Emer Wnp/c 7)pe" buh as hple Measurement" (nc:ual sample type used during monitoting period) and as !
"?cemit Regmrement " (e.g., Enter " Grab" for indardaal sample, UJlic" for 2&heur composite. "N# for contmucus monitonng. ete )
- 10. Where viobtions of pennit reqmremem are reported, anach a brief cuplanation to descnbe c w and corrective
- actions taken, and referer.cc cach violaimn by date. !
11.- If"no disch1rge" & curs danng monitarirq period, entet % lb harge" acmss form in pla:e of data cmr).
- 12. Enter " Nam! YO!!e qf I'imCi[*a! l.EechtnT 00iNr" ulth "Sigrw:.re q! !'rmt spu! Executive Q!k er q! A;ithorned Agent," " Telephone Numhcr." a nd "Ikte" at bauam of Tonn ;
- 13. Mail ugned Repait to Omec(s) by date(s) specified in r ennit Retain ecpy fbr your records l
- 14. Marc ditikd instruchons br use cf this Dscharge Momt. ump &p rt 6 Mild ferm may be obtained ftom GP. ire (s) '
l specified in pennit, ! l Legal Notice t P Tlis nrp wt h ruim: d by in (B U.S C 131i; 40 C.F.R.125..vil. Fa!me n4 re or fader h r pon truthfub on i remit in call perMbes not to c: weed !!ON00 pa de vf a Mon; >r in 6 ruan ? ,4 de' um t 1
- J $25.000 pa day j o[ VioI3riod, or by imprii' , h9t [M r d WOt e ihm one year, cr by k
- i e
t . t EPA Form 3324 ('iten DhMS) a _ ._ b
PERMITTEE NAME/ ADDRESS (Terhede Fert*.fr Nans Larsteen qfDrfwwed N/4TtON AL POL.LUTANT DeSCHARGE EUMt:1". TION SYSTEM (NPDES / Form Appnved. DISC NAME ;; eg ggy , ;g j q
-+77 , ,E MONITORING REPORT,/,0h y $r J pt !y ao! Ly , OMS,No.2040 4004 T
^EE **
ADDRESS I , ) , -)% 3 P * 'l ' I - ?
- 7D' ($U3j )$) . , ,
A T 1 ': ; -$V!3 0 1 N ; ., n ; PEnMIT NUMBER DISCH ARGE 6:UMBEP. e p{gg{ m , w
.o ..T. r.n v. . +e-, - c. . -- ,+ .; n y ?
- g"*" n e Ft.CluTY 7y3y 3 jg((gy p p j e-MONITORING PERIOD
;7m77mu LOCATION FROM
- l ; ; TO un !* oV aC ;I5">*c1*
NOTE: Reed instructions beford completing this form. M) de-i7*": 3 .* V ! S , 9F (2G271 (22-231 (24-251 (26-271 (28-291 (3G31J (3 Card Only; CUANTITY OR LOADING I4 Cerd On/yf QUANTITY OR CONCENTRATION NO. FREcutNcv SAMPLE PARAMETER (46-539 (54-619 (38-451 (46-63) (54-619 OF (32-371 EX ANALYSIS TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,es.es, ,,4_ggj g,3_7g 7(Jt', 73r-[ SAMPLE a-S-3 ?. M : 3
. ecce '
( 39)
~ , ,,m- . , ,
, t e
c MEASUREMENT
)S- to 1 -) PERMIT ^
reen+ e r- n * * 's ' ser ac4*cn tg 10. , ,; I C f / 9hD 7, , .,
.3 7g 7- REQUIREMENT y93 sn . , , , . n3yg gg ,77, .. g y ., q 37t . . , ,
e ; SAMPLE s '*% en'? ;e s c u, ( le)
, .3, 77o.. .y . MEASUREMENT 7
11[ } ) 1 PERMIT '.9 hee? *: c e r 9 c : ~9: .:: n c o c e - r 3r WIC{/ 'Ab
- r. .q. e. .,, j. REQUIREMENT ge 3 ;j- 3 4 7 ,, y ,
, ;7 y 9y7
, n, It .3t' 37a SAMPLE ( 3) 3ean -
- ~ c ^ 41. '
*M ASUREMENT n u yc p;g, fy { 4g i n q q ._ 1 0 PERMIT cs ' 9 L "- r no r 6enem e n ;: 0 < c.: t won .nz , a y, Q 7 37;v; s , ty < : . ,, ,-
7z;,- REQUIREMENT 1
, 3y- s,,,, ,, , , y n e. r SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI*V UNDER PEN ALTY OF LAW TH AT I MAVE PERSONALLY EXAMtNED AND ,
TELEPHONE DATE AM FAMtUAR WITH THE INFORMATION SU6MITTED HEREIN: AND BASED ON j . p' My moumv OF TwOSE moeviouALS eMMEDIATELY RESPONSIBLE FOR /
/
,] j i,f,,,Jfj1 j
Dayid Ortidorf OBMNING NE mFORMATION t SEUEVE NE SUsutTTED INFORMATION IS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT TMERE ARE h A f
/ y ---
g SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING ,g Gnenista"J Mana<'cr ' O THE POSSr5tuTY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 51001 AND 33 f 412 3.q 3- 13 iN 10 gb U.S.C. t 1319. #Pwwses sawar W=se seenes mey siebwe Aaee se so #10,000 810 NATURE OF PRINCIPAL EXECUTWE g TYPED OR PRINTED sav er m==s=nn 1- _ c er eerw a a moves.as s y rs.s OmCER OR AUTHORIZEO AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference et/ attachments here)
/d- /\, s. - i- - n s EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.l ,c PAGE OF e,._ ,i ? / f r l,b.t l - t, i r, 3 f ,
1
.c + c t Paperwork Reduction Act Notice !
l Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as ao 6 l average per responr4 foi r,ome minor facilities, to 110 hours as an aurap per response fbr some major facilities, - l . with a weightai average for major and minor faciliticiof 18 hours per response, including time for reviewing " instructiorts, tearching existing data sources; gathering and maintaining the data needed,'and completing and l reviewing the collection of information, Send comments regarding the burden estimate or any other arpect of ; this; col lection "of infbntution,^ including suggestions for reducing this burden, to Chief, Infernution Policy
! - Branch, PM-223; U.S. Etairnemental Prot-etion Agency,401 M Street, SW Washington, DC 2030, ed to the }
. Office ofInfonnation and Regulatory Affairs Office of Management and Budget. Washington, DC 20503. j
_ . u.. _ __ _.
- -. _ _ . .J l General Instructions i is f form has been partially completed by prepnnting, disregard instructions directed at entry of that information
- already preprinted.
7 2: Enter " Permittee Names / ailing Address (and facihty namcilocation, if different)," " Permit Nwnber," and l
" Discharge Numbcr" where indicated. (A separate form is required for each discharge.)
3c Enter dates beginning and ending "A/omtormg Period" covered by form where indicated .
)
4c Nnter each " Parameter" as specified in monitoring requirements of permit. i 5 Enter "Samp!c A/casurement" data for cach parameter under "(/uantity" and "Gualirr" in units specified in permit. !
" Average" is norma!!) aritlunctic average (geometric average for bxterial parruncters) of all sample measurements' !
for each parameter obtained during "Alon.toring Period", "Alarimum" and "Afimmum" are normally extreme high l and lua measurements obtamed dunng "afmitorirh: Permd " (Note to municipals with secondary treatment l requhement; Enter 30-day average of sample mesurements ander " Average." and enter nminmru 7-day ascrage ! of sampic measuremcots obtained danng monitormg period under "AIar4 mum ") ' l
- 6. Enter *?crmrt Requiremo:/" for cach parameter under " Quantity" and "Guality" as specified in permit. ;
- 7. Under "Na In' emer number of sample measurments during monitoring period Out exceed maximum (and/or l minimum or 74ay average as appn priate) penni! requirement for each parameter, if none, enter "0". l 5
l 8JEnter "hryuency of Analysts" both as " Sump /c A/ramcment" (actual frequency of sampling and analysis used j j during nwnitoring period) and as "Penmt Requirement" specified in permit. (e g , Enter " Cont," for continuous monitoring, "I 7" for one day per week, "If.M" for one day per month, "160" for one day per quarter, etc ) ,
- 9. Enter "Samp/c 7)pe" both as " Sample A/easurement" (actual sample tvpe used daring monitoring periody and as t l "Premit Requireme,n!J (e g., Enter "Grap" for individual samp!e, "NHC" for. 24-hour compos:te, "N A" for ;
- j. conunuous momtonng. etc.) ,
l i
- 10. Where violatirms of pennit requirements are reported, attach a brief explanation to dese:ibe cause and corrective l
l actmas taken, and reference each violatkm by date. l l 11. .If "no'dischrate" occurs during nwnitoring period, enter "No Dncharge" acmss Ibnn in place of data entry
- 12. Enter ?NameTide of Pruicipal Exewit.>e Opicer" with
- Signature c) Prmapal Erewtne @ er qf Auth:rned ,
Agent," " Telephone Nwnber," and "Date" at bottom of fonu
~
s 13.' Mail syned Report to Ofliee(s) by dre(s) specified in petmit, Retam copy for year wcords. ;
- 14. More detailed instructions for use of this Dinharge A /amtonng Repet (DA!R) fann may be obtained from OfliceN specified in permit. 4
- Leoal e Notice l
This reNrt is requim! by la (33 U.S.C.13!8; 40 CLR.125.27). I a; hue to repmt or fuf ere m report truthhdiy w l restdt in civd yndties not to exceed $10.000 ptr day of vio!alion; or in criminal padhm not to ewd $25,000 per dn i Ef delation, or by imprimnmera for not more than one year, or by both. t. 1 ;f EPA Form 33204 mcv. CL95) I
e PERMITTEE NAMEAADDRESS(t=weFerdryN Leesraae(Dders r> sr,ATIONAL PCMUTANT DtSCHAROF EUMINATION SWEM (NSDES/ Form Approved. -" NC NAME pg4yp3 yg((gy p g ;j g g 3747{3g _ MMMC NT (D% tt7 ty ;I7 } py( y OMS No. 2,0404)O04 pprs S ADDRESS P . 3. "O X i4 " ' ' "i ' f N1C 7'1 ? (53BR O$) res,G3 ; PERMIT NUMBER c:scHAAGE 10 UMBER e pggg A??Mi "AV1D CPSD0RF ra p g net,, A+ i3 .0 ; g s, t. g ,r,g7y u g -) ,". r 2 - MONITORING PERIOD FACitfTY gggy 3 y p r, s gy pggpy q7g77gy , , LOCATION pgog y ,, g, ., 'O 9o s' . &&S 9Q (I%y4PCE l Q?4 girN: niVTP 3 7 w 9 J :' F (20'27J (22-23/ (24-251 (26-271 (28-29/ 130 3Fj NOTE: Reed instructions before'e&n{pleting this form. PARAMETER (3 w on&i QUANRTY M LOADING (4 Ced M1 QUANTITY M CMcENTRAUM N O. FREQUENCY SAMPLE 146-53) (54-61) (36-o: 146-53) (54-691 OF (32-37) EX anatySis TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAX 1 MUM UNITS ,em ,,,,,,j ggg7, sv SAMPLE poiM e u? 9 ' <sa>SSc [, </ $ ( 17) ^' //
/7 MEASUREMENT [, { [ h N,4
? ')'10 0 [ ') O PERMIT ceceM mote?c e :ce ,,Q
, ncecpt %Q ngy nps
'Fr?M'tT ~ : 1 S '; vi f P; REQUIREMENT , ,y e e y 7 9 , ., p n N g q q g ., en
', 3 L [ n s , I ') r A J. SAMPLE ctate+ *- M e e :: e ?: 9 c c i ( ;g} //
;;gpgypgg MEASUREMENT /C, ,2 #,,7, () b /7 hf ,
)?E]q ] S p PERMIT ceA&en o ph e e O Nn tocec^ 13 l ') 0 ' E r n ',Y HAe
] rt.uvsr . 3 '; 3 VsLyr REQUIREMENT we g g73 - 347g gg ,g7
)[L A19 r. 9 r 4 7 7 SAMPLE coethS a re ; 3 o c o S cr - _ ( 1 ly /
*?ON ' f T il N r' A V iE Tt MEASUREMENT < 6_ G O 7 (1, , g, b 135;b ; 3 f) PERMIT cceeec merecec-e 9ec o@oarc l ', '! O e m. y .kAs
, p p g , ,, p 3 g 3 <- g gg; REQUIREMENT m r-; y 3 v 7- 93 ;g yy ., f T 7LCW, IN C 3 H O l' I ! Op SAMPLE O,6SG
( n3} c? W N e03cce c o r;: p O /~/ 7 M 9') " 7 '". A I N .T PLAU. MEASUREMENT O,C// Qf i ?; q ',, 3 } n i PERMIT n e p o r: P prengT cccar co QCOMO Ococto ' Ne+ Eggg qT[y3
' F F Y,0 C o
- C P 3 3 '- 7 ; T.17 REQUIREMENT g gy; ngry, .; ggn egg SAMPLE MEASUREMENT PERMIT REQUIREMENT !
SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER 1 CERTIFY UNDER PENALTY OF LAW THAT t HAVE PERSON ALLY EXAMINED ANO / TELEPHONE DATE AM FAMILIAR WITH THE INFORMATION SUSMtTTED hEREIN: AND SASEO ON - MY INQUIRY OF THOSE INDtVfDUALS IMMEDIATELY RESPONSt9LE FOR / /#
,ad d O r r. Or OSTAfNING THE INFORMATION, I BEUEVE THE SUSMtTTED tNFORMATION IS Chensitr7 ManaEer mE. ACCURATE AND cOMPtETE.
SIGNIFICANT PENALTIES FOR SUSMITTING FALSE INFORMATION, INCLUDING s AM AWARE MAT THERE ARE , '
/
-4,, h> g%> !, .-'
THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 412 M3-5133 %.. 10 18 U.S.C. t 1ste. #Funesses enver e=s. sienne mer eiebee snee o es s 70,000 SIGNATURE OF PRINCIPAL EXECUTIVE TYPED OR PRINTED and er msnmiin : _ _ - oraer. s momne new a r rsJ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO OAY b COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s/Istrechments here) r s EPA Form 3320-1 (08-95) Prevfous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) q g, PAGE OF _ ._ .-__-m____ _ _ _ . . _ _ _ _ _ _ _ _ _ .
1 'I
- Paperwork Reduction Act Notice
; Public reporting burden for tb "ection of information is estimated to vary from a range of 10 hours as an .
i average per ietonse for some r facilities, to 110 hours as an average per respc,nse for sonw major facilities, with a weighted average for c. .nd minor facilities of 18 hours per response, including time for reviewing -
,' instructions, marching existing a sourc% gathering and maintaining the data needed, and completir*g and j
reviewing the colles: tion of information. Send cocunents regarding the burden estimate or any' other aspect of '
~
this collection of information; including suggestiom for redu6ing this burden, to Chief, Infbrmation Policy ; ' l- Branch. PM-223, U.S. Environmental Protection Agency,401 M Street, SW Wasidngton. DC 2(M60; and to the i. Office of Information and Regulatory Affabs, Office of Management and Budget, Washington, DC 20501
**h*'-"'**'W48d -een,mme=-=me ase euw -weq.mese-.h,wcry-asame-sw-me.a.'e-as.g',, e 44gnam ,m g e,= {
i i General Instructions 1 1.'If form has tun partially completed by prepnnting, disregard instructions directed at entry of that information j l already preprinted. i , i 2J Enter "Permittec Name Afading Address (and facility name/ location, if different)," " Permit Number," and l i "Diacharge Number" w here indicated ( A separate form is required for each discharge ) 1 4 4 2 3; Enter dates beginning and coding "Monitormg Period
- covered by form wbeie indicated.
1
- 4. Enter each " Parameter" as specified in monitoring requirements of pctmit.
. 2
- 1 Enter "&unp/c Meamrement" data for each parameter under "puannif and "Gualit/ in units specified in permit. .;
a " Average" is normaHy nothmetic average (geometric average for bacterial par:uneters) of all sampic measurements - 1 for.cach paramcier obtained during "Aivnitormg Pcemd"; "3/arimmn" and "Afimmum" are normally extreme high .
- and low measurements obtained during "Ahmitoring Period." (Note to municipals with secondary ticatment {
- requirement
- - Enter 30-dry aserage of r, ample measurements under "Arcrage/ and cn cr maximum .7-day aterage l
, ; ef sampic measurementa obtained dunng momtonng period undct "Afatimum."/ i l
,,. 6. Enter "Perinit Requirement" for each parameter under "Quanntf and "Qualit? us spectned in pennit.
- 7. Under "No Er" enter number of sample me.surments dunng monitoring period that exceed maximum (and/or :
. rmnimum er 7-day average as appropriate) permit requircruent for cach parameten If none. cater "O" '
t I 8. Emer Yrequewy of Analpu" both as " Sample Afcawrment" (actual frequency of sampling and analysis' used l
- daring monitoring penod) and as "Perrri.t Requiremem" specified in permit. (e g , Enter " Cont,". for contiaucus i monitoring. "//7" for one day per week, "ldO" for one day per month, "F90" for one day per quarter,e '
- c.) ;
) O Enter *&mple 7)pc" tmth as "Lm;'!e Aleasurement" (actual sampic type used during monitoring period) and as l j '"rcnmt Reqmryment." (e.g , Enter " Grab". for indisidual sampk, ".NHC" for 24-hour composite, "NM" fo.
- contmucas. momtonng, etc.) ,
i
- 10. Where'vio!ations of permit requirements are reported, atixh a brief explanahon to desenbe cause and corrective :
1 actions taken. and reference cach unfation by date. t c
- 11. If "no disdurge" occurs daring manitoring period, ente 'Wo Dmharge" across form m pLwe of data entry. ,
i
- 12. Enter "Nwnciale of Princiticd Execu;ive Ober" with "Sgnature of Prina;wl Exe uuve Ollicer ofAut !wri:cd j Agent: *Teleplwne Number," and "Date" ut bouom of form l 13. Mail !.igned Report to Office (J.) by daue(s) rpecified m permit. Ret:un copy for your recordi 1E Mare detailed instructmns for use of this Discharge Afonnor;ng Report (DA/R) fann may be obt. tined from Office (s) j specified in pennit '
Legal Notice This re;wt h rapured by hw 03 U.S.C.13!8; 40 C.F1 12L27). Faifare to report or f.ahn 1 to report trmhfully cao seult in emi pendue;. M to creced $10M10 per day of si sti<m; or in ennunal p;nzhies um to eneed $25,000 per day of vietation, or by i:nprisonment for not mme than one pr. or by beth, i
- FPA Form 33201 (Rev. M45) t
, __ . - - - -~-
- .- . __ - . _ _ . . __ _ ._~.m._._,.._ _ . _._.~-m. . . - .
. i PERMITTEE NAME!K.DDRESS erarwe Forme,N.=e E reenou (fD@eed NATION AL POLLUTANT DISCMARGE EUMWAftON SYSTEM (NPDES / Form Approved. .
EME nqgy7* yggggy p g.g g y 3 7 7, + y ;) y NT_% m mMRNT(D% f t7 333 g 3 9gpq M No, 2040-0004
^EE s
ADDRESS P e ? e 3 ^) I 16 "107?ROI 3l T E ( S !! B P O5) $ ' ) %ITH; ) AVID 08A?ORy PERMIT NUMBER CISCHARGE EUMBER { ,, p7qgg
- S G I P i> I N ', P M I Pi iM77 DE M FACILITY MONITORING PERIOD yggy7g y4{ggy p p g <* v g=gt733 LOCA M FROM fo >f it TO <* L! > .. a CDC ND DISQiEr [_{ 0$a NOTE: Reed instructione before completing this form.
A
- T L' : D R iiI a 3 D D 0 9 5' (20'27J (22-231 (24-251 (26-271 (28-2.9/ (30-31/
(3 Card on&l CUANTITY OR LOADING /4 Card Onys QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE PARAMETER 146-53) (54-61) (36-451 146-53) 154-691 OF , f32-37; EX m yss TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE W MUM UNITS ,ss.es' (64-681 (6S7a sq SAMPLE coeMt *s?0000 u ne); ( 12) j MEASUREMENT 7, / 7 (, j( O 7 Srd 13400 1 S O PERMIT 60eSte Ochect c '; c 3. 0 97000% a , f) G y, L Y .RAa' P r L 'J F y * " i 3 ", 4 7 A LU3 REQUIREMENT wac 37q;ggg . ,,, 4 y Q e. - .; e.
"l L T D S , T ry 7 t L SAMPLE o c e- 9 e e e o e:
- s e o n c e. c - 9q o ,
? J *^ U Z % ? " D MEASUREMENT _ t_
~
g7 g /
-~
1 "j 'i '8 0 1 ") O PERMIT Mocce e c ot-e c c act oceco 19 13 gy _g g ,
> F F !! v v 7 1770s ?ALnr REQUIREMENT ,, 3 p yg ,, g 977, ,,
,,p
)[L l ', ') p -g3i SAMPLE C & & ^r o c nc^7$2 ?03603 ( l ';) f/ ;
' 1 " 3 T, 'ITR-GPAV FSTF MEASUREMENT 47 4g O // Q _/
])$$6 1 3 3 PERMIT co"re r - ^ e e o ?: e e tc^ c0&cce 15 2 ,) . E }% L T ; SAP-
' r e r (g me a :9137 y Attg; REQUIREMENT 3eu e 3g 33 y(p 3g r/L 7 L O .' , IN 'DDU:7 f)y SAMPLE ( Q 3) e0000$ ic %3C e70cce j !
'H99 !;PAF9 4T PLAN. MEASUREMENT gg7 O,f g O 7 g7
- pqG { 3 0 PERMIT ; " p '? rl = untnpy cceego cecose cegocc My ggLy g r I *g p i
, F F T,13 # *,T 7ElOi Va Mt. REQUIREMENT ga gg- g,y y p y ag .,n g c e.t i SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT
- j NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER 4 CERTIFY UNDER PENALTY OF LAW THAT e MAVE PERSONALLY ENAMINED ANO / TELEPHONE DATE AM FAMIUAR WITH THE INFORMATION SUSMITTED MEREfM; ANO BASED ON MY INQUIRY OF TMOSE INOtVfDUALS IMMEDIATELY RESPON98LE FOR [,
[s # 4 y
/
/
OSTAINiNG THE INFORMATION, I SEUEVE DIE SUBMITTED INFORMATION SS i' e /- O ])ayid Orndorf TRUE. ACCURATE AND COMPLETE. I AM AWARE TMAT THERE ARE // , V,j z /, g7,#v[- t f k 90NIFICANT PfMALTTES FOR SUBMITTING FALSE INFORMATION. INCLUDING ^ i Chemistry Manaecr - THE POSSSIUTY OF RNE ANO IMPR!SOMMENT. SEE 18 U.S.C 91001 AND 33 ggTURE OF Prep 0CIPAL EXECUTfYE 4I2 393*5111 39 10 lei U.S.C. t 131o. tNweee sener snees seenme mer hen M shes se no sto. coo AREA TYPED OR PRINTED ema er men
- mew : _ - : er**rwesa s memne ena s yeare.s OFFICER OR AUTHORIZED AGEffT CODE NUMBER YEAR MO DAY ,
COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference et errechmettrs here/ EPA Form 3320-1 (08-951 Previous editions may be uSed. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.l PAGE , OF 93,L01/960o._L u- C'4 0 3 1
l,e ' Paperwork Reduction Act Notice Public reporting burden for this collection of infonnation is estimated to vary from a range of 10 bours m: an [ average per respone for some rmnor facilities, to 110 hours as an average per raponse for some rnajor f acilities, with a weighted average for najor and minor facilities of 18 hours per response, including time for reviewing - i'nstructions, searching existing data nources, gathering and maintaining the data n*ded, and completing and reviewing the collection of infonnation. Send comments regarding the burden estimate or any other aspnt cf I this col!cetion of ~infunnation, includang suggestions for reducing this burden, to Chief, Infonnation Policy ( Branch, PM-223, U S. Environmental Prote,; tion Agency,401 M Street, SW Washington, DC 20%0; aaJ to the j ; Office of Informatmn and Regulatory Affairs, Of fice of Management and Budget, Washington, DC 20503. j 1 i General Instructions l 1 1, if form has been partully completeJ by preprinting, disregard instructions directed at entry of that information l almady prepnoted. I
- 2. Enter "Permittec Vame3faihng Addren (and facility namc/ location, if different)" "Permet Ymnber " and '
" Discharge bmber" w here indicated ( A separate form is required for each discharge]
- 3. Enter dates beginning and endmg "At<mitormy Period" covered by form where indicated, i
- 4. Enter each *Paramerce" as specified m motutoring requiremems of permit.
]
1
- 5. Er:ter " Sample A/eamrcmenF data for ca;h parammt under "guantay" and "Quahty" in units speciGed in permit. '
"AWray" is normatly anthmetic average (geonttric :.Wernyc for bactclial paramCt0Is) of all 52 mph measurCDCmS l for exh paramctcr obtuncd dunng "A/omtonng ?crmf'; "Afaromem" and "3/mimeti are ucrmally extreme high !
and low meannements ob:ained during "ifonuor n; Permd" (Note to rnunicipais with secondary neatmem ! requirement: Ent a 30 day avemge cf sample measurements under "Awraxe," and enter mnimum 7-day ascrage of sampb measuruncuts obuuocd during monitoring penod under "3 fanmunr. ") 6 Cmcr "Pern< Reym nnt" for cach parameter under N)nnnty" and "Qualay" as specdied in pesmit
- 7. Under "O lY enter number of samp!c measunneras dunng monitoring penod that exceed tuaximum (and/or mmimum or 7-day n erage as appropnate) pernut requiremem for cach parameter If none, enter "0" 8 Eruer "ingtm > q/ Analvm" both as "'.amj /c Alcawrment" (actual frequena of sampling and analysis used during neoniwring period) and as " Permit !bjuirenn nt" specified in pennit fc g , Enter " Cent " for cominacus momtoring, "//?" for one day per wech, "/00" for one day per month, "/50" for one day pcr quarter, etc.)
- 9. Emer Wrple '/}je" both as "Samjk A/easuran nt" (aMal sample type used during racnitoring period) and as "A trnt Majmrcm wt/ (ig . Enter "timb" for ir.dmdual samp!c, "NI/C for 24-hour composite, "NW for COUliDUou$ Inuni!ormg, Cte.)
- 10. Where violations of permit reqmrements are reponed, anath a brief explanation to de cribe cause and conechve actions taken, and reference cach '.ialanon by da:e
!I. _lf"no dischargc" occurs darmg monitoring period, emer "Yo /bchmye" moss fann m pire of data entry 12, Emer "Namc 7itic ef Prm:: pal Ers ailw @w?" uith "Spature - ! Pnwpal lhecutwc t @cer of.tuth: n:ed
.1 gent * "Tde;hme Mmber," und "Date" at bottom af funn
- 13. Wil signed Report to Offrce(s) by date(a specified in permit huin copy far your records. i
- 14. More detskd h.structions for tne of this leschar,ec Mmt av 3 pmt (DA/R; form may be obained from Of fice(u specified in permit Legal Notice msy,nn,musd83 s m o s.c ou u o mn mum tmp+mme % e nday m I
<~ don svd pehm en-md mm dem% ~ inea m u mu m m m m pe %
DI V 5(da!I-OL or by t r'If f a i sM ' I b r 'M ): fDO' Ih3n iN } NT, GI by bdh. EEA ['04i033 k ](bt'%Im *D)
PERMITTEE NAME/ADORESS a=reede Fer#aeyNas.e Lorernee trD#s s er) $%TIONAL POLLUTANT C:SCHARGE EUMIN'TTON SYSTEM (NPDES 1 Form Approved.
- DISCH R E MONITORING REPORT,(D ff N.*.ME g r g g, ; ,, ., g ( ( g 7 g g g :, ; zr7gg p 473, r ; ., : g - g OMG No. 2040-0004 , 9 ADDRESS P . J , 4
?X II *' '
- S ' ' A ' ' i * ( ~;ij C 3 S3) EE PERMIT NUMBER D;SCHARGE EUMBER
;epy; ,ayIp g % r q u .- 7 . r{g ;
,,2 ,- y ,in ,3r. vp 5 en t <) . '
'
- y'> p MONITORING PERIOD FACILITY 3r3,ay y3,(y7 g9grt 747737 YEAR MO DAY YEAR MO DAY LOCATION FROM aa i'a TO 99. e t) Mc aq c!5FMiCt; *' ( cc' NOTE: Read instructions before[ completing t 4* y. pty77 3- yar (20'277 (22-23/ (24-251 (26-271 f28-291 (30-3ff (3 Ced on/r/ QUANTITY OR LOADING (4 ced ontyi QUANTITY OR CONCENTRATION N O. FREQUEN W SAMPLE PARAMETER I46-531 (54-691 138-45) (46-531 (54-619 OF (32-37/ EX ANALYsS T'. ,
AVERAGE MAXIMUM UNITS MtNIMUM AVERAGE MAXIMUM UNITS ,,u ,, (64-6s) (6% s. i y SAMPLE ceeear 6eeecs eat 36 ( 12) MEASUREMENT 33400 1
- PERMIT n o r.- e * + ehecic < un ..G c?0?3: 9 PPN r ,, icd / HAb . r e p t 1; ' : ; 'j 4 * ; REQUIREMENT 33c. 37yyung i,. g y , , g %- en g prp ', l ',, T *i i , T 9 [ 9, L SAMPLE e c c e r. . enne- o c. n + y -
( in) 75py,,g,g MEASUREMENT
' 9 5 3.j ; 3 p PERMIT Moonc e r.e e a c I 30: cocW h 10, c 'g I c t / rag r e[ n. 97 ; n- - V a t y :. REQUIREMENT 4- .-
g . <; p3 7 g qz ;f; p 7g
,;t s -
gsq OT ' SAMPLE MEASUREMENT r e "- $ 6 u eAn^co inrect ( 19) r g q . ; c ,g ; y c7;
'15%o L ? p PERMIT o n a r. A n a o 6 *: e n -- 'Sc c e n .;r c o is 20 yIg/ ;g g
- r t, f r y e ;, s; - y*1 REQUIREMENT ,n, eq ,y; g7 y y ~;jp . . gp.
s ( c. _ , Is 33 ;y;+ p- SAMPLE ( q 3) +
- O c :.. ; *: ? t 3 0 r:4+
q; 3 eoegp,,- p ,g p . MEASUREMENT Qg khV
,Tos a 1 3 a PERMIT ,7007- n e r p r. v noc4Ac c c o ::c c c .v ? m e is. gEq eg I -
ynvg;y- , y g g; REQUIREMENT ,g t y ., n g y 7.7 3 3r7 ce SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT - SAMPLE MEASUREMENT PERMIT REQUIREMENT _ NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT $ HAVE PERSON ALLY EXAMINED AND n TELEPHONE DATE
/
AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY INQUtRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON98LE FOR < jO[ -
.[
Di4Vid OrndOrf OBTAIMNG THE INFORMATION, I BEUEVE THE SU6MITTED tNFORMATION IS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE &
.' .'j A .tjAp-
,,j g U '[i- '
g; - CherliS try llandSCf SGMmCANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING 3 g,, THE POSSSILITY OF FINE AND tMPRISONMENT. N 14. D.J - 51 1.m3 96 10 .o U.S.C. l 13te. trwimmes smeer enese samme mey 6SEEetwe,18 U.S.C. sinee l 1001 se so s r0,000 AND 33 SiONATURE OF PR!NCIPAL EXEbUTIVE g TYPED OR PRINTED emt er mensa.m, w : or aerween s mores smr 6 resra# OmCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# strechments heraf 0 h j ', e k - >- ? EPA Forrn 3320-1(08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF n ,, q _ . gqy
.. ~
I Paperwork Reduction Act Notice Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an j average per response for some minor facilities, to 110 boun as an average per reponr* far some major facdities, with a weighted average for major and nunor facihties of 18 hours per response, in .uding time for reviewing -
! instruction searching exittir.g data sources, gathering and maintaining the data needed, and completing and , reviewing the collution of infonnation. Send comments regarding the burden estimate or any other arpa,t of l this collection c.f information, induding suggnticas for reducing this burden, to Chief, biformation Policy j Branch, PM-223, U.S. Environmental Protation Agency, 401 M Street, SW Washingtoa, DC 2N60; and to the ,
i Office of Information and Regulatory Affairs Of 6ce of Management and Budget, Washington, DC 20503. j i ) l c__.._-._____ _ _ . . _ _ _ _ _ _ _ _ _ . _ _ _ _ - _ _ _ _ _ _ . _ _ _ . J General Instructions 4 1. If form has been partially completed by preprinting, disregard imtructions directed at entry of that information , " alrerJy preprinted. , 2. Enter "Permittec Name 3/aihng Aldrm (and facility name/ location, if different)," "Pernut Nwnberf and
" Discharge Numbcr" where indicated. (A separate form is required for each discharge ) !
l l 3.. Enter dates begmning and coding "Alumtormx Permd" covered by form where indicated. l i 1 4 Enter each " Parameter" as specified in momtonng requirements of permit. l 1 l 5. Enter "Nampic A!eamremcet" data for caeb pammeter under "Oaannry" and "Guaho" in muts specified in permit. i "hcraw" is naimaHy anthmeti; cm. rage (geometric aversge for bacterial parameters) of all sample measurements , , for each parameter chtAnca dunng %nnorog Pernf% %r,isd and "Mminum" are normally extreme high l 4 and low mmmcments obtained daring "Momtveme Pceml" 6'me to municipals with recendary treatment ; requnement Entcr 3n-day avemge of sample measuremca ; under ".h erage." and enter mmmum 7-day ascrage 1 of samph: measurements obtamed du;ing rnonitoring penod under "Almimum.") o Enter "I'crnut Fequiremt nt" for cach parameter und;r "Guantig" and "Gualite" as specified in permit. 1 7.,Und,tr "Yo Er" emcr number of sample measurments dunn;, monitoring peried that exceed maximtun (and/or rr.inunum or 7 day m erage as apprepnue) permit scquacment for each parameter if none, enter T ' S.' Emcr "Frepency q/ halwis both as Wnple Aks arment" (actual frequency of sampling and mudysis used dining mondonng penod) and as "Pt rear !bpirement" spa.ified in penmt. (e g., Enter "Gart," for wntinucas monitoring, /P for one day per neck. "/ 90" for one day per month, "!&u" for one day per quarter, etc )
- 9. Enter Samp!c 'lijv" both as " Nam;>!c Mraxurement" crJual sample type und during mamtenng periud) and as
" Perm.t /Mp:rementf (e g., Entu "Gmb" for indecidual sam;4e 'W1/C" for 2 8-hour composite "N;1" for contmuous monitoring, ete-)
- 10. Wliere violations of pernut reqidrenic ase reported. mtach a brief explanatieri to describe cause and correcthe actmas taken. and ritenec cach uolation by d.de-1], if "no diSih2rge" occuG durmg monitaring pcnad, enter "W DUcharge" a. 10% fann in place cf .l.:!d Cutry,
~
ll. Eli Cr f #NQHid ' idle q! !'rinCifal! EL U Uln e Ull der" w ith "Stl ~Qtlirr yf Plim'ifa! lhelkh t? Ohrer ol'.lLll,ori:Cd Agent," "Icirph:me h umkrl and "Date" at boucm of fone
- 13. Mad sigr,ed Rep:nt to Officea) by d.vcD) qweified in permit Retun ropy for your recctds.
- 14. More detaded infaructions far use of this Din / arge Mmdormy Report (IEftO fenu ma he o!,:ained from Of!icct s) sp?cified in permit Legal Notice ns om ,n+ muse macummso e de<,reonyun m nit in enil p:rita . no 'o e ra eed $ WEYJ ; e da of viha c or ;i c ri mi N Aes n A to ex vd 15,0@ g r by of VK h21.on, or by imi'r! " erJ W . M more thun me year, or hy bMh.
EPAI'orm32n1(Rn. W98
_ _ _ _ m _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ __ . _ _ _ _ _ . _ _ . _ . _ . . . _ _ _ _ _ _ g ea 3 PERMITTEE PeAME/ ADDRESS 0=* Mere #> Name forenoqD@ew) NATIONAL POLLUTANT DISCHARGE EUWNMION SYSTEM (NPDES) Form Apprived. . NAME DISC ,E MONITORING REPORT (DM , OMB No. 2040400,4 . *
,ggy3 , ygg(gy yg eq ;7 s; Sy ,
.- y 9g- ; 7, PE# **l * ", OS-3U98 ADOREIS P . O . H 7 i. 4 E A 5 ' C A ' C 3"* *
(539i 35) ; PERMIT NUMBER DISCHARGE %UMSER g -7y4{ . 1 E"!N* D4V!! 3 P 7 0 n r .
';aropy3
~'- - ' ' ' '.*o4 c.* 1' #- r. 7 7
' 3 '3 3 e '
MONITORING PERIOD FACILITY ~*4 .-+ y4%vy - t c. y s.3. *. .e -, e s= g~'r4 p YEAR MO DAY YEAR MO DAY , .,,. LOCAT m FROM +, 8
!e TO 4r
- CC' nn ?!c~' U"! j y : %
(2& 271 (22-231 (24-251 NOTE: Reed instructions before completing this form. a!T1: DiV!3 st # D V F (26-27) (28-291 (3a3,j (3 Ces onrys QUANTITY OR LOADING (4 Cerd on/yf QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE PARAMETER (46-531 (64-691 (36-451 146-531 154-619 OF (32-37; EX ANALYSIS TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS es3; pg ,_gg, fgg7g ! s; SAMPLE annee" *: ^ e ^ e s n195+O ( 17) MEASUREMENT
: 50 1 3 , PERMIT encenn e n e _+ A a - per , C. ry n g n g,n ggy gg e (;; ; ;e ,
;,t < ;1,gq; REQUIREMENT ge g7g7 3 ogy7 , .
+
3 g; SAMPLE
- n +. S e * ^+<~~; a - O r- e-5 ?, I [. ; , { 19) l
.4 2 .r. n .
s < MEASUREMENT
'3G]O i ? PERMIT coenc9 eee?A6.e ;*: :+ 0 er 0 c e 1^ i rt 0 F%LY pAb ycggr+ , 3 y7rq4 REQUIREMENT -
3r g7q pg rg q ., q f p
- [. 4 31 ;t er: SAMPLE + v e o r- ^ ^ ^ n e- r n e ., s ( ; g) ns 1;a - ;gy 9) yr MEASUREMENT 17 s n 1 ; PERMIT coa ^e^ e *
- e e e.
- s+c GWANnq 15 p t) ,eg;) pp
.. v g , =+ ; y 3 t, , REQUIREMENT 2ee q gy; 9;g yy ,
;f7 I 'r 4, s. .v . , y I 2 SAMPLE '-e^*^^ <-~nn
- enNen? ( I t; \,
MEASUREMENT a, naru ,,
- x. d .)
9 ;10 J e s PERMIT 0?Or 9 c: te^3 ' a 50cte' Rgpg4' 7(PORT EEKLy u [. 7yi,99 . 3, 7gg REQUIREMENT <r 33 gg7 n p, T g. ,, y 3 r; f y
;L '. it r-1, T'rgi SAMPLE 300+0'
- ente: cie00 ( 'G)
.o. .-t.-
MEASUREMENT ii; ; :t PERMIT coqe9N Menen ( >Ja .: e c y c o ' 1 - brN M N 'a REQUIREMENT ,,y~
.. p r g , .: 7y_ y);. y7 3 g, - pg7 y y .qft 9 g.g fs D' SAMPLE c j) 34 tr - pg+z, r. 3 u e f ~
' t. W , !> , j ! -'
(
-ewe +1
- . rs. ~e 3, u 3. .:
. MEASUREMENT hk J ,f ;w
' ? ? % 'i 1 PERMIT g 53e? n *' p c r y o o c o o c. .:e n et on%gp g , ,^,7,,
'"' 7',
r q m :- ;- y 4; 3: REQUIREMENT -g gyc g3y;y 3y y;g
- .t ; JINP, r a i r, L SAMPLE 50' e m e ?. 2c301 ( 10) 7 r p. o z L MEASUREMENT
, ? O ,.1 1 PERMIT '".2 o C- P ^FNe*3 . %' "Y C 0 0 0 ': J. 5 L. i5 . L *, L 1 :xAt rf[gt wv ; 3 .. YA;' REQUIREMENT 3o< y9 1yg i y r; y n7g < .; f (
NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER 8 CERT FY UNDER PENALTY OF LAW THAT I H AVE PERSON ALLY EXAMINED AND / TELEPHONE DATE AM FAMIUAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON A 6 -
/
MY INQUIRY OF THOSE INDIVIOUALS fMMEDIATELY RESPONSIBLE FOR f
- 1) avid Ul'UdO t' [ OBTAIN8NG THE INFORMATION. I SEUEVE THE SUButTTED INFORMATION 13 ' . j /
.y, e TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE o ,, ;,. / , ' //' 8 f ChCHlClTy MlM13geT SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. fNCLUDING ' g7 3y}g{}} -
(g gg {g THE POSSISIUTY OF FINE AND IMPRfSONMENT. SEE 18 U.S.C. I 1001 AND 33 meowe SlONATURE OF PRINCIPAL EXECUTIVE g TYPED OR PRINTED U.S.C. w I sais. #Psa ar m.-- - mee
- F mer s.r. ewas steams mer.as a a m a*. rms s v s=s se se s ro. OFFICER coo OR AUTHORt2ED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e// strechments herel
? ? ? ' '. _ ! a r A** * ' 91 N ! f. M C ;I T i oi" . T7 *^7[V "M?! $?9T95c DP V7' L ! ? 9 P . . ~ ? ") "' " *e. LtTLY F?Yl?ON Na e STO v
*-1 sv.. ir ; s a 2;;tc ('y a .: . -' , t r . ) : -q/L. (Tac L1*?? !" Ti -4
;/ L Ar A 'gILY M A i .)
M N, e EPA Form 3320-1(08-95) Plevious editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) , s PAGE , OF 1 1. ,_ s/ , o, . u u , r_ o3 - t
l Paperwork Reduction Act Notice l Pubbe reporting burden for this collection of information is estinuteJ to vny from a range of 10 hours as an I average per regee for some minor facdities, to 110 hours as an average per response for some major frilitics,
, with a weighted average for major and minor facilities of 18 hours per response, induding time for miewing
- l indrumons, searching exisung dau wurces, gathering anJ maintaining the data needed, and compkting and I I
reviewing the colkction ef informAon. Send cormnems regarding the burden ntinute or any other aspect of l I this cohetion wf infomation, inviudiry suppNiom for reducing this burden, to Chkf, Infernution Pohey t Branch, PM-223. U.S. Environnenta! Protection Agency, 401 M bct, SW Was.hington, DC 20E0; vnd to the 3 4 Offke of Information and Regulatory Atfairs, Office of Managenwnt and Budget, Wa3hingtori, DC 20503. l l + L , _ . . _ . . . . _ . _ _ _ _ . . . _ . _ _.._._ . .. __.._ .. _ 1 ___ . . _ , _ . _ . . . . _ _ - .. J General Instructions :
- 1. If form han been partially completed by preprinting, disregard instructions directed at entry of that infornution alreaJy preprinted.
- 2. Enter
- Permittee Lme Mading Addren (and facility namellacation, if di!Terent)." " Permit Monber," and "M harge Number" where mdicated (A separate form u required for each discharge.)
- 3. Erter dates bepnning and ending "Emteng Permd" covered by fonn where indicated 4, Enter each " Parameter" as specified in mamtorm2 requirements of permil S. En:cr Wnp'e Mmmrem '" dan for each paran eter 'mder "pumisty" and "pudly" in unos specified in permit
' hee" b wrmn!h anthmetic awge (gcomatne aurage for batterial pa:ameters) of all sampic mensurements lbr ca;h parameter chuoned during "t!.nntorme Perior. "itm m" and "Mmmum" are norm.Jh citreme high hhd ]W MO TONCl h Uhlamid du'ing "i/M!< >rtng /5 % > !" (Not- 10 mimicip tk wuh set.ondarv treatment reglprentCGl dHiCr Md3) .h CTDUC Cf Mmpk in.LUrtmJTit" Uud0r ".!Nrage," aPd Gdd maUmmu 7-day 34Crdge of sampt: meamtn :nts obtained during memoring penod imir "Miammt. "j fi. Entur "[er',*mtI crju/rrugt:t" [Or Cash p3f r. T elel imdCr 7h,xmlity" Und "pudbly" '15 pCibed Ifl pOnnit
- 7. Under "L 12" cnict number of sampk measmments Junr.g monitaring period that exceed maximum (and.'or minim'.ml OF Mdy M tiagO J > Spp!Opn3tf pCTHUt reqJifCm0"1[0f CaC}l param;lCr. If NOD? CDtCr "O"
- 8. Enter "Freymy of Malym" both as h;le Afcamrwnt" (actual fregoma of samphng and analpis used dannt nmmtonag pmod) and as "Pernet Megwrewnt" specified in pcrmit te g , Enbr "('ont" far continuous
!!!Omlating, "lC" for 000 dQ pf WCCk "I 80" [UT Ona d ty per manth, "/ W ihr One dl) pCr qu iricT, CtC )
- 4. Enter W '\ 7)p ' bol / ".97 > js .\/m:/rcmcet" (xtual Mmpb/ type used duriPj mnmtoring penod) and as "lvrmd Rcprewt," (c L , Emer "G.
for mdmd=1 wmp'r, "N!/i'" for 24-hour compute "M far conunuous momtming, cf;)
} O, NerC TiObliOnS CI[CrEHf ?CQuirCfDCGis * . r:TpCTICd a%Ch 3 Dri;[ CTh!QliOn iG dC5ClihC Cab -, ,Wd Corf CCit\ C aClion$ INCn. and rNfCHOC Cdch viabtion by date
!! If *RO disc!Ldry" J ,WS dunPg UWniL n G ;XrM CUcr T> Da hary" 3:mM funn m plXt C[ data cMr;,
- 12. ElitCT "Nat'W iIlt!? ({ [%" , i tfd l D't s
(})l Cr" M )f lt " '"n lun' . ] !'r* : i.*'1lM! En: lit t f yflil ;(( . l L O < L'cs!
,fgnt" TeictOm '&nber/ and " Dam" at banum erfonu
!3, Mail Mgacd Repor: to Miia(s) by d!;c(d spailied m p; mit. Retam copy far yom .md, i i
- t. IC dIUi1ed inJfrdU!iOM fOI U$C or $bb 'I b @ ! ! ~lIC ' fly ik[W bP iR) Im m h h. obt! Ed 00m O CCM j 5pcCdiCd m PCImil j Legal Notice m tw e s ca w u m um.c m ~
< u m m , #e mn-a oy : n eng ,
1 mult b cWd ;w rmm ' M to m d ii W9 p i ofs l air; m m _ dp P ,n ;t3 e w j5?.14p<Je of mfaw, m by mpo <t nt for m more than m var in M UA lbrm 3Rt.Fl (Urt. MMS j i 1 0
. .. a
- PERMITTEE NAME/ ADDRESS (TarhMeede Nwlseer o= eflhS-sar) n'6 TION AL POLLt/f ANT DISCHARGE EUMMTION SYSTEM (NPDESJ Form Appr ved. .
NAME z g g jp g . j74((gy pgggg q 7 g 7 7 3., DtSCHARG,E gy,y# MONITORING REPORT g,7_ (DM,Rf3f M . O N D05) P N 5 A r '. B LM D O ^"""A 5^W** 2ph . ADDRESS P . 'J . DI e ^'""'6"*" - 4"' " (Sans
- A. T i $ ; DAVID 1HTTeOhf PERMIT NUMBER CKSCHARGE 9:UMSE3 p . p7o g{
3 3I N I% C F 0Ii ?A 17'77 MONITORING PERIOD UM FACtLITY q g g tj r.y p y 4((g pggvg 37Ai73- . YEAR MO DAY YEAR MO DAY - LOCATtON FROMa 9t ts4 4ri TO as ,4 .t _ ce? N o b ; 3 3 3 n r; 5f l eet NOTE: Reed instrucWons bet c&npleting this form.
- 7. *
- 4
- f) L y ? O ) R % ry 3 4 f (20'211 (22-231 (24-25/ (26-271 (28-29/ (30L3,j (3 card Ontri QUANTITY 03 LOADING (4 Cerd Ontyl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE PARAMETER (46-531 s$s6tp (30-451 (46-531 (54-619 or (32-371 EX Analysis TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS .w2-s* f64-ses (6S 70r rypqA 79q SAMPLE cocnee ^ M o t t.
$0noce { ;q)
MEASUREMENT
;; p 3 1 -) p PERMIT wten e.a c A u ( 3ec com w; g 3 p g;,y +3 g ?rrLqeN; 1 77 ,5 vsLU, PEQUIREMENT .,0 e 3 y gg; gg y, y .y 5f7 SAMPLE !
MEASUREMENT bf() ho u) . PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT ,
^
REQUIREMENT i SAMPLE MEASUREMENT l PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSON ALLY EXAMINED AND -m / TELEPHONE DATE AM FAMILIAR WITH THE INFORMATION SueMITTED HEREIN; AND BASED ON 1 / i MY tNQUIRY OF THOSE INDIVfDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING THE INFORMATION, I SEUEVE THE SUButTTED INFORM ATION IS // 'e j #.
.. s
/ ^.
i N!!Vid OrndOrI TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THEr!E ARE / g.7 , [',u fj. SIGN 6FICANT PENALTIES FOR SUBMITTING FALST INFORMATION, GNCLUDING C!IOT3 i E E r V M&UOROY THE POSS!BluTY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 412 J.93-5113 % 10 l o, ' U.s.C. t 131s. spensames sesor sese emos ener betale snes se so sto.opo S10 NATURE OF PRINCIPAL EXECUTfvE g TYPED OR PRINTED emt er me==nn w-.- -..: et eer- s. s monins amt s rows # OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# ettechments hers/ 1 T ? > A .'. ! *; 1; A N :) A M M;;% { ? " r3 '! I ? 3 r ! s ? '9 p?"Le p r* * ; . ; p!p[np, 3r sp+ (y Y vip c p eq 7 7qg pgp;y w y, y ;-$ w pg, j3 g W .i t K C y' P . ) : sc/L. (rat L I ,= i p Ir 13 * ;/t 33 4 Szyty t, 3 y , ) r - s}J n W,?I';CMt3GItc uu -- ( 2 'i H J. , EPA Form 3320-1 (08-951' Previous editions may be used. (REPt. ACES EPA FORM T-40 WHICH MAY NOT BE USED.) , PAGE OF
, q
, -- .. . _. .- -. ~ _ - . _ . . . -. . _ , . . - . . . . . . - . - . __- . . . - _ _ - . . . - , - _ _ _ _ _ - _ _ _ - - _ _ _ _ _ _ _ _ - _
.___ =
Paperwork Reduction Act Notice I Public reporting burden for this cohtum of infornution is estinuted to vary from a rang of 10 hours as an ! *' 1 .
- averap per re<pme for unne minor frHities, to 110 hour < a
- s an averap per repee for some major facihties, ;
, with a wcqbted average for nujor and minor facilinn of 18 hours per texpora, includmg tim" foi reviewing ( I in JruJons, mrthing uisting dab some s, pth: ring :al nwintaining the dau needed, cd completing and l
- rewirwing the collection of information. knd commenh regardmg the N
- rden e' tim..te or any other aspect of l this mlhdim of inforuution, includig g 4 .Jions in reducir.g ds burdc , to Chief, Infornution Pobey 'l l- Branch, PM-223, U S. Ensironnwntal Prowtbn Agcumy,401 M StreS SW Wohington DC 2040, and to the i Offke of infornution and Regulatory Af fans. Ottke of Mzvemmt ar:J Hu@.t. Wehington, DC 20503. j t
._~,- - - . - - . , - .~. - - . - . . - . t
- . ~ . . . - - - ~
General Instructions
- 1. If form ha ban putially compicted by prepinting, di.sregard intrustLons dirxted at emry of that infornution alnady pwprinted.
- 2. Enter "Perrmitec Nawe Atallmg Ad!ren (and facihty nameMacadon if ddferent)7 "Pervat Nmnberf and "Ducharp Emhcr" ubere indicated (A sep: irate ferm n required for cach discharge )
- 3. Enta dates beginning and t nding "Momforine Pcrmd" anered by form where indicated
- 4. Enter each "Paranreter" as spec dkJ in monitoring requiremenn of permit.
- 5. Eont %lf ed W acmo# da:a for ah prammr unJa "Ou:/,rc" md Tud;ty" in unhs speafied in permit
" bvmw ' is norm.div ;o chnmc as cra7 ' mcon mc nurm W ba. trial paracters; of nil mmdc mca:;urc:aerds fGr C3Ch p;;f!mWf 0r dOnu:d dunnu "ifanm h Or : I' ' ifenm uY and "Ifmmnd me n ma,dly CMiem? lngh DNd k.i M L !YNelHL DR obl3med dJ fi' " Of) p !, : ; /l, [' " c h /, " (NC to MUMeds %ith G andlf) ((c3', me n t rcq mrce rcut : Enter to-day , ver of wpic ! , sum:, , ,
un Er Wmg " md car muunum 7 day astrap ' fl[ WMO IlhSm CUK,ClS Uba10;d d;U1Mg UNDO:my, pe!Dd undci "i/J Cmum ") j
- 6. Enter "iiren t l'ojuirc."<nt" fer erb p:am 'eto under "Camtzt:" and "Gualay" . > speaned m per mit.
- 7. Unkr 'To li enn numix t of s nW mearnuents cunny me mmg gned that excced mmunum (and/cr m nunum or 7 da) a. aasc . , apprepan) peruut rcquima.;nt lar hh para, car. If runc, enter "0".
ft Enter "Fre pncy r/ .1m/on" huh as "Nvnl>/c \ /ccc.r wnt t#:ted frequena of sam;1ing and ..nalpia uwd during monaonne prod) .md 7 Y " w !?c:pur, e on" spwEed m pemat W t. Enter "Qn!" for ccntinuoas ; maaiieting. "1 " (or ( ne day per ned . "/ O " f< r one day pe r mod "/{ ' far car day pd quarter, etcj I g 4 f ' 3 $ k4 . - _ - * $
.w .
( . .
._ 4 4 . b , O
"/Yrmit Rc/wremgt " (e.g., Enter " c' fm ituhujd s.uupk ".NHC" fer 2&hcur crsmpo ate " A ? " fo r j TPbUMOUS 10DDPCrW4 C!C. ) '
- 10. Whde ViMJNCD4 OI Jrrm!! IcquiiO1GL ' 3It rcjkr%d aMXha hriifeV m3OODIJ b MA IN CM4 4 ad L riccilVe
.% h0M Mhen, 'id Ic[elt UCe CNU \ idail(:'I b) dd
- 11. If "no disclO.Ip " cu'hi s darm a mh rug pu ni CN;r ' Vu lh chs " acW,8 fum m jk Lf da:.a ehu).
1} b'H Y "; % 14.? "[i r [ !'Tincll~*! ! O % l n ( N; ! r" V .d1 * >T: ' rc i 5 t e; %>
, !hti;'s (}ljhero';\L,0lv . ':l M m " Telepknr Nweler," & "D ' ' at tala of fonu 11 M3d 51PDOd b.Cp4I Ie $hc($) D) d"l%Q Q&ifACd :R p2f!Ui! $ i :M Copy % , W ITCCOrdi 14 Mm t ai!:d m/.nc ' ; fm tw of th:> a wi: a 'f i-i t j u et W (R) h . m a e N 01 x d fem O!Tn:m i 9xined m pema I. Poll 4
xNOliCP,. - Tb s port o q -J h j a 5 (U li'.C 13 >C - D' >> _ '>r , f4 te '
- r tim:hk!!, .- m J!in_cid pa s 'or Oth "': ; <. . of vb i ' tro !. ; t ,' s s
' N 4 0 pa 1 9 ef WNado% m by m: A , . f or v nu e th- m ye r m I ~ Wh ITA 11rm MMI (b. t 95)
~
a e, e-Form Appraved.
- PERMITTEE NAME/ ADDRESS a=weFor%N==.Lorene (D#e e W N20NAL POLLUTMT DISCHARGE EUMtN20N SYSTEM (NPDES)
NAME MSC D ng(g pggg 3 g g 3 g OMS No. 20N4 '. ;
< g E, y { , y 31,(g y Mg e3 37;77gy E MMITMM REPW[t7 i.
ADDRESS / e 3. MI 4 4TyN; y37;a 9 :,,y 9 g g y
" ' ' v ' R PERMIT NUMBER 317
- DISCHARGE KUMBE.4
(%F 05) y PJgg{
^"'*It*N?' ON'.
- SMTPPI4GPORT PA 15077 MONITORING PERIOD 'E FACILITY g r g ;g c ,r yggggy pgger 3 gygg LOCAT m FROM eo e' L TO **. t - ,
000 40 DIS"Mi?G5 NOM Reed Q) OM k& Mfore %M % form. k?TX: n8ViV D:%333F v20u2tl t22-231 124-259 126-271 12s-291 130-319 13 Cerd on/ys CUANTITY OR LOADING v4 Cerd On/rf QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE PARAMETER 146-531 (54-61) 13e451 146-531 154-691 OF (32-37/ EX ANAtysS TYPE AVERAGE MAXIMUM UNITS MIN! MUM AVERAGE MAXIMUM UNITS ,5m f64-681 (m 2 SAMPLE ecenc 66eecg Mepc ( }2) MEASUREMENT 10400 ; ') PERMIT cogees cerseo c- to? ,,0 9encco 3,q gggy g y3 y s- v y ye :3sg y.ptt REQUIREMENT ,g: 3 p s j .s g w ggy7wgy- p
; SLID 3, T 'y r a, ; SAMPLE concer eencoO SOcce> ( 10) i 1 S P E N D D MEASUREMENT 1991 1 3 3 PERMIT f;ce6e~ 0 ? $ f: f'r e: e .St e=a c e o 4 100 g.g g ly pg3 F r rm - t r ;.ac /1 L e 1
REQUIREMENT 3pg 3 g73 g g 7 -j vv ,4 c 7 7
)T L A N !: "; v g ', ; , SAMPLE n o
- 6 e *- Nrco, egen ( ,9)
'O+3J v y ; r; .~ , : gy 377, MEASUREMENT 10t16 [ 3 PERMIT ecceee f-* M a e e Me c c 5 & y f,. 1 '; lC .
gggLy 333
- REQUIREMENT -se'
-ci ? y L y* . .? :) 9 *; I 9,1, y - 'n AVS B4TLY et WL
' L C 'J , IN CONJ 3IT ij p SAMPLE ( 91) 0 0 Q 6 ': /; M rk c i t MOOO: 7
- 4 '1 B ?' (A"'"FT PLA9T MEASUREMENT gy p { ;
17n5n 1 7 n PERMIT shp3P*
- Mrr "> > a 0 " 30*'e' OMo u ? . C u *' L L% L Y 3rf*A
.' " r '! sr a r;5 y 1, T.8 9 REQUIREMENT vn AV" %**Yv *( d.," Gcho SAMPLE MEASUREMENT PERMIT REQUIREMENT '
SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER CERTIFY UNDER PENALTY OF LAW THATI HAVE PERSONALLY EXAMINED AND
^ / TELEPHONE DATE AM FAMfLIAR WITH THE INFORMATION SUBMtTTED HEREIN; AND BASED ON n r MY tNOUIRY OF THOSE INDIVfDUALS IMMEDIATELY RESPON9BLE FOR \ f OSTAINING THE tNFORMATION,8 SEUEVE THE SUBMITTED INFORMATION IS f UaVid UrudOrf TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT T ARE i
f-4 , Mg, j, _ ,. diet:ist r*v tianabet S'aNiriCANT PENALTirS FOa Su=MirTiNa FALSE .NFORMATiON. NCtUD,No HERE f4 - - 41.' 393-5113 %. 10 10-THE POSSIBluTY OF FINE ANO tMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 " U.S.C. t 131o. naemee esiser sw seerween mer beamie snee see re #10,000 SiONATURE OF PRilWCIPAL EXECUTIVE TYPED OR PRINTED AREA NUMBER and er mernaum '.- - --. oreerween s menste and s peare.s OFFICER OR AUTHOR 12ED AGENT CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# srtechments here/
/ )- b ,<-L - -
EPA Form 3320-1 108-95) Previous editions may be uSed. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
,c _.1 1 5 / % 3 r.
2
,t , " - 0,. 0 3 1 m
I Paperwork Reduction Act Notice Public reporting burden for this collectmn of infoururion is estimated to vary from a range of 10 hours as an -
~
average per response for some minor facilities, to 110 hours as an average per recponse for some major facilities, l' with a weighted averm for najor and minor facilities of 18 houn per response, mduJmg time for reviewing
- instructions, searching existing data sources gathering and maintcining the data needed, and completing and
, reviewing the collecthm of information. Send consms regndmg the borden estimate or any other aspect of this collection of informtion. including ggetions for reducin, thi< burden, to Chh f, Infornution Policy l !, Branch, PM-223, U.S. Lavin,cm-ntal Protectbm Agau), G1 M Street, SW hairrton, DC 2040; and to the l
i l Office of Infurnution and Regulatory Altairs Of fice of M:magement tnd BuJget, Wm.hington. DC 20503. I L _.. . _ . . _ . _ . _. . _ _ , _ _ _ i General Instructions 1.'If funn has been pauhally completed by prepriming, disregard instructions directed at entry of that information already preprinted. 2 Enter Term!! tee knedfar/:ng Aj:!ress (and facihty rcmn.:/ location, if differem)." Termit knhcr," and "Disharge Amber" w here indicated (A separate form is required for each discharge.)
- 3. Emer dates beginning and ening "Alcmto ing Fern!" covered by form where indicated
( Enter each Tarameter" as speafted in inomtoring requirements of pernut. l
- 5. Enter %nple A fa wmcn!" dau for cach panuneter under "(hantin" and "(hm/a3" in um!s spaified ia p. ~ nit. '
".hrrner" is norm:d!y arithmehe ascrye Igwmetric ascrap for tv,ctenal patameen.) uf all sample measurements ,
let cach pMDP A" M'inCd durinf, "3 /Ai/Grt0V /' Crud. "!/Jtuttim1" u nd "3finmuun" are norm 311) CNilene high ; araf la me wuemcm oblincd donop " Mon:;rrme l' d" (No' to ruunicipah w ah second3n Ucatment ILqu Nement EmCr 3Nday ,1VCra PC of MNp!e m 2dSUICment5 t.ni.T Elwrca *
- and entcr mujmum 7-dag a\ emgg cf samph na n,re:aen:s ol'tauu rd danng munimring period under ".!atm:um "i
- 6. Emer Tcrim!!bzw mer "" for each para ete: under "@antaf and "@cl ty" as specdkd in pencu 7 Under "lo D" emer number of Lunph amnems during, monitoting period that exceed maximum (and.'cr minimum or "~d.o m cragt m apptepnte) pennu requiremem far cath parameter .If nane, entu "0"
) Enter "/m queng of z!m4m" twh m "sc:":f,/c alcmmmem" hetuM frequency of sampling anJ analysh tsed i l dsing mondoring renod) nd as Ternn/ I:c<;mecewnt" spec,ficJ m pernm (c g , Emer "G ra," for cucinuous nionitoring. * / 7" fer cue day per uci "/CT for one J n p;r nemh. */ W for one sy per qumer, etcl l
% Emer "Smyle 7)p " both as "W' Me,wemmt" txtu d suuple type used dming monitoring penaJ) and as !
Tcrnat Repirment," (e g . Enter 'tird" far m hvidual s mpia, "N!!C" fd 20 Lout compente. 'W.-1" for COnulm335 EOnRO!mg, CIc.)
- 10. Where victuiom cf pern.it reqwreme :de rep.v ! auxh a !nicf c:q;lanY an la decnbc c.mse and conxtis e actica, uken, and reference cAh siobnen by date
- 11. If "no dmharp" o, ca; duriu ma iiicana peroJ. cmer "W lh in:r,e" a;mq fann in place of data entry 12 Ente 1 " U nt' Ti!!i ul !i':Mil%il ! u lt!t t ? I f Li ?' Wnb "?gri:!!urd : n ['i l . tpG! EltL l H!!W O!b i ' f . $ m!L r :et f
.1 gent," "lelijhone %dcr.' ud "Date" ut bAtom of fann
- 13. Mail up.ned Repat to Olia ty by dw q spxified in y mut Rubin copy for your wc ed,
!4 M arc deuiled in: nu,inan im use cf t!us ! ><w/ ge '. ! n rm;c ih port (D)! ; Im r he ohtmu.! from OfGenu speedied m permit.
Leeal s Notice Ih! s r.'yf! 1* f ripJh?'d I y [d A (31 $ I S f. ' 3 ! E' Ul f. P ' 12 ' 27) . c h I - i' ) ! Q' W 1 " Ia
.4 a Le H,K 1 iral!.b!II) L M dtlati'vk! p ?O!tU ; fM d I 1 dw "d b ) C / N d pd dJ OI \ i.[, ' ,([ 4 tuu dt f
' 'l ; W.'d I. ) $ h I {
- M n of sidm ,, or by on; r; < nt for rc
- eN < ye:.r : bj tub FPA Fonn 3310-1 (Rev. 0%95)
_ m .m . . . _ _ . ._ .. . . . _ _
, t > e PERMITTEE NAME/ ADDRESS ame4MerervNe=e Imrerves t/Afprud) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES / Form Approved. .# "*" DISCHARGE MONITORING REPORT (DMRf
- Or%V?' V A L L i' Y P O 'e l t STATID9 v2-16/ f f 7-f 88 'I V ! ! 1 GEMRTR HLWOMS No. P 4
- ADDREIS ;> , 3. Bli 3 mae3,qg14 rn5 m (3yqq 3) Ahro egres,Oh W g, a
A 7
- 1 ;- 3 A V I ') o u N D o 71F PERMIT NUMBER DsCHARGE NUMBER y . 'y{q4{
?il PPI M J E 0 ; T PA 15377 MONITORING PERIOD ^3 Ft.CILITY q e g 7 7 p yzy(gf ti g g 7. -- g y s,7 7 3 y 6 LOCA A FROM -se .i 9t TO w i 9 ?. %0 ;O D!sC'IA M F l d c44 (20'2rJ (22 231 (24-25J (26-27; r28-29/ (30'37/ NOTE: Reed instructione before -n 4;a this form.
AT*4: D2V!D 7hN'M -ir I4 cent on/yf QUANTITY OR CONCENTRATION PARAMETER (32-371
\ (3 Cent ontrf QUANTITY OR LOADING v46-53) 15
- 6 79 138-459 146-539 154 619 NO.
EX mEQUENCY
.Nms OF SAMPLE TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,ese gg,_6s) (6 m aJLIDS, T.)Ti( SAMPLE "; s o c e e e a- g 3 39gn ,3 MEASUREMENT 4 3 S P "7 D( r.
1953g { 3 0 PERMIT -> c e m c e rM e e t we oesees 19 106 ggg qu'
/ P T L !.f ; a ;* caSq' y .t r, n e REQUIREMENT cy e 3 gg g ;. g g33ty q ., .- f t r ;, y , I ;, ;)eggIT gq SAMPLE h), h 9 pj ( n3} a:00ce* Mac c - Mouc E H ': 0 TAPA*1tNI ? lag, MEASUREMENT
;70:i3 1 3 0 PERMIT pgpq - wepp+ n e *, ; g c on g .y g ge n ,g g3 ," 7
' ' 7" ,'" .
,y e cy y g; g 3. c .y g y REQUIREMENT .a , y ,f - ng,p , 7 , ,. y ,
SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT - SAMPLE MEASUREMENT PERMIT REQUIREMENT vw SAMPLE MEASUREMENT PERMIT REQUIREMENT ,_, NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PEN ALTY OF LAW THAT I HAVE PEMSON ALLY EXAMINED AND . TELEPHONE DATE AM FAMtUAR WITH THE INFORMAT10N SUBMITTED HEREIN; AND BASED ON /. ' . MY fNQUIRY OF THOSE INOfVfDUALS IMMEDATELY RESPONSIBLE FOR / N . -y%s gy{g 97ggI { OBTAINING THE INFORMATION, i BEUEVE THE SUBMtTTED tNFORMATION ts TRUE. ACCURATE AND COMPLETE. 6 AM AWARE THAT THERE ARE ,[, //k [/. 4
~*
y-,
'y ' ' AJ,, ["'p' '
SIGNIFICANT PENALTTES FOR SUBMI" TING FALSE INFORMATION. INCLUDING G Cn i S E !"f li3 Nigt- r 1 * *I2 3 93
- b 11,)
9b 10 [ D. THE U.S.C. POSSIBfUTY OF FINE 9131s. p%nen=e AND seuler IMPRi$ mese JNMENT. emet,ses SEE 18snee mer eraweie U.5,C. 9,1o01 e so AND 33 s 70,000 SiONATURE OF PRWGCIPAL EXEh AREA TYPED OR PRINTED sae or mer*meC ~ : er 6 e-e-e s meams end s tearmJ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# ertechments heref U i # r, ,.r.-<< EPA Form 3320-1108-95) Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE 311 /S9 / 0 ;.,1 P - 3 G H 2 3 3 1. OF
.- . .. _ - - - . . _ ~ _ . . _ - - . . - _ . ___ - _ _ _ -
o .. ., r Paperwork Reduction Act Notice 4
\
Public reporting burden for this collection of information is e thrated ta vary from a range of 10 hours as an , average per respome fc.r some minor fnihties, to 110 houn as an avuage per regmnw for sone najar f aahties, ; j with a woghai avuage for major and mirmr fa ditics of 18 hours per respan:e, induding time for reviewing *I instructions, se. arching oistir.g data wortes, gathaing and auintaining the Jata needed, and wmpleting imd { renewmg tN coHedion of information. Send emaments repiding the bordai twtimate or any other aqwt of i j thb colledion of'informtion, inch; ding suggesdens fw redu ng this bu &o, to Chief, Informion Policy [ Drm;;h, PM-223, U.S. Emironmental Piohhoo Aycnty,401 M Sumi, SW hha gton, DC 2040; and to the l Of fke of Infornution anJ Regulatory Af f airs, Of Q e of Mangemat and Bu4t, hhington, DC 20503. I i l l General Instructions
- 1. If form he ban partiauy compideJ by preprintmg, disrrgard inanittions directed at entry of that information alicaJy preprinted.
i 2 Enter
- Pcena tice Lae m!mx Addens (and facdity rumc/ location, if d:fferent)," "Perent Nmnber," and "Om harge Numbe r" w hcic uid:cated t.A scparme form is required for cach discharge ) ;
- 3. Enter dates begmning and cndmg "3/mumemg Peric.!" cme:ed by form where ind:cated 1 Emcr cach "Pmamercr" as speedied in mmutormg requirements of permit I
- 5. iWer 'hple 31 memcm" data fur ed puamcter und;r "g;z2: nf anJ "p. alar in muts sp=ified in permit "h egr is non%Hy rithmtic aerace y muutric maq e fm ta;rn! pammcters; cf :J1 sample measurements luf crh paras tri okuwd daring "3 /:v:it >r;, /Yr n !" "Ala t , 'mnt" naJ
- in"; :::o"" art nm mauv, cxtreiw: hig,h l a . . -7 * . 0 .
(4 $, 4 4 4 I CJj bi f en 30n!' En'ir .Iedai a Cf a j Of laIUpb i ;UNm; .tS P Kl "M i t r.!$ " s ud cn!Cr f a.nloturn 7-da) M Cral}C OfL'UJ JI nLaMirJmel !s (ULu h0d dtHKg fn mi[U:tDg periJd un 'lci 3 /atimul9. ")
}
- 6. En!cr */#, ilt'il /Mjun e < ' # for ca,.h p;aamitt unht " Guai 'irl" i.F.d '(M olay" M 5pecdh d in ptimit. '
1 Under "G W cnta nmnNr of wu: ple un ' munts during muoring penud that excecJ mnimum O,od!cr ' l I minntnun or 7dQ av igt a, apprepnac) pernut tquatuant f w car.h parameter. If non.:, enRr "C" I
- b. N MI L g b('/!h' f i , fit j K l U. 5 l 'ly dJ t h Dl? f fi[ ( h(!!U IClhlCli o haji { Il{, O alla. l h S UN p
d.:rin; n.r.mionng puiad) and .4 >
"lWGI /h s m.wi U" spccdid m penmL (e g Enter "G >r.t " for continuous j .WOmh? ring, */7 [Or On0 day p0f bJCL, "/ . ( ' kr Chc da pJr inou!h, "/ 8 f 0r 000 dQ p?! quiu1ct,til ) l 1
l i I, !!lCr . Y
/k'[ 'F ' % lb 4 14.% b # I //!l II . f aL_'ilne I.I Iil C 5h$ t i k i![il. b hii} II $ $.h ! l d[4 ah l "f Wma lie <pirr wntf (c g . Ecr "Gr# Er m.!n dr! = nple. UJI!? fer lheur con;pusite. * / . t " fo r l l motmu3us moMenng, etcl I
l j 10. Where vbMntmas of pt mit t4 i le : m m Icpcrt:J, at h a inf es' la:a m ta 0 ,eribe time and concetn e m tim 13h;II. Jad I;ft f rXC Cat h \ mb! 60 ! -Qdjic l
- 11. If " ni dmharp tm .s dung nu amb a p;mi auer % , i ~ r c" .cro , funn m pkJ c.f da:a entry.
1: Y DiCr "hw Tli.L' u ?l } 'ri m 'aj ;! }h r m Ch W (" % d .* e
! P e 'l j 't . i a al llt t: s '! \ u ()llG a r ul .1;;;.%* C %l
, k *, "Telephme M +:1 c r. and "lxt? ut k ea < f Wtm 3 3. $id Mf': Cd b'jbdiD OOd. ) lef di 2{5 ) yr.ilb Jd il j KIC U! NCUD!i Ci:pV 10r ) W.I r Curd.>
I l lL W ' Ad u,/tanuu fcr in of th: :i m i f, m:t c - Fcem t , M UG f. .m :,nfI V dtahc d fum OffktN
- 7 %d in pMimt.
Legal Notice v,um1 !s a m u ,4 o . cu. o., ,
, , en a m tm um m rc h ir. - H p r ,, '. t . t 'L,( t i! V !;- !- 5 ; o in n; o! F
'ri+u J MiO pa Ay W , 4 1.+ w i .- i w t vm Jfc - i, m yi cr. o y h ob.
I 1 p k k UM 3.$)l ( N C4 bba9b)}}