ML20135B922
| ML20135B922 | |
| Person / Time | |
|---|---|
| Site: | Beaver Valley |
| Issue date: | 10/31/1996 |
| From: | Noonan T DUQUESNE LIGHT CO. |
| To: | NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM) |
| References | |
| NPD3VPO:0554, NPD3VPO:554, NUDOCS 9612060100 | |
| Download: ML20135B922 (64) | |
Text
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, e aver Valley Power Stat 6on SNppingport, PA 15077 0004 THOMAS P. NOONAN (412) 393 7622 DMs40n Vkm Presiderd Fax (412) 393-4905 huclear Operatbns November 26, 1996 NPD3VPO: 0554 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
Dear Sir:
Enclosed is a copy of the NPDES Monthly Report as submitted to the Pennsylvania Department of Environmental Protection. Sincerely,
/
T. P. Noonan Division Vice President Nuclear Operations DNH/trs cc: D. A. Orndorf J. A. Cool R. K. Brosi q j Central File hv'- } l I 9612060100 961031 PDR ADOCK 05000334 R PDR ggggggggg 050031 nu'n ENERGV
l g@g av Vaney Power Station l smppingport. PA 150U4004 l THOMAS P. NOONAN (412) 393 7622 Divisaon Vice Pres 6 dent Fax (412) 393-4905 Nuc6 eat Operens November 26, 1996 NPD3VPO: 0556 l i United States Environmental Protection Agency . Region III, Pennsylvania (3WM52) Water Permits Branch Water Management Division 841 Chestnut Street Philadelphia, PA 19107 1 1 EPA Permit No. PA0025625 ReDortable Occurrence l
Dear Sir:
l As required by the EPA Permit No. PA0025625, the following i information is provided in regard to a reportable occurrence at i Beaver Valley Power Station. I On October 7, 1996 the Unit One Sewage Treatment plant effluent (Discharge Monitoring Point 203) measured 5.60, outside ) the required permit limits of 6-9. The previous measurement (on October 1) was 6.19. An addition of sodium bicarbonate (baking soda) was made to the sewage treatment plant on October 7 as a temporary measure to elevate the pH. The pH was measured the following day and found to be within required discharge limits (6.71). On the 29th of October a similar event occurred, with the pH at discharge monitoring point 203, being measured at 5.80. The previous measurement had been 6.58. An addition of sodium bicarbonate was made and on the 29th and the subsequent, pH measurement was 6.71 (within the required limits). l l The cause of these pH excursions is being investigated and the system is now in compliance with all permit parmeters. DEllVEllNG GUALITY ENERGY
. _ _ ~ . - -. . _ . - . .. . . i l . .
1 November 26, 1996 I NPD3VPO: 0556 Page 2 If you have any questions concerning this report, please do not hesitate to contact David A. Orndorf. Sincerely, w T. P. Noonan Division Vice President Nuclear Operations SLV/tra cc: D. A. Orndorf J. K. Cool R. K. Brosi Central File - Keywords: NPDES Reportable Occurrence l 1 l 1 1 1 I
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.. i A ggg av van.y Po.., station 4 shippingport. PA iso 77 ooo4 ,
1 THOMAS P. NOONAN (412) 393 7622 DMeton Vice President Fax (412) 393-4905 ) Nucl.ar Operations l November 26, 1996 ) NPD3VPO: 0553 ' l Attention: "DMR Clerk" Department of Environmental Protection Bureau of Water Quality Management 400 Waterfront Drive Pittsburgh, PA 15222 NPDES Monthly ReDort. EPA Permit Number PA0025615 1 I' Gentlemen: NPDES Monthly Report for Duquesne Light Company, Beaver l Valley Power Station for October 1996 is submitted for your consideration. i Sincerely, l T. P. foonan Division Vice President Nuclear Operations DNH/trs Enclosure cc: D. A. Orndorf J. A. Cool R. K. Brosi Central File DEllVEllN( 00ALliV ENERGY
Bear Valley Pgwor Stt6on E' Shipp6ngport PA 15077 6 I l THOMAS P. NOONAN (412) 393 7622 l OMason Vice President Fax (412) 393-4905 l Nuclear Operations November 26, 1996 NPD3VPO: 0555 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, T. P. Noonan Division Vice President Nuclear Operations DNH/trs Attachment { cc: D. A. Orndorf J. A. Cool DEllVEllNG R. K. Brosi ! l Central File QUALlTY ! E4EIGY l l
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' Instructiens:
DISCHARGE MONITORING REPORT SUPPLEMENTAL SEWAGE SLUDGE REPORT Month: &/
- Year: f 9yg:,
- 1. Complete monthly and sutunit with cech DMR. Attach addittenal - '
sh0ets and connents as n edad for completeness and clarity. Permittee: Fl/GUESA!6 L/(,f/Tccei-tA v / )^
- 2. Sludge production information will be used to evaluate plant ,
Plant: @ W;re v4 c r f M gx 57,7g,t?.gr 2 l perfonnance. Report only sludge which has been removed from NPDES: fA coanis digesters and other solids which have been permanently removed Municipality: s w e r< w c a r g o e w /r - t from the treatment process. Do not include sludge from other County: f,5AvJg plants which is processed at your fact 11ty. '
- 3. In the disposal site section, report all sludge leaving your For sludge that is incinerated: '
i fac111ty 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) HAULED A5 LIQUID SLLME HAULED A5 DEWAltRED SLLM E . (Conversion (Tons of (Gallons) X (% Solids) X Factor) = Ory Tons Dewatered SleMe) X (% Solids) X (.01) = Dry Tons a o. ec e R *4 .0000417 u7 .01 i i L t TOTAL = TOTAL = DISPOSAL SITE INFORMATION: List all sites, even if not used this month t Site 1 Site 2 Site 3 Site 4 softown o f p, m 4cA i Name: 5 p % c reE4 ras 7t w 1 i
- Permit No.
- /4 oo 2 of:t '5 3ry Tons Disposed: /.c.7 :
Jye: (check one) . i Landfill [ Agr. Utilization Other (specify) County: BF4mt _ n 2n( / CHGfnlSrd htAr/AGER b/& HI2.-M3-51l3 (SSR-1 3/21/91) Mqnature
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( PERMITTEE NAME/ ADDRESS (7=MFereerNo-.'t.een trzhp,.we NAnoNAL POLLUTANT orscMAmoE EuMRsAftoN sysitM (NPDES / Form Approved. NAME ., , t - ., , ~ , , , . . DEC AygGE MONITOMG REPMT[,D 7 f ,yr.. ,. , ,. OMS No. 2040-0004 _ . ).. - . - .
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,,_ y,, , REQUIREMENT 3e3 y, ,, p a*TrY wv ./T NAME/ TITLE PRINCIPAL EXECUTNE OFFICER 4 CER*1Y UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMWED ANO '
TELEPHONE DATE AM FmMILIAR WITH THE INFORM ATION SUOMITTED MEREIN: ANO SASED ON MY INOUmV OF THOSE INDIVfDUALS tMMEDIATELY RESPON98LE FOR 08TAINWG THE INFORMATION. I BELIEVE THE SUBMITTED INFORM ATION IS h /,
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[T 1 - daU h ' ' . i W ' TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE i
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' L ^ , t. . y Ji,n 9GN!FICANT PENALTIES FOR SVBMITTING FALSE INFORMATION. INCLUDING < - '
I g4 I <3 ,L i 3 J . > ? THE POS98tLITY OF FINE AND IMPRISONMENT. SEE 10 U.S.C. I 1001 AND 33 *i< *- I1 iU e SiONATURE OF PRINCIPAL EXECUTIVE gj TYPED OR PRINTED . er enem,a
.u.S.r.C. e t 3is. # r_--
Pen en- :war e=.= s,enam er eer merwiende
. e monew s yearms saw se so a 70.000 omCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference atlettschments heref
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(. Lt yr- r 35 -:/L 3; y pit g -. t ; , ) EPA Form 3320-1 (08-95) Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
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Paperwork Reduction Act Notice :.
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'PuNic reportmg burden far this coI!ection of inforneion is estirrsted to vary from a range of 10 hours as an i brisage per re90nse for.some rninor fadhties, to 110 hours e an average per response for vmm mahr facilitin,,
' udth a wdghted averge for nujur md rainur facilities-.418 hours.per responso, including t'ime for reviewing .
. iuruetmns, searching existmg deu soum,. gathering.and maintaining the data needed, and completing and
;seviewing the c.ollatkn of infomutwn. Send comuunts seguding the burden r.stinute or any other aspect of ,
,ths co;.ectivo of infornu! ion, includnig suggestions for reducing this burden,. to Chief, Information Policy
;- "Tidnih, PM423, U.S. Envirormental Protectied Agency, 401 M Street, SW Washington, DC 2040; aru! to the l Office of Icfor: ration and RegulMory Atfairs, Office o' Management and Budget, Washington, DC 20503; 7._ _ _ 7
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General histructions ' i l< Jf form ha been partially completed by preprinting, disregard instructions directed at entry of that infornution salready proprinted. ,
- 2. Enter "Permittce NameAfollmg Address (and facility name/ location, if different)" " Permit 'Numbc ," and
*lh harge Number" w here indicated (A separate form is required for cach discharge.)
r
- 3. Enter dates beginning and ending "A(oniturmg Period" covered by form where indicated. ,
"H - _
l 4, Enter each " Parameter" as spedfied in monitoring requirements of peruut. 1
'5. Enter "Sampic Afraamt ment" data for cach parameter under " Quantity" and "Gu' a /ity* in units specified in permit.
- h cro;;e" is normal!) anthmede average (t;eometric aserage for bacterial parameters) of all sampic measurements fstach p uameter oltained during *Afanitoring Permd"; "Alanmum" and "Almimum" are normally extreme high and law ineasuremes.ts obtruned during *Atenitomig Period" (Note to municipals with secondary treatment
; reqmrement: Emer 3hlay average of sample measurements imder " Average," and enter maximum 7-day average :
- cf sampic measuremem obtained during monitoring period under "Alanmum. ") '
6c Enter "Perrmt Regmrgent" far cach parameter under 'puantity* and "guahty" as specified in permit. , 7. Undes .*No 1&" cmes : umber of sample measurments during monitoring period that exceed snaximum (and/or i mhnsnum or 7-day aver.te as sppropriate) pcnait requirement for each parameter. If none, enter "0" 8[ r;ttr "Trcquency of Analysn" both as %mple dhasurment' (actual frequency of sampling and analysis used i
'daring mot:itoring perisd) and as " Permit Regiurement" specified in pennit. (e.g., Enter " Cont," for continuous momtering "lH* for one day pcr weck, "l/JU" for one day per month, "1/90" for one day per quarter, etc.)
9f Enter' "Sen/de 7)pe" beih as hple A/casurcment" (actual sample type used durir g monitoring period) and as "Permir licquirement." (e g., Enter " Grab" for indistdual sample, "JJllC" for 24-hour composite, "N/A" for continuous monitoring, etc )
'10.,Where violations of permit requirements are reported, attach a brief explanation to describe cause and conective
' actions taken, and reference exh violation by date.
I1. If "no discharge" occurs during monitoring period, enter "No Dircharge" across form in place of data entry. I2. Erver "Nmneintle el Principal hecumt Oficer" with " Signature of Prmcepal Executive OJJicer ofAuthorized Apnt," "Telepfwne Number " and "Date" at bottom of form.
- 13. Mail 1.igned Report to Office (s) by date(s) specified in permit. Retain copy for your records.
l14. 'More det:aled instnntiens for use of this Ducharge A/omtoring Report fDAIR) fonn may be obtained from Office (s) mecified ini permit. Legal Notice This repott is required by la (33 U.S.C.'1313; 40 C.F.R.125.27). Failure to report or failure to report truthfully can rew!t la civil p:nmities rmt ;o oceed $10,000 per day of violation; or in criminal penalties not to exceal $25,000 per day el violation, or by impriwr,mt r.t for m>t more than one year, or by both. y EPA Form 3320-1 (Rev,0&95) l
PERKTTEE NAIE/ADON33(T=e de FerstryName%ren== efDdlbrew) $$ATIONAL POLLUTANT DISCNARGE EUMotAftOss SYSTEM (NPDES 1 Form Approved. NAME OtSCHARGE MONITORING REPORT (DMRJ *
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/ 3 I, L M f e O N :? '4 3 7 4 ?' I ? '- YEAR MO DAY YEAR MO DAY _ , , ,
LOCATION FROM >< ' 1 TO 9' : 4
?o? 9a nT' O AF";Y l ^$t ,
n p v >-: . n e ,) e n 9uanaov 120u211 122-231 124-251 t26-27) 128-291 (30-319 NO N R*** W*'* YlW N **'*- PARAMETER (3 ced On&s QUANTITY OR LOADelG I4 caw %; QUANTRY OR CONCENTRAN NO. FREcuewCY (46-531 154-671 (36 45) 14 & 5 31 154-619 oF SAMPLE (32-37/ EX ANALy n TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ess, gg; gm L N; , T' ')r; D ? i 7 to SAMPLE , ng) e;, n 3;333: ,c3ce- 7 j j y - r, > tr eL4n7 MEASUREMENT Q gg 4 g ,73 y g
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MEASUREMENT PERMIT REQUIREMENT 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 I HAVE PERSONALLY EXAMfNED AND D TELEPHONE DATE AM FAM. LIAR wtTM THE PIFORMATION SUBMITTED NEREIN: AND BASED ON 3 MY INQUeRY OF THOSE INDIVfDUALS IMMEDIATELY RESPONSISLE FOR ,', / OBTAINING THE INFORMATION, i BEUEVE THE SUBMfTTED INFORMATION fS d, f 4 ,-- jf Q"/ DilVid UTUdOff f TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE /W ,j ' ,/ StONIFICANT PENALTIES FOR SUDMITTING FALSE INFO 81MATION. WCLUDING - - Chentstrv Manager THE POssresuTY OF FmE AND IMFRISONMENT. SEE 10 U.S.C. 91001 AND 33 - 412 D3*h113 Yb '1 , Ab
.u.s.C. E 1319. frensasse esiser ews, seen,see mer m anos se se # 70.000 840' NATURE OF PRIIGCIPAL E'XECUTIVE g TYPED OR PRINTED ad er mene==nn _. : reer. a s mores erw s rearms OFFICER OR AUTHORIZE 0 AGENT NUMBER YEAR MO DAY CODE COMMENTS ANO EXPLANATION OF ANY VIOLATIONS (Reference s# ettechments herel EPA Form 3320-1 108-951 Previous editioris may be used. IREPLACES EPA FORM T 40 WHICH MAY NOT BE USED.) - - .
PAGE OF 4 J 3 4 / t t.1 J D 3 + i n '. 41 1
- {
wm + ,m.x . w .w- e,w.s.m ms-+,. o.- -w t , ipublie' reporting burden for this collection of infonnation is esticuted to vary from a range of 10 idre as an j 1
, ' average per responw for sone minor facilities, to 110 h'o urs as an average per rerponse for sanomjor facilitiesc 'l 1 ? with a weighted average for major and minor facilities,of 18 hours per response,Jacluding time for reviewing -
'l 4 iinstructions searching existing data sources, gathering and maintaining the data needed, and mmpiedog and J ,
.i. ; reviewing the collection of information, Sead conunents zegarding the burden estimatf or any other aspect of E !
th% w!!ection of information, including suggen,tions for reducing this hurden, to Chief, Information aPolicy l
;11 ranch, PM '223, U.S. Envinmmental Protection Agency,401 M Street, SW Was.hingtn, DC Mt60; and to the t
. Office of Information and Regulatory Affairs Office of Management and Budget, Washington, DC 20503? .j i .
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-General Instructions 1'.:!f form has been partially completext by prrprinting, dinregard instructions directe<1 at entry "of that infonnation l already preprinted. ,
.2. Enter *Pmnater Name&failing Address (and facility namellocation, if different),"
- Permit Number,* nnd
" Discharge Number" where indicated. ( A roeparate form is required for each discharge.) '
l
- 53. Enter dates beginning and ending "Afonaoring Period" covered by form where indicated. !
i 4.' Ehics och " Parameter" as specified in monitoring requirements of permit. t
'5. Enter 'Somple Atcaxurement" data for cach parameter under ' Quantity" and "Guality" in units specified in permisc j "herage" n ncrmally arithmetic average (geometric average for bacterial p:uameters) of all carapie measurements i for each parameter obtained during "Alonitoring Period"; "Afaximum" and "Almimum" arc'normaDy extreme high
, and low measurements obtained 'during "Atomforing Perlud" (Note to municipais .with secondary treatrrient ,'
requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 'Niay average of sampic measurements obtained during monitoring period under "Afarimumf) i
> ( ;
'6. Enter " Permit Requirement" for each parameter under 'Guantay" and "guality* as specified in permit.: ,,
j
-l:
'7.:Under "No Er" enter number of sample measurments during monitoring period that exceed maximum (aad/or
-' minimum or 7-day arrage as appropriate) permit requirement for each parameteri If none, cnter '0" ,
j
- 8. Enter " Frequency of Analysts" both as " Sample Arcaxurment" (actual frequency of sampling and' analysis uIed j
, ~during monitoring period) and as " Permit Requirement" s;ccified in pennit. (e.g., Enter
- Cont,' for contimsous monitoring, "#7" for one day per weck, "U30* for one day per month, "#90" for one day per gitarter, etc.) l
< J i
- 9. En'ter "Sansple 7)pe" both as "Vample Arcaxurement" (actual sampic type used during monitoring ' period) and as
" Permit Requirement" (e g., Enter
- Grab" for individual sample, "2,f#C" for 24-hour composite, " Net" for continuous monitoring, etc.) 1
; 10. Where violations of penuit requirements are reported, attach a brief explanation to describe cause and conective actions taken, and reference cach violation by date. -
1
- 11. If"no' discharge
- occurs during monitoring period, enter "No Discharge" across form in place of data entry. l i 12.' Enter *Name/ Title of Principal Executive Officer" with
- Signature of Principal Executive O@cer ofAuthorized ,
sigent," " Telephone Number,* and *Date" at bottom of fann.
. i
- 13. Mail signed Report to Omce(s) by date(s) specified in pennit. Retain copy for your records.
'! 14. More detailed instructions for use of this Discharge Atomforing Report (DAfR) fonn may be obtained from Omcc(r) 3 specified .in permit. ]
Legal Notice . I l This' report is required by law (33 U.S.C,1318; 40 C.F.R.125.27). Failure to report or failure to n port truthfully can ; rer. ult in civil penalties not to excmi $10,000 per day of violationt or in criminal penalties not to exceed $25,000 per day -
~
.i of violation, orl by imprisonment for not more than one year, or by both. , l OM M2 1 (D'. @dS -
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FERMITTEE NAME/ADORESS tr=64. rere= h Lerw (Dr.dwww/ r#.TiONAL POLLuvANT pScwAROF EuMm'. Toe Sm (NPOES1 Form Approved. N *.ME OtSC y 49.s 3 yy .y .y .
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4(4 E~,q~ 7 3 s PERMIT mp* >- - n n ,. q;.wy 33 737 ewene ( ,3 ,
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REQUIREMENT , , , , , p,y, ,,, , , , , . ,. 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 e CERTirY UNDER PENALTY OF LAW THAT 4 NAVE PERSONALLY EKAMINED AND m e" / TELEPHONE DATE AM FAMILIAR WITH THE INFORMATtON SUBMITTED HEREIN: AND BASED ON g/.
/
[);,g, } d O t p d o ;- j MY INOUt8tY OF THOSE INDIVIDUALS IMMEDIATELY RESPONStBLE FOR .' // / e OSTA NtNG THE INFORMATION. I GELfEVE THE SUBMITTED INFORMATION IS CineP.i G C ry 21dnUKCT TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNiFICANT PENALTTES FOR SUBMITTING FALSE INFORMATION, INCLUDING ( ,4'/ b h #~f
./
f g'j -- 15, 3,9 3 = j,1, 3;, 9Q 1,( ,. 6 THE POSSISluTY OF FINE AND IMPRISONMENT. SEE 18 U.S.C.110o1 AND 33 u.S.C. e 131o. aRemmes a ww mese sea,me may 6 cauew naes se as sto. coo SIGNATURE OF PRINCSPAL EX"ECUTIVE g TYPED OR PRINTED mM er meremen . ._. _ .:ereeeween s manmeamts rearms OFFICER OR AUTHORIZE 9 AGENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# errechments here/ EPA Form 3320-1 (06-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF 117 / 4 '.10 7 3 , s j .u 1
1 . , j
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Papepwork Reduction Act Notice , a '. . 4 3 . s publ)e@riing turd a fcr this co!iection of iriformation is estimated to vary from a range of 10 hours as an l
'! ! avbrap per reoponse f e wme rnim>r facilitia, to 110 hours as an average per response for some major facilities, ,
"i mth aweighted a3eruc fcr unjur and minar fuilities of 18 hours per response, including tlme for ireviewing f i f insuuctions, tarching Mfing data, r.ourew, gathering and nuintaining the data needed, and . completing and : j reviewing the en!!atin : of irdonation. Send comnents regarding tbc burden utimate or any other aspect of , f this collection of infonn.dmn, induihng suggestions for reducing this burden, to Chief, Information Policy
- Bremch, PM-223 U.S. Enumonrotal Protation Agency,401 M Street, SW Washington, DC 2(M60; ard! to the r i :0,ffice of Infonration and Itegulatory Affairs. Office of Management and Budget, Washington, DC 20503, .
c____ _ _ _ _ _ . _ . _ . _ _ _ . General Instructions t
'4 1.:lf form he been prtia!!y completed by preprinting, disregard instructions directed ~at entry'of that'information ;
4 'already preprinted, m . , }
+ > .. .. !
- 2. Enter " Permittee NamwAfathng Address (and facility namcIlocation, if different),"
- Permit; Number,* and
, # Discharge Numbar" wl tre indicated. (A separate form is required for cach discharge.) ;
- 13. hnter dates begirmim ud endmg "Afonironng Permd" covered by form w here indicated. I 1 ErSr cach "Paramritr' as specified m monitoring requirements of permit.
< i
- 5. Enter "Namp!c Alwme ent' data fer cach paramcter under "Guantity" and "Guahty" m umts specified in permit. f Mwrage" is non . ;y anthmdit average (geometric overage for bacterial parameters) of all sample measurements "formch parameto dtained daring "Aloniimtag Perioa*; "Afarimum" and "Afinimum" are normally extreme high
. and low measurments obtained during "3fomforing Period." (Note to municipals with secondarv treatment . ;
rrquirement. Enw 10-day tacrn;c of sample mesurements under " Average," and enter maximurn 741ay average of f.ampic measurc,xnts obtained during monitoring period under "Alaximum.") , 6c Enter " Permit Re.t:nrement" fer cach parameter under "Guantity" and "(!uality" as specified in permit ; 17/ Unkt "No Ex" er rumber of sunple meamrrnents during monitoring period that exceed maximuni (and/or i l K miriimum or 7-de average as appropriate) permit requirement for each parameter. If none, enter "0"' l
- 8. Enter "!ircquency of Analuif both as "Nampic Atenwrment" (actual frequency of sampling and analysis used
~
- daring nmaitoring period) and as "Penmt Requirement" specified in pennit. (e g., Enter " Cont " for centinuous .
monitoring. */O" for one day per weck, "/60" for one day per month, "lS0" for one day per quarter, etc.)y
' 9. Enter " Sump /c 'l)p/ both as " Sample Afeanecment" (actual sample type used during monitoring period) and as
;" Permit Requircn:cxt," (e.g., Enter " Grab" for individual sampic, "N/IC" for 24-hour ~ composite, "N/A" for l continuous monitoring, etc.) ;
t
-lonWhere violations of permit requirements are reported, attach a brief explanation to describe c:mse and corrective !
actions taken, and seference each violation by date. 1
!!1. If "no discharge" occurs during monitonng period, enter "No Discharge" across form in place of data entry. ;
- 12. Enter "NamerTale of Pnncipal Executive Oficer" with
- Signature of Principal Executive Ofcer of Authori:ed <
?
- ? Agent " "Teicphtme Number," and "Date" at bottom of form. l f
Jj L13. Mail signed Report to Offict(s) by date(s) specified in penmt. Retain copy for your records. l
'14.' More detailed instnetions for use of this Discharge Af<mitoring Report (DAIR) form may be obtained from Officc(s) 7+ specified in permit. i Legal Notice ;
e This report is required by law (33 U.S.C.1318: 40 CJ.R.125.27). Failure to srport or failure to report truthfully can ! result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day l of violation, or by imprisonment for not more than one year, or by both. l
. i
. EPA Form 33241 (Iter. 0095) ;
[ ,. . . - j
PERMITTEE NAW/ApoES 0=sindeForeasyhmeteamme arDWhww) NAT10NAL PouUTANT DOARGE EUessesATION SYME =a (NPDESJ Form Approved. NAME DISCHARGE MONITORING REPORT IDMRA G *' I ! O 'f I IOOLG TO ggm
.i"ty e 7LLLE? DOWFt '3 T A T I "! \ 12-7 81 177-881 ApoRE::s p [ , q)g ,"a a a ' ' ' ' ' ' " '" *
(530n 05) NIN f* A7i4; D&VID 7 Mi 0 C g MW NUMBER mw NUMem p . s7y4g . U!I i
- Di M 3 ; T n R . 15 0 7
~
I3"
##" MONITORWG PERIOD %
t 7tYi" 72LL6Y f34'H i ? A ? I 3 9i YEAR MO DAY YEAR MO DAY LOCATION ._ FROM +n 31 ,? TO 7s ia 4t ena yn 3 ! pt g M c
- u~+.. e syrc sc,n3; a 120 219 122-231 124-253 12s-211 (20-299 130'311 NOM Reeniinewmnione W'o%gg %hec %.
PARAMETER 13 cent On&J QUANTITY OR LOADING I4 Cnid Onyt QUANTITY OR CONCENTRATION 146-531 15+619 146-53t NO. mEOutNcY SAMPLE 13te-451 154-6t9 Or (32-37/ EX m yys TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS serem ,,,,,, ta M ot
. . , SAMPLE $c3me, e e n r :; 3 ~3c333 MEASUREMENT
[ ;3 REQ IR NT N kT M f t f ,, - sne* wy.,rwre g7yggy. pi r 14, Ir 7]SDUIC N SAMPLE r. y c e r- e m eteeet ce c e 9 e e ( c<g *eg4 SCg7 0Ltui MEASUREMENT gg { h gy
; 3 r. g y '} g PERMIT a g p y> + t e c n t y- otteen u^ tem catete r "t s ?. y,ggLY REQUIREMENT s EASMC r vr J>y+ -oo~< y
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' ? L ') .t ! ? t, 7 3 7 A {, SAMPLE acon +e *eese2 $$Ses-MEASUREMENT
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.. z. 1. a ,. u s ont0 ; 1 PERMIT %ntte t e c- 9 & t e 59+ ottecs % c, 1, y s; gyggy gg REQUIREMENT s ee,qt- r - , 3 < r; ya; ne3 59 3 y4 y3gp 34y qr jg
' q L ') a y i E , r t; [ F. SAMPLE : a e- - e ? 6&ee3t t :; 6 e c ?
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, MEASUREMENT gocj [ 3
( . PERMIT cetcaer cet m c r> > o g g e:$ $ S, ? 7,5 1 ErgLy p q t3 ee, , ,
- :, , g .- ygt.. REQUIREMENT 3e$f 3 y : e g p, 3 g .g p g g qgg SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERM!T REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT
- I NAME/TITLc PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PEN ALTY OF LAW TH AT I MAVE PmSONARY EXAMMED ANO '
TELEPHONE DATE AM FAMlUAR WITH THE 100 FORMATION SUDMITTED HEREIN: AND BASED ON - m # MY INQUIRY OF THOSE INDivtDUALS rWMEDtATELY RESPON98tf FOR OSTAINtNG THE WFORMATION. I BEUEVE THE SUsamTTED MFORMATION IS
, 1// /
)3 f David Orndorf [. y TRuE, ACCURATE ANo COMPLETE.
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I AM AWARE THAT THmt ARE .f , . Cherd a t ry Ibm a r,e r MGNIFICANT PENALTTES FOR SusutTTwo FALSE fMFOsIMATION. WCLUDmG ' - yng posse e 4UTY OF FmE ANO IMPRISONMENT. SEE#m 18 U.S.C b AI2 19 3 = $ 1 } 3 % 1l 2b u.s.c. m nor awA,se . se.91001 AND 33 , SIONATURE OF PRINCIPAL SEECUThrE aro. coo TYPED OR PRINTED *=.C_s%nem :ar arv erme.1sie. eree.n e- a e m.ae mw a ms oFrecEn OR AUTHOfMZE9 AGENT NUMBER YEAR MO DAY COOE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# ettschments herof b, b.<, , ,. a. EPA Form 3320-1 108-95) Previous odetions may be used. tREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) n,. . PAGE op u 40/)61003-081,, 1
( . , . -.
-: Paperwork Reduction Act Notice
}.
j
, Public reporting Imrden for this collection of information b estimat<x! to vary from a range of 10 heurias an 4. I % . average per response for nane minor facilities, to 110 leurs as an average per response far i,omomjor facilities, -
I
;with a. weighted average for major and misor frilities of 18 hours per pspomeminduding tiine:for;teviewing + !
instruction, searching existing data. sources, gathering ami maintainiog the data neuleJ. r,nd completing and ,<
- i reviewing the collection of infonnation. . Send comments regarding ths burden estirmta or any other aspect of j
{this collecti<m of information, including suggestions for reducing this bunlen, to Cl.icf, Infonnation Policy j lBrarxh, PM-223, U.S. Envimamental Prutection Agency l 401 M Street, SW Washingtou, DC 20460; and to the ! I
'Oflice of liformation and Regulatory Affairs, Office of Mamgraxnt and Budget. Washirgton, DC 20503; j
- j. !
. 1 General Instructions -
"I, If.fonn has been partially completed by preprinting, disregard instructions directed at entry of that ,infornation
.% - already preprinted. ;
3 1 l l
- 2. Ehter "Permitter Name/Afading - Addrexx (and facility namcIlocation, if difTcrent).*
- Permit Number,* and.
? Discharge Number" w here indicated. (A separaic fann is required for cach discharge.)
. Enter dates beginning and ending "Alonitoring Period"cowred by fann where indicated.
'4. . Epter cach " Para:neter" as spdfied in monitoring requirements of permit. ,
i ; i l
- 5. Enter "Smnple Afeasurement* data for cach parameter under 'puantity* and "Guahty" in units specifi;d in permil -
" Average" is nonnally arithmetic average (geometric average for bacterial parameters) of all nmph incasurements 4 i
foi cach parameter obtained dunng "A!unimring Period"; *Afarimum" and "Afinimum" are normauy extreme high ; and low measurements obtained during *Afomforing Period * (Note to municipals mth secondary treattnent l s : requirement: Enter 30<tay average of sample measurements under "Airrage," and enter mx<immd klay average t of sarnple measurements obtained during nwnitoring period under "Alaximum.") !
- 0. Enter 'P$rmit Requirrment" for each parameter under "Guantary" and *Guality" as specified in permit.
?
- 7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximym:(and/or ;
minimum or 7-day average as appropriate) permit requirement for each parameter. If rane, enter W. ' '
]
- 8. Enter " Frequency ofAnalysis" both as " Sample Afravurment" (actual frequency of sarnpling aad anaipis used l
, during monitoring period) and as
- Permit Requirement" specified in permit. (e g , Enter Tontf for continuous !
.. monitoring, "#7" for one day per week, 'F3r for one day per month. *160" for one day per quaner, etc.) L l
- e. . !
- 9. Enter Wnple Type" both as ' Sample Afcaxurement" (actual sample type used during rnonitoring perica) and as !
x, . Permit Requirement " (e.g., Enter ." Grab' for individual sample;"J41KB for 24-hour composite, "N/A" for ( continuous monitoring, etc.) l 10.?Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference cach violation by date. i
'l I, If "no discharge" occurt during monitoring period, enter "No Discharge" across form in place of data entry.
12 Enter'*Nameffille of Principal Executive 0))icer* with
- Signature of Principal Executive Oficer of Authort:ed {
, Agent * ' Telephone Number,' and *Date" at bottom of form. ,
y 13. Mail signed Report to Office (s) by date(s) spxified in permit." Retain copy for your records. , 1 14. More detailed instructions for use of this Discharge Afomforing Report (DAfR) form may be obtained from Office (s) :
. specified in permit.
Leoal 6 Notice ! s This repmt i~s required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfuty can . result'in civil per.tities not to excaxi $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day f of violation, or by imprisonment for not more than one year, or by both. 4
,> EPA Form 3320-1 (Rey,08-95) ;
- . ~ . - .
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PERMffTEE NAME/ ADORES 5 W rare,Ms= I,eens= (Dtfww) est.TiONAL POLLUTANT DrScMARGE tuMmanON sysTEw (APDES/ Form Approved. NAME
;e3gy4 yge(7y g yn g pg p7 y MNMG T (D tt? .,. YT T\ T c? Y Yg,, g -
e. ADONIS g , 3, ~') y 'l "*6' *C '9-( $ 3 if ; O$) $
;T7"; ii ( 7 I O 31 K ) D 9 :- PERMIT NUMBER DescHARGE NuMeER , _ yyaqg ,
<ypn7ea~"x.' ' '
* ?en77 wt ~'i"-n ,
FAmW 'g.
, 4 y 7 g y LLg7 7 g ,, y n MONITORING PERIOD %
37g773 YEAR MO DAY YEAR MO DAY _ LOCA N FROM *
< Ft TO 4+ *
<1 0 $ ?- 23 ;ITN'bGr..l~ [ u?
=*-*. ntvr3 ,: m , u e, (2G2r# (22-23/ (24-251 -(26-271 (28-291 (30'37, NOTE: Reed instructlene before .T_. m Weis fehn.
PARAMETER (3 Cent on&# OUANTITY OR LOADWG I4 Cerif on&f QUANTITY OR CONCENTRAmW NO. "EQUENCY 146-531 (54-s ti 130-459 446-531 (56611 OF SAMPLE 132-37; EX angygs TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS sem ,,,,; foyo, SAMPLE q; r
/'7
.,s, et - q 7[
s O , OO S- 63) 02.*cac c 'r e t ^: t WN?oct O ~ 4 . .,2,L.s$)n-.p'$772., g, ss
- - . MEASUREMENT M O/b. O bY'
,9qng 7 ,; PERMIT ,rpqn* neger c a t n c a: wre?ch acMac r Oc t rmy nIg g
.,,.,g, REQUIREMENT .-. , ~ . ,
rrt . . - _ . , - -
. 39- n , y. , , y; 3 e- c %
SAMPLE MEASUREMENT t PERMIT REQUIREMENT SAMPLE MEASUREMENT f PERMlT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT - REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT n NAME/ TITLE PRWCW'AL EXECUTIVE OFFICER I CERTIFY UNDER FtNALTY OF LAW THAT t HAVE PERSONALLY EXAMMED AND AM FAMtuAR wtTH TME INFORMATION SUOMITTED HER0es; ANO DASED ON j . rs f TELEPHONE DATE , MY INQUIRY OF THOSE MDIVIDUALS fMMEDiATELY RESPOtfSISLE FO84 i
+
bM Mg gIUdOI.[ OSTAINfMG THE INFORMATION, 9 SEUEVE THE SUBMITTED INFORMATION IS 4 ! O*# TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE StGNtRCANT PENALTIES FOR SUDMITTING FALSE INFOftAATION, fNCLUDeese
,'t M,4g Mh) P 1{ 2h C W { g( ry MMia (tr THE POSS881UTY OF FINE mfd IMPRISONMENT. SEE IS U.S.C. 91001 AND 33
+ * , sg g u S.C. t 131s. #Peasanes easir owse saranne mer *icamie anos se so s 70.000 800 NATURE OF PRINCIPAL EXEh ARE A TYPED OR PRWTED maar er ====*==== _ _ er6 rwe a s enemneans s rewas OFHCER OR AUTHORIZED AGENT CODE NUMBER 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 7g 3 ,g
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- T _ _ _ _ .
4 [ .m _.x-_ 1 y I'
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Paperwork Reduction Act Notice
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[ ' iPelic repbrting 14rdm fu this c.o!!c4 tion of iriformatWn is utimated to vary from a range pf 30 houis as an , .j W: , i Mage per resporne Im ame rnirmt facihtin, to 110 hours as an average per response for sorne major' facilities, t i (- '
! _ i with s.wdghted ascry.e kr nujer and rninor facilities of 18 hours per respcmse, including tind fur reviewing ! I -l j . instructkns, watchir.p disting data sourcu, gathering and maintaining the data needed, and completing and
-l f :rdiewing the co!!ectim ofjnform.dion Send corranents regarding the burden estimste or any othsr aspect of j i ! J this' coHection of inforndch, including sugge:3tions for redacing this burden, to Chief, Info mation Policy , j j Brkm.h, PMQ23, U.S. Drvironmer.tal Protection Agency,401 M Street, SW Washington, DC 2M60; and to the l
;O!Ece of Information ar<d Regulatory Affairs, Office of Management and thxfget, Washington, DC 20503. .
l 4,
..y_, . _ _ _ _ . _ -_ _. _. +5 l a
y General Instructions -
' l .7If fons ba.s been partially comple.ted tAy preprinting,' disregard instructions directed at entry of that information l already preprinted ~ .- - -
. s .
?
1 g; ~"Ducharge Ehter "Number Permitteewhere indicatedYarwAlading (A separate Addros {and facility form is required for cach namellocatioe, discharge,) if differcnt).'
- Permit l ;
~ .
s
. :3. Ehter dates beginning mjd endmg "A/onitoring Period"coiered by form where indicated. 5 -
I
- 4. Enter cath "Parame!cr^ as specified in monitoring requirements of permil ' ~
1 f
~
1 Enter "Senple A#amrcment' data for cach parameter under "Guantity" and "guality" in units specified in permit; j s Werage" is nono:d:y arithmciic average (geometric average for bacterial parameters) of all sample measurements :
-for-tach parameta cbtained during *Alonitoring Penod"; 'Afaximum" and
- Minimum" are nonnally cxtreme high W
; and.-iow mcasuremtub obtained during "Atsni!nring Period" (Note to municipals with' secondary treatment >
l requuement: En:cs 30 day average of samp!c measurements under Werage," and enter maximum 7-day average r : of utmple measuremenh obtained during monitoring period under 'Alarimum ") l
< i
;6qEntgr " Permit Reynrement" for each pirameter under "guantity* and "guality" as specified in pennit. . j
- 7/OndE*Nd Er" cater number of sample measurments during monitoring period that excecd maximurn (and/or ;
"minhnoin or 7-day awthge as appropriate) pcrmit requirement for each parameterf If none, enter "0";
j 8f Enter "I'rcquency n/ Anald both as "Sami e Afensurment" d (actual frequency of sampling and analysis used i E =during monitoring period) and as " Permit Requirement" specified in permit, '(e.g; Enter " Cont," for continuous '
. monitoring, "//7" far one day per weelg *160* for one day per month, "1/90" for one day per quarter, . -
etc.) }, 1 Enter " Sample Tv;# both as "Samp!c Alcaswement" (actual sample type used during monitoring period) and as } (. -
" Permit Requirrment " (e.g:. Enter ""Grah" for individual sample, "14HC" for 24-hout composite, *N/A" for ;
\ s ' continuous' monitoring, etc.)
^
- 10. -Wliere vio'lations of permit requirements are reported, attach a brief explanation to describe c'ause and corrective I actions taken, and reference each violation by date. :
- 11. 'If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. I
- 12. Enter 'Namei7itle qf Principal Erecutive OJJicer* uith " Signature ofPrincipal Erecutive Oficer ofAuthori:ed Agent,' ' Telephone Number " and "Date" at bc. tom of form: l y L l'L hiail signed Report to OlYice(s) by date(s) specified in permit. Retain copy for your records. * ;
g . .
- 14. More detailed instructions for Use of this Discharge Af<mitoring Report (DA(R) form may be obtained from Office (s) !
specified m permit. l
+ ,
Legal Notice ; Thisieport is required by law (33 U.S.C.1318; 40 C.F.R.125,27). Failure to report or failure to report t'ruthfully can ! restill in civil penalties not te, exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day l J of violation, or by imprisonment for not more than one year, or by both.
; 4 l
. ~ !
- EPA Form 3320-1 (Rev. 08-95)
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PERM;TTEE NAME/ ADORE 25(AudaleForeriNewter.n grop,wp r.r.TiONat POLLUTANT DescuARos EtwNanoN system (NPDESJ Form Approved. e NAME DtSCHARGE MONITORING REPORT (OMRJ
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- v OMB No N
"'~ * '*' *' Approval eNpiene 06-31-98 ADOREt3p ,') , J1; a ($U34 35) : r **
.r. e. ?. i ,. , n. R y I n. n .e %. 7g ..
PERMIT NUMBER c:SCHARot t uMaER y , p y ., g - , o
., c n n ,
,viIr.,7i..4e33
- e. i 1s A 2 '
MONITORING PERK)D m- 'm - 7 0 =" T?KV'y 7 g L L 5. 'I ?3kPF 1 l' 4. T 1.1 " YEAR MO DAY YEAR MO DAY m. e LOCATION FROM TO
-x i J, S t> -
0?? 73 Di9C"AFG 007 . s>ev. ntyT ) 1- n n1s (2021) (22-23) (24-25) (26-271 128-291 13&311 NOTE: Reedino m w er @e & M term. PARAMETER 13 cent ows QUANTITY OR LOADING I4 cent OWJ QUANTITY OR CONCENTRATION NO. FRE0VENCY SAMPLE 146-531 154-671 (30-451 446-531 154-619 or (32-37J EX augys,s TYPE AVERAGE MAXIMUM UNITS MINfMUM AVERAGE MAXIMUM UNITS , ens ,,,.sgj gg,7o,
. SAMPLE ttee$ ne?2SS c - 0 > *r c ( 1y MEASUREMENT i -) ; a n 9 ) - PERMIT ecote. p e e e r. e 3 :c e ,,g wissee ), g ' .
gyg g y .,ga
- . e , , , ., ...,c 3. . q ; , REQUIREMENT 33, g y y , g ., - 3377,q, ; .,
L*4, rs f35yf[- 3n SAMPLE ( ,y -~aen' *-Sect e 9 9 ; <: e
= 3 ng ;et e v yr yp p ts c .
MEASUREMENT gg ) 3 3 r "., -) 1 ) , PERMIT 9p pp + y r. - e n t $$gneg my, 9 g, g,3 ' cc,o, . . . - 3, .
., y 7 . , ,
REQUIREMENT .g ,p. 3,y , , ,,,,, SAMPLE
,La7I*.C, [3rAL MEASUREMENT cm&?q~ eted?? S S d e t. *_ ( 14) r-., .. T ,, ,,, .s w
-) , < p i
PERMIT t e t e- s e cemee5 g uw o c t o rf e *) , $ 1-,25 , gggty- p s, q
-era: u7 -.q, e g , ,, REQUIREMENT pe; .. n 97 yq37 33y y .; f p 9e , s y *; . , f, ,
SAMPLE s tetnr t~et3y a,090oS ( i9} _j;7 , 1, MEASUREMENT
,qeq; } 3 PERMIT oo5cin S * % e t-
- c e cAh3ee S,j ;,3 4 ygay gag REQUIREMENT we* 3yrttc" 'a A y r M '; a
- , . , , . 7 7 , e. y37: 1~/L SAMPLE MEASUREMENT PERMIT ,
REQUIREMENT SAMPLE MEASUREMENT PERMIT i REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER 8 CERTY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND / TELEPHONE DATE AM FAMIDAR WITH THE INFORMATION SUSMITTED MERDN; AND BASED ON m / I MY fNOUIRY OF THOSE fMOIVIDUALS IMMEDIATELY RESPONSISLE FOR OSTAINING THE INFORMATION,1 BEUEVE THE SUBMITTED INFORMATION 85 I
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[ F - TRUE. ACCURATE AND COMPLETE. ' , (' 'g #
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Dayid Or n d o r 1= I AM AWARE THAT TMERE ARE sioNireCANT PENALTIES FOR SUBMITTWO FALSE WFORMATION. WCLUDWG - m
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THE POSSsStuTY OF FINE.AND
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COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# ettechments heref
,I' ',- rn La,, r ,r 17;;te >Le 7tn*ro , ; :S -,4 t !. o> t w;L ri t v r > 3rc 33;orn a osL7 ngst ; ryog
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t l- h e - EPA Form 3320-1108-961 Previous editions mey be uSed. (REPLACES EPA FORM T-40 WHICH MAY NOT IBE USED.) PAGE OF 3nn f) ,y
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-x a Paperwork Reduction Act Notice
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l 3" lpubbe reporting burden for this'co!!ection of informdtion is estinuted to vary from a range of 10 hours u an - {
*- ? svirage pu regense for some minor facilities, to 110 hours as an average per response fx some nojor facilities, . Lwith a_ weighted average for aujot and minor faciliths of 18. hours per response, induding tibtfor reviewing 4 instructions, searching existing data sources, gathering and maintaming the data needed, and completirg and y_ ,
jreviewing the colhttion of information. Send comments regarding the burden estimata or anp other sapedt of :
;this collection of infonnation, includmg suggestions for reducing this but len, to Claef, Informatmn: Policy ]
g 1 Branch, PM-223, U.S, Environmental Protection Agency,401 M Sinxt, SW Washington, DC 70460; and to the OfUce of Infonnation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503 _ _ _ .a.= _ _ - _ _
.{
4 t j . General Instructions -
'I. If form has been partially completed by preprinting, disregard instructions directed at entry of that ,infornation l a already preprinted, j
's (
j i I2. E6ter " Permittee Name4failing Address (and facility name/ location; if difTerem)," " Permit Number," and "lpischarge Number" where indicated _ (A separate form is required fur each discharge ) g i
~ j
,3. Ehler dates begittning and ending "Alonitonng Period" covered by fonn where indicated. j
.. i .~
4 Enter each " Parameter" as specified in monitoring requirements cf permit. -{
- 5. Et\ter " Sample Afeasurement" data for each panmeter un. der "Guantity" and "Guality" in units specified in pennit -
" Average" is normally atilhmetic average (geometric average for bacterial parameters) of all ramph measurem?nts l for each parameter obtained during "Afonitoring Penod', "Afarimum" anj " Alm! mum" are normally extreme high j
.and low measurements obtained during "Afonnoring Per/od? (Note to nmnicipats with secondary treatment t requirement: Enter 30-day average of sampic measurements under " Average,* and cnier maximum 7-day average > ;
> 4 of sample measurements obtained during monitoring period under "Afarimum. ")
', i 6f Enter " Permit Requirement" for each parameter under " Quantity" and *Guality" as specined in penait.;
,, i 7 Underl"No Er" enter number of sample measurments during monitoring period that exceed maximum (and/or '
'l minimum or 7-day average as appropriate) pennit requirement for each parameter. If r.one, enter "0" j
)
~ 8.1 Enter ." Frequency of Analysis" both as "Samp/c Afeasurment" (actual frequency of sampfir@ and tmalysis used ;
during momionng pdod) and as " Permit Requirement" specified in pemut (e.g., Enter "r'ont," ,for continuous s
-monitoring. "//7" for one day per week, "la0" for one day per month. "//90" for one day per quarter, etc.) - .;
i i
- 9. Enter "Sampic 'l)pe" both as " Sample Afeasurement" (actual sample type used during moni'oring period) and as
" Permit Requirement,"' (e.g.; Enter "Grah" for individual sample, "24/E" for 24-hour composite, "N/A" for
, ; continuous monitoring, etc.) i 10.Shere violations of pennit requirements are reported, attach a brief explanation to describe cause and corrective U actions taken, and reference cach violation by date.
I i1, If"no discharge" occurs during monitoring period, enter "No Discharge" across fonn in plaec of data entry.
- 12. Entet "Name/ Title of Principal Erecutive ODicer* with " Signature of Principal Executive Oficer ofAuthori:ed l
Agent," " Telephone Number," and "Date" at bottom of fann. s
- 13. Mail signed Report to Oflice(s) by date(s) specined in permip Retain copy for your records. l ik. More det5iled instructions for use of this Discharge A/cmitoring Report (DAIR) form may be obtained from Offim(r)
, specified in permit. j Legal Notice j l
{ This report ir, required by law (33 U.S.C.1318; 40 C.F.R.125. 27). Failure to report or failure to report truthfully can !
! result in civil penalties not to exceed $10,000 per day of violationi or in criminal penalties not to exceed $25',000 per day ;
of viointion, or by imprisonment for not more than one year, or by both.
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~f EPA Form 3320-1 (Rev. 08-95) '
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k PERetfTTEE NAME/ ADORE 43WNe9NewLorenaitrtVimew> NATIONAL POLusTANT DescMARot EuhNantiON se (APDES/ Form Approved. I NAME -,3 3 7 e y yg;pyy py7g yy ,yyv [N g, ys;7 y g y y, p g, q y 3 M No\Np ; ADDRE2S p . 3. H){ u **C '""
- p 3 r, 3q APP(@ 48 A7'N; p Of I b DMS 93 V PERMT NUM DescMme NUMsER ,jpyN4L .
1 59fP?!93PS" ~0A 1M77 MONITORWeG PERIOD 3M 7 i FAN , p y ;, 4 7LLL,7 p g q 7, , z 7,g 7 T ' YEAR MO DAY YEAR MO DAY LOCATION _ , FROM ss TO r e- 5( CM NO SI5Cy5 MP l
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-; J 4' !a NOTE R*'A l *> M ,
n 8 ;r 9 1 ') n il 4 m a p 12O 21) 122-2 % (24-25) 426-271 (26-2.91 13O 311 & 0'IE O PARAMETER (3 ced W QUANTITY OR LOADWG M Card W QUANTRY OR CONCENTRATION NO. mEousecy 146-531 154-611 130-451 146-55 (Sa-691 .or SAMPLE f32-37; EX my,,, TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS asm ,e fu p SAMPLE ~*>.,--w..~ %. .^#. , ~ , . . %*s~, zw 1,3 } . { 14^3 [ } 7 PERMIT m u a. g
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3 g PERMIT .- o g s a a gnense c .e e $ 23- 3g- ~ gycy 39-e e t_ 'l r e r iani- REQUIREMENT g, gy. p,y(y V4f1F g y 7 .,, ,y 7, r ny TN ~ ) ( p T ,. g; SAMPLE < q 3} gyseg escryce onese
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PERMIT REQUIREMENT SAMPLE MEASUREMENT
- PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMtT -
REQUIREMENT m NAME/ TITLE PRWCW'AL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT t H AVE PERSOS. ALLY EM A48mED ANO TELEPHONE DATE AM FAMIUAR WITH THE lesFORMATION sUSMITTED HEREIN: AND BASED ON D ' e} MY INQUWlY OF THOSE IIeDIVIDUALs thsMEDIATELY RESPONSIBLE FOR // f David Ortidorf OSTAltefMG TNE INFORMATIOes. I BEUEVE THE susealTTED 18eFORh8ATION IS / i
- TRUE, ACCURATE AfsD ConsPLETE.
PENA I AAP AWARE THAT THERE ARE /
, b -- j O Chenistry Manager iT MENT. sEE s,,u,,e,M,so.Tma is v.s.c.
,12 M3-5113 <> ta 11 26 s,0N,mcA,N,T,tiry twE oss E,o o,LT,!,E,,s FO,,R a, e s ro, FALsf in*ORMATiON. inctuoissa r
TYPED OR PRWITED
.s.c. s 131s. mwimmee saisier
.uw or ais=*ivenn : --- c erase so sseusee s ==ame wmer.siceusw s yesms micoo s iOO,i Asso SIONATURE sa OF PRNGCIPAL EXECUTIVE g NUMBER OFFICER OR AUTHORIZEO AGENT CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aE altschments heref EPA Form 3320-1 108-96) Prewous odetions timy be used. IREPLACES EPA FORM T-40 WIGCH MAY NOT BE USED.I PAGE OF 0 3 M 9 / 9 610 3 3 - S S 34 i ,
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fgnosj[ei[uction Act Notice' - 4
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PubHe Mrticg .Lurds e kr this cob. tion of infomatieri is estimated to vary from a range pf 10 hours as an !
, ; Mrage per sevponrw f4 tcme mined fadlitics, to l10 hours as an average per response for some snsjor facilities, j
' with. a wighted averrafcr major and minor facilities of 18 hours per response, including tirne for reviewing
; Linhructionk, garchint nisting date sources, gathering and mamtaining the data needed, and completing and r
. rdiewing )he culk:ctim at information. Send comments regarding the burden estimate or anymther; aspect of
- q lthm cobtiba of infmmnon, including sugge.stiora for reducing this burden, to Chief, Inforination Policy
; Brinch, PMy223, U.S. Envimamental Protection Agency, 401 M Street, SW Washington, DC 20*60; and to the j
.. ! ! Office of Infohnation er,d Regulatory Aff airs, Office of Management and Budget, Washington, DC 20503.
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i r General Instructions '
')..lf. form has been partially completed by preprinting, disregard instructions directed at entry of that information f
, .already preponted. -.
i Euter '"Permitice Name/Afailmg: Addren (arul facility name/ location, if different)," " Permit? Number," ' and !
*/As harge Numb r" u here indicated. (A separate form is required for cach discharge.) !
3 Enter dates begmmng and ending "Alonitormg Period' covered by form where indicated. ,
- i. t
- 4. Enter cach'Parannace" as specified in monitoring requirenv.4ts of permit. !
- 15. Enter "Sampic Afa orement" data for each prirameter under Guantity* and " Quality" in units specified in permit. i
" 1veroxc" is ner +Sy ar:thmete average (geometric average for bacterial parameters) of all;samp!c measurements 4
- for c9ch parameter ebtained during "Ahmitoring Period"; "Manmum" and "Alinimum" are normally extreme high !
aml. low measurraents obtained during "Afomforing Permd" .(Note to municipals with secondary treatment s , j crcquirement; En cr M day aserage of sunple measurements under " Average," and enter maimum 7-day average . ~
- of sample meanuments obtained during monitoring period under " Maximum ") . , i !
'te Enter "pdmit Recpmvment" for each parameter under *(>aantity" and "Guality" as specified in pc'rmit. -
6 i . . . 1 Under fNo EP cmcr number of sample measurments dating monitoring period that exceed maximum (and/or
; minimum or'7-d@ average as appropriate) permit requirement for each parameter. ~1f none, enter *0".
8jEnter'
- Frequency of Analysis" both as "Sumple Aleawrment" (actual frequency of sampling and analysi'. ' sed e
.dging monitoring period) and as " Permit Requirement" specified in permit. (e g., Enter " Cont," for continus i
, monitoring. "//7' for coe day per week, "l/30" for one day per month, "1/90" for one day per quarter, etc.). !
i n Enter "&mrple Bre* both as "Smnple Alcasurement" (actual sample type used during monitoring period) and as . j j- ' 7"Permrt Requirement," (e g., Enter " Grab" for individual sample, "2.II/C" for 24-hour composite, "N/A" for j ccmtmuous motutoring, etc.) ; 1
~
l 10..Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken. and icference each violation by date. ;
- 11. If"no discharge" cccurs during monitoring period. coter "No Discharge" across form in place of data entry. l
- 12. linter "Namei7'itle of Principal Executive Officer" with
- Signature of Principal Executive Officer ofAuthoruzed t Agent " " Telephone Number," and "Date" at bottom of form. ,
1
- 13. Mail signed Report to Of fice(s) by date(s) specified in permit. Retain copy for y our records. i i .
5
- 14. More detailed instructions for use of this Discharge Ahmitoring Report (DMR) form may be ob'tained from OfIice(s) }
specified in permit. j Legal Notice , i This report is required by law (33 U.S.C.1318; 40 C.F.R.125,27). Failure to report or failure to repost truthfully can
,, result in rivil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day ;
of vsolation, orlby, imprisonment for not more than one year, or by both; f v , 4l s, j EPA Form 3320-1 (Iky,08-95) _
'W. *- W r
PERMITTEE NAME/ADOMESS tf=u rec 6phwierenea grD.A r> NAnONAL PouuTANT DescHARoE EuMm Anon system (NPDES / Fovm Approved. NAME
.pA7P, y;LL Y ,V E 77\77), N%% MNmG MT f, f y 7 7 7 79L 7, , ,; ,_ M No. N4 ,
ADONT,3 p , 3, y3g a ~* ' * ' ' - 'C ' ? ' ( 3 IJ O I S h) N i+ i .< ; Diyin n ? *: 9 n 9 7 PERMIT NUMBER OtSCHARGE NUMBER p , e g( .
-enn1e.t3 i1 - n. ,i
,t 1 -) . -r4 MONITORING PERIOD s 'a~ m' .
1r177? V4LLEf P3WPT 3
- s ? I )! YEAR MO DAY YEAR MO DAY _.
LOCA N
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FROM , 3 1 TO u s, si 10 3: 5 C 1 1. A '; r [ l n rt c . n *y. n. <rY , . n , ,. r (2a2fs (22-231 124-251 12s-27; (28-291 (30'371 NOTE: Reed Instrucelone before~esmp4eting this fomi. PARAMETER (3 Card W QUANTITY OR LOADING I4 Card O= M QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE 146-531 154-691 (30-451 146-5 5 154-619 OF (32-371 - EX mys,. TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM t%TS c.s3 ,gg,j ,,m SAMPLE 3753& w -e.gs 3 3ca33, ( 37)' g< MEASUREMENT ] gf"' Q gf C '
,,Q 133gr 1 3 PERMIT on en x g e r. g p e .
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.ge 3- . 3- .,.. , 3e.. , agf yy77 33 7 vgge prqq SAMPLE L a t, r s 733SurT 9; r n )) ae2ce: e4c;23 43c;er
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REQUIREMENT yn g97 3gyte w; . - - ym SAMPLE acnye'
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.er' *t - r REQUIREMENT .,er y, a 7, yy7 uzy 3 f g,
- a7 vainr
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j37 ; ;, MEASUREMENT g ,p e g f)g ( 11) C 7/ / 3- . j ^ < PERMIT $*eewe S^^*t* 0 &? :.c s o c S i.7 l , 5, L(r p u ;$
.;.-- , .y 7 ;,. ,.p, REQUIREMENT ; .s c : ., .g ,. g q c y ggygggy Sgfg SAMPLE i MEASUREMENT '
PERMIT REQUIREMENT SAMPLE , MEASUREMENT PERMIT REQUIREMENT NAMERITLE PRINCW'AL EXECUTIVE OFFICER e cERnFY UNDER PENALTv Ori AW THAT e PAVE PERSONALLY EXAMINED AND TELEPHONE DATE AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON n MY INQUWtv OF THOSE fMDIVIDUALS IMMEDIATELY RESPomistBLE FOR ' I 3fj e
,/
Dnvid Urndorf " f . g/ /. TRUE."mGACCURATE THE MFORMADN. AND COMPLETE.I BnJEVE THE SUBMtTTED I AM AWARE THAT THEREINFORMADON ARE j IS /} g4 g ff , - SIGNtFICANT PENALTIES FOR SUOMITTING FALSE fMFORMATION. MCLUDMG gg (-,nCT11 S L Q, yGIl350 > ' _, ,, s
* *y q* g g 3 ~ $~ g { 3 [{ 'yI THE POSSISfLITY u.S.c. e 13:e. reawe.OF FINE.ANO sier an IMPRIS.r)NMENT.
sonn., m mer icam si e ., ne SEE s to, 18 coo u S.C I '~S40 1001 MATURE AND 33 OF PRINCIPAL EXWCUTNE m TYPED OR PRINTED and er mene =n= 2 _ -_--- : et 6.ri a e marme aw a ms OmCER OR AUTHORIZED AbENT CODE ' NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# ofrechments heref op- ror 3s;r y w
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n.' - ne - 4 . t!- (72 .. q=-3.) : -;fL, (?He L I *; I ; Tg 15 y
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t n-- , -s;,p EPA Ferm 3320-1 108-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
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Act Notice: ' e 5' . ! { Public repordng burden for this collection of information is estimated to vary froro a range of.10 $cri as an j
+
isverage per respon<e for some sninor facilities, to 110 hours as an' average per respcme idr udrsajor facihties. - 3 with a weighted average for rmjor and minor facilities of 18 hours per respon,se, including _tirne for reviewing
, l
. ; instructions, r, earthing existing data sources, gathering and maintaining the data neem, and completir:g and . ,
j ' reviewing the collection of information. Send comments regarding the burden estimate or anyothet sdpect of ' '
^
,this collection of information, including suggestions for reducing this burden, to Chief, Infornation,Pdicy ;
t Elr'anch, PM-223, U.S. Environmenta: Protection Agency,401 M Street, SW Washington, DC 20160; and to the !
! Office of Information and Regulatory Affairs, OMce of Managenent and Budget, Washington, DC 20503; l c
,_ _._ _ _ _ . _ . _ _ _ ) ,
L L i : General Instructions . l
- h 11 form has been partially completed by preprinting, disregard instructions directal at entry of that information u latready preprinted. ,
.. I r 2. Ehter "Permittec Name,A/ ailing Address (and facility name/ location, if different)." " Permit Number," and i "I) scharge Nenher" where indicated. (A separate form is required for cach discharge.) ,
- 3. Enter dates beginning and ending "Afonitoring Period" covered by form where indicated. 1 l r
- 4. Enter cach " Parameter" as specilled in nionitoring requirements of permit. !
- 5. Ester "Sampic Afeasurement" data for each parameter under "Ommry" and "Guality'in unip specified in permit *
"Arerage" is normally arithmetic average (geometric average for bacterial parameters) of all 1 ample measurements l fm cach parameter obtained durmg "Atomrarmg Period"; "Afarimum" and ?Afmimum* are normaHy extremc hhh and< low measurernents obtained during "Afonitoring Permd." (Note to municipals with scumdary treatmcat l requirement: . Enter 3041ay average of sample measurements under *Arerage " and entcr rnaximum 7-day average of sample measurements obtained during monitoring period under "Afanmum ") ;
6 Enter */.'ermet Requirement" for each parameter under "Guantity" and *(heality" as specified in permit. '
)
- 7. Under."No Ex" cnter number of sample measurments during monitormg period that exceed maimum (and/or minimum or 7-day average as appropriate) permit requirement for cach parameter, if none, enter *0".
'8/ Enter " Frequency of Analysis" both as *Serple Afrasurmont" (actual ficquency of sampling aad analysis used"
' during momtoring per od) and as " Permit Requirement" specified in permit. (e g, Enter Tont,' for continuous i monitoring. "l//" for one day per week, */G0" for one day per month, '/M0" for one day per quarter, etc.)' :I i
9.; Enter " Sample 7)pe" both as 'Sampic Afrasurement" (actual sample type used during monitoring period) and as
" Permit ' Requirement," (e.g., Enter " Grab" for individual sample, "N/IC" for 24. hour composite, "N/A" for continuous monitoring, etc.) ;
- 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date. .
i i 1. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry ] 1
- 12. Enter,*Namer ntle of Principal Executive OJJicer* with
- Signature ofPrincipal Executive DJJicer ofAuthn: d l Agent,"
- Telephone Number
- and *Date" at bottom of form. . l
- 13. Mail signed Report to Of0cc(s) by date(s) specified in permit. Retnin copy for your records.
.14. More detailed instructions for use of this Discharge Afemitoring Report (DAIR) form snay be obtained from Officc(s) specified in permit. !
Legal Notice ;
. 1 This" report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil pe.nahies not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day I 7
of violation, or by imprisonment for not rnore than one year, or by both. ) a. s EPA Form 3320-1 (Rev. OS-95)
- o. ..
PERAMTTEE NAME/AODRESS #=we Forepr#mwleressa lfDWow) nation AL POuuTANT pscMMooE EtanN ATiON svstau (APDES/ Form Approved. . > waug DISCHARGE MOfstTOI4NG REPORT (DM41 ogg g y., ,
$riV-3 f A 1. L f PGVE' caA?* r2-r 61 f f 7-r81 0tMsL ::4 -
ADDRESS ,,3 , pr 9 -*'^ '* * ' ' *
- rf M ^EE" ["ET** *
(333* "G} . Ar+N; p1 fin aasD0e- PERMIT NUMBER ascMARGE NUMBER v . 2{qg g
- 4 I p ? I y ., ? '; e " 3$ 1397' 'AU3" MONITORING PERIOD e FACILITY , g .7 7 .7 ;, y p g 37g,73 LOCATION pggy 7g
, y5 9: g7 9 g (.
,; 9 g ; $ g 4 y p ,; y g~ g 99p , ;
, 4 ,m . n,;3 3~rnnsr (2a271 (22-23s (24-25s (2s-27i tie-2si (Ja3rj NOTE: Reed instructions before eiNnpieting 1No form.
PARAMETER (3 ced on&i OUANTITY OR LOADING (4 od Owl QUANTITY OR CONCENTRATM NO. PREcufwey SAMPLE 146-53, 154-679 430-459 146-531 (54-671 OF (32-371 EX m yss TYPE AVERAGE MAXtMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS sie gewp gg ,.7a, t L:/, IV
- SAMPLE S yy 33g39 e .g g y g g, e, O
_)t ' J .I " 13 j[ ,
, an n .,e MEASUREMENT O.CQ y CMg ; e,7~
2 , , m. e #.1 1 u3 .7 s 935' I )
- SCp3?? * * * ') r' T Mitche $?^ $3e s e. c 3 c o - ( y r. ^ ; y qg g yg
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SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT ' REQUIREMENT SAMPLE MEASUREMENT
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MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON98tf FOR '
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OSTAINtNG THE INFC9MATION I SEUEVE THE SUBMITTED INFORMATION is ' David O.rndort-dlLLti e t. ry Man a t'e r TRUE, ACCURATE AND COMPLETE. 9GNtRCANT TwE PENALTIES posseitivy OF FINEFOR ANDSU,BMITTING iM RisONMENT. I AM AWARE TMAT THERE ARE FALSE sEE INFORMATION. is u.s c. e soci INCLUDfMG AND 33
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412 393-5113 11 26 u.st e isis. consnmes war owse sMeme any *=em mee se es s 70.000 S4088ATURE OF PRIIOCIPAL TYPED OR PRINTED w er mar ==== : _ u-_ _- : ereerween s meaew ear s yearms OFFICER OR AUTHORIZED A CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# strechments here/ EPA Form 3320-1 106-951 Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT SE USED.) ,, PAGE OF
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j L ' PuNic rep 6rting Fordg, kr this collection of mfornation is estimated to vary from a range hf 10 hours as an 'l ' k; ; f awsage per rispone fm tenm minor faahties, to 110 hours as an average per response for mine majcr facilities, , l %ith a wrighted averucifw m.tjurm! minor facihties of 18 hours per response, including Sme for tekiewing ! f -
' instructiors, r.carthing oiqing datoourem gathering and maintaining the data needed, and?completjng and . y
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,- ;rekwing the colhtioniiinforrution Smd comaxnts agarding the burden estinate or 'any other aspect of -
f I {thip collecho of inf wmdon, including a.uggestions for re&cing this burden, to Chief, Informatihd Policy
! Branch, Phf 22), U.S. ihaironmental Protection Agency,401 M Street, SW Washington, DCl20460; and to the f Office of Information rA Peguldcry Affairs, Office of Management and Budget, Washington, DC 20503; l
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l, i i ; f .r. General Instructions 1 i ( tjf; form has been partidly completed by preprinting, disregard instructions directed at entry of that 'information 5 already preprinted l j 2. Enter *Permatce Aanfed/ ailing; Addrcxs (and facility namc/ location, if different)? " Permit Wumber/. and ';
?Diuharge Numbcr" wl cre indicated (A separate form is required for each discharge.) , .;
' 3JI!n!ct dated beginninp, and ending "Alonttoring Perind" covered by form u here indicated.
~ 4. Enier each "Paranc.ter" n specified in monitoring requirements of permit. '+
p 51 hinter "Sm5ple AfcaarrmenP data for each parameter under " Quantity" and "Guality" in units specified in permite ! Sircrage" is wrmcJ%rithmetic aerar,c (geometric ascrage for bacterial parameters) of all sample Incasurements fotsch paramet.r obtamed durmg "Alamtoring Perim/"; "Afaximum" and "Afinimum" are normally' extreme high . .
- and low menurem.mt3 obtained daring "Afonitormg Permd" (Note to mmdeipals with secondary treatment {
' requmnacnt En er N day ascrage of sampic measmements under "Arcrage," and enter maximum 7-day average ! ;
! cf sample meamtements obtaincd during monitoring period under "A/2rimum. ") ,
l t g % Emet "Pe'r mt Rerparrment" for cath parameter under "(?uantity" and "Guahty" as specified in permit. !
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- 7. Under ."No Er" cnter number of sample measurments during monitoring period that exceed maximum (and/or. '
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' minimum or 7-da) v etage as appropriale) permit requirement for each parameter. If none, enter "0". .,
l f 11/ Enter " Frequency qf Acalysis" both as " Sample Afrasurment" (actual frequency of sampling and analysis used ' ,
~dbring motutoring period) and as " Permit Requirement" specified in permit. (e g., Enter " Cont? for continuous : '
7 monitoring, "l/7" for one day per utek, "ldu" for one day per month, "l/90" for one day per quarter, etc.) i 9.'En$r "Smn/ ed 7)pe" both as " Sample Alcasurement" (actu;d sample type used during monitoring period) and as !
, 1* Permit Rerjuiremnt? (e g., Enter " Grab" fr individual sample, "24HC" for 24-hour composite, "N/A" for l
, ; continuous monitoring, etc.)- ;
1 10,':Whe e violations of permit requirements are reporteo, attach a brief explanation to describe cause and correcove l actions taken, and reference each violation by date. j 1 L If *no dis, charge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. i
- 12. EnterI *Name,7)tle of Prmcipal Executwe Officer" with " Signature of Principal Executwe DJ)icer ofAutlwrited i Agent,"
- Telephone Number," and "Date* at bottom of Cornt _ {
i 13 Mail signed Report to Office (s) by date(s) specified in permit, Retain copy for your records. t t 6 Id. More detailed instructions for use of this Discharge Afonitoring Report (DAIR) form may be obtained from Ollice(s) l specified in permit. ; t , , Legal Notice l t Thiireport is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can ,' t result'in ' civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day ofvidation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 0095) m, ,u
I PEmemTTEE NAE /ADOfESSWFerenNa-arteren =(D@rew) NATIONAL pot.Ltff ANT Ot9CMAPOE EUMasAT104 SYSTEM (/WPDES/ Form ?g;.M. NAW I @
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PARAMETER (3 Corit on4J QUANW OR LOADWG I4 Corst on&s OUANm OR CMCENTRAM NO. *E0VENCY SAMPLE 146-6 2 154-619 130-451 44 6-6,% 164-Ett Or (32-37/ EX anacym, TYPE AVERAGE MAXIMUM UNtTS MINIMUM AVERAGE MAXIMUM UNITS num gge,, ,e eq SAMPLE ; ye$eo n = *. ; y - wesp *,g 9, /
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.dayid Orndorg TRUE,, CANT PENALTIES FOR susMiTTiNo re .sf INFORMATION. WCLUDmfG s,oNI #- f#3 f
,c . THE POS996UTV OF FINE u.s.c. e 1sie. sPenom ANO esimir enIMPRIS.ONMENT.
se.nm m y *ieAa= SEE is U.S.C. snee se a sto.opo
'v e 1001 AND SIOh[ThRE 33 OF PRINCIPAL Eb 4 IT 3D3-%li1 % II 2D TYPED OR PRINTED saw or man *mec .: er eerw ,,,4 e nierrs>e ans s renas OmCER OR AUTHORIZED 4 GENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# ettechments trere/
EPA Form 3320-1 (06-95) Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE , OF w-/ > $ ,, ,., l a,
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; ! Publi< %rting burden f$r this collection of information is estimated to vary from a range of.10 Iwbre as a !
; ! sve. x -r response for some mirmr facilities, to 110 hours as afaverage per respont,e far sons major facilities, .i
;with w phted average for major and minor facilities of 18. hours per response, including'tirmjor reiliewing )
2 instructions, s.carching existing data sources, gathering and maintaining the data needal, and completing and i ireviewing ,the collection of information. _ Send comments regarding the burden estimate or any otherispect' of , l j
'thir, collection of information, including suggestions- for m!ucing this burden, to Ctief, Informatiatc Policy
' Branch,~ PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the ;
- Ollice ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. !
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, General Instructions ' -
1 t , ! h Af form has been partially completed by preprinting, disregard instructions directed at" entry of that information j t algeady preprintal. .j
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,2. Ehter "Permitter Name/Alading: Address (and facility name/ location, if different)," " Permit. Number / and 3
,~ "Diacharge Number" where indicated (A separate form is required for each discharge.) .
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- 3. Enter dates beginning and ending "Afonitoring Period
- covered by form where indicated. l l
- 4. Enter each " Parameter" as specified in monitoring requirements of permit j uantity" and "Quahty" in units specified in permitc w j
'S. "Aceroge" Enter "Sa nple Alcawrrment" is normally data arithmetic average for each (geometric parameter average l under "O'or bacterial parameters) of all ram; kn each parameter obtained during "Afonitarmy Period"; " Alar / mum and "Afininwm". are normally extreme high j
. and low measurements obtained during *Afonitoring Period." (Note to municipak with secoadary treatment requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average
. of sampic measurements obtained dunng monitoring period under "Afanmum. ")
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6c Enter " Permit Requirement" for each parameter under "Guantity" and "Quahty* As specified in permit.,
- 7. Under '*No Er" enter number of sample measurments during monitoring period that exceed maximum (and/or ' '
minimum or 7-day average as appropriate) pennit requirement for each parameter; if nonefenter "0". .
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- 8. Ente: " Frequency vf Analysis" both as " Sample Afeaxurment" (actual frequency of sampling and analysis used '
Eduring monitoring p.riod) and as " Permit Requirement" specified in pennit. (e.g., Enter " Cont," for continuous - monitoring. "l/7" for one day per week, "/So" for one day per month. "100" for one day per quarter, etc.) -
^R 4 Enter ' Sample Type" both as "Vample Afeasurement" (actual sample type used during monitoring period) and as r" Permit Requirement," ~(c.g..- Enter " Grab" for individual sample, "21HC" for 24-hour composite. "N/A" for M ! continuous monitoring, etc.)
~10,7Where violations of pennit requirements are reported, attach a brief explanation to describe ca: se and correcthe actions talen, and reference each violation by date.
I1, If"no discharge" occurs during monitoring period, enter *No Discimrge" across form in place of data entry.
- 12. Enter)*Nameintle of Principal Executore 0])icer" with " Signature of Principal Erecutive Ogicer ofAuthorized Agent," " Telephone Number l and *Date" at bottom of farm-
- 13. Mail signed Report to Office (s) by date(s) specified in permit. Retnin copy for 3our records.
i
- 14. More deta'iled instructions for ute of this Discharge Afonitoring Report (DA/R) form may be obtained from OIIice(r) specified in permit.
= Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil pe:nalties not to exceal $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both. '
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> EPA Form 3320-i (Rev. 08-95)
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PEnemTTEE NAME/ ADORE 23(h= hum.atwpu.-vt.e.o.= cfD@ o NATioNAt potttrrANT DrScw ARGE EtmeesATiON svsTEM (APDESJ Form Approved. .
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IAN HP'71 4-tPLL7Y P f)V 2; 1 T .4 ? 7 J J YEAR MO DAY YEAR MO DAY _ e LOCATION FROM 43 i: .** TO ->< ti _t ! 0 NOTE ^ ': en ?I3Nt7CE { Reed instuneens h eempioeng 1him h. j 0?) e
.r n. nyyy7 7: .me- -(2021/ (22-237 124-251 (26-277 (28-291 (JG3,j PARAMETER (3 Cent W MANM M LOAM M MW MAMM M CNTRATION NO. mEom SAMPLE (32-37s 146-53) (54-619 (30 451 146-539 (50-619 EX or A ALy,$ TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,su., gm,j ,e 3
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p etI c e r To' m- REQUIREMENT SAMPLE MEASUREMENT f PERMIT REQUIREMENT g NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I CERDFY UNDER PENALTV OF LAW THAT t HAVE PERSONAdY EXAMWED AND TELEPHONE DATE AM FAMlUAR WITH THE INFORaSATION SUDMITTED MEREIN: AND BASED 000 t /~'. , MY INQUtRY OF THOSE WeDfVIDUALS IMMEDIATELY RESPONSIBLE FOR / , David Orndorf OSTAINING THE INFORMATION. I SEUEVE THE SucestTTED INFORMATION t$ TRuf. ACCURATE AND coMatETE. : AM AWARE TWAT TwERE ARE
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5 M/ PENALTIES FOR SUDMITTIIeG FALSE INFORMATION. WeCLUDeNG
/ 'j g 412 393-5113 90 11 ,6 Cher21stry .3 tanager SIG,N,IFICAN,T,uTv 7, oss, OF FINE AND IMPRISONMENT. sEE is u.s.c. e ioot AseD ss ssGNATUnt of PnseC8 PAL EXE TYPED OR PRINTED U.S.c.
wis or m.-=,n e isie. spwimane an=Av :ermen m.s. s.onnen a m ime.as m y a=AmN s vs. ras mi.e a se s to. coo NUMBER omCER OR AUTHORIZED AGENT CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af strechirwmts here/
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Paperwork Reduction
,. .. - . ~# w Act Notice; .,q."
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! ; i Pubhe. reporting t urduc .fcr this c611ection of infornation is estimated to vary from a range of 10. hours as an ,
[ j ' antage per reeponse f x scme minor facilitics, to I10 hourg as an average per response for sor6e major facilities, , j
} iwith a weighted avernu fur mdor and minut.facilides of 18 hours per response,' including timeufor reviewing j
!- ' instructions, searching enting data sources, gathaing and maintaining the data needed, and, completing and ; !
. reviewing the collectim of infornationi; Send comments regarding tie burden estimate or any other; aspect of ;
(this collation of infornubn, including suggestions for reducing this burden, to Chief, Information Policy i Branch, PM-223 US Envimamental Proto; tion Agency,401 M Street, SW Washington, DC 20460; and to the {
-(Office ofInformation ud Regulatory Affairs, Office of Management and Budget, Washington, DC 20$03.
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. General Instructions - , :
;J.'ll form has been ratia!1y' completed by preprinting, disregard instructions directed at entry of that information i
already preprinted. z
% Enter
- Permittee Name:Afailing ,lddress (and facility namellocation, it different),*
- Permit Number," and . t'
> ' 1"D!dharge Number" where indicated. (A separate form is required for each discharge.)
- 1. Enter dates begior;ing nr.d ending "Afonitoring Period" covered by form where indicated.
- 4. Enter cach'"Paramaer" as specified in monitoring Icquirements of permit. !
- 5. Enter "Somp!c Afn wrement" data for cach parameter under "Quantgy" and "Guality" in units specified in permit. -!
"Awrage" is ncnaai:y crithmetic overage tgeometric average for bacterial parameters) of all sample measurements i for each parameta obtained during "3/onitormg Period"; *Afarimum" and "Afinimum" are normally extreme high j and h)w measurements obtained.during "Monitormy Period" (Note to municipals with secondary treatment a 3
. requirement: EnTr M-day average of sampic measmements under " Average," and enter maximum 7-day average ;
of sample measmmeals obtained daring monitoring period under "Afarimum.") [ 6f Enter "fermit Requ;rement" for cach parameter under " Quantity" and " Quality" as specified in permit. ,
- 7e Undcr."No Er' eu:er number of sampic measurments during monitoring period that exceed maximum (and/or [
" minimum or 7 dx, n ernge as app ~ropriate) permit requirement for cach parameter. If none, enter "0"( !
- l 4.: Enter "Fmjuency nf Anahsis" both as " Sample Afeamement" (actual frequency of sampling and analysis used j c:aing monitoring period) and as " Permit Rec;uirement" specified in permit. (e.g., Enter " Cont " for continuous -
monitoring, "l/7" for coc day per acek, "1/30" for one day per month, "l/90" for one day per quarter, etc.)
. 9[ Enter'"Samp'c ' Ope" both as " Sample Afeasurement" (actual sample type used during monitoring period) and as f
(" Permit Requiremcnt * (e.g., Enter " Grab" for individual sample. "241/C" for 24-hour icomposite, "N/A" for 6 continuous; monitoring, etc.) ;
'10. Where violations of permit requirements are reported, attach a brief explanation to describe c:mse and corrective ;
' actions taken, and reference cach violation by date. l
+
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I1, If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. t
< 12. Enter "Namerfule of Prmcipal Executive ;Offiar* with " Signature of Principal Krecutive Oficer ofAuthorized t
. Agent," "7'elephone Number," and " Dale at bottom of fann. ;
- p
,13. Mail signed Report to Oflice(s) by date(s) specified m pernut. Retain cc,py for your records. . *
- 14. More detailed instructions for use of this Discharge Afonitoring Report (DA/R) fonn may be obtained imm O'flice (s) !
3 specified in permit. ; E ^
- Legal Notice
{s
+ This r' eport is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can !
result in civil penalties not to exceed $10,000 per daf of violation; or in criminal penalties not to exceed $25,000 per day l of violation, or by imprisonment for not more than one year, or by both. r j
, EPA Form 3320-1 (Rev. 08-95) ,
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.e q n er -oy.q wggr m&3 ep 4g .p4Qy y(- <r./ L SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRecrAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONARY ERAMWED ANO i TELEPHONE DATE AM FAMiuAR wrTH TwE peroRMArioN sumemTTEo MEREiN: ANo sASED ON MY IMOUIRY OF THOSE INDrVIOUALS IMMEDeATELY RESPONSISLE FoR OSTAJNtNo THE spePORMAT1000. t SEUEVE THE SusMITTED INFORMATION is
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Dayid orndorI- ACCURATE ANO COMPLETE. 8 AM AwangE THAT TH RE T, RUES aN FiCANT PEN = Tits FoR sumemTTw o FALst = FORMATION. Ctuo is ERE A.No
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*12 m. 5113-
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. THE PossueeUTY OF Fleet ANO eMPRiSONMENT. ancesse S,EE mise18 U.s.C.
e so e ,1001 Afs0 sso, con 33 SIOftATURE OF MAL EXE TYPED OR PRWTED U.S.C. ew e 1ste. ormm anisa -- meismos: enienereraseer. asnese.seNee a m.mne'end ame vens AREA NUMIER OFFICER OR AUTHORIZED AWNT CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Referene, e# ettechments heref { om re m mam mrmn r, sw wr ; num or e v.rvP. l l l l EPA Form 3320-1100-961 Prewoous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF i 00055/7619 o.34 e L
- . _ _ _ _ . . _ . _ _ _ . _ . _ _ _ _ _ _ _ _ _ _ . _ . . _ _ - _ . . _ _ ._ _ _ _ __ __ ___ _ _'3 _ _ . _ . _ -
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A j. i~ Paperwork Reduction' Act Notice - . + _ , - t I Pubik repdr1ing Ourdw fer this cellection of infonnahon p estunated to vary from a range t hf lo hdu's as'f
' antige per re'imnx fo wm minoi facihtim, to 110 hours as an averige per rewnse for some major' facilities, i
jNih a weighted avens for major $nd Ininor facilities of 18 hours per reponse, mcluding time for reviewing !
..! ;in3trwti:g, Hrchiny existing data souten, gathering and maintaining the data needed, and completing and '
icvi-wing the.collectica cf infonsdon. . Send comments regarding the burden l estimate or any other aspect of .{
} ;
I i this collc< tion of infmnation, including suggations for reducing this burden, to Chief, Information Policy :
i Drknch; PM-223, U.S Environmental Protectiori Agency,401 M Street, SW Washington, DC.20460; and to the Office of Information and Regulatosy Affairs, O!! ice of Management and Budget, Washington, DC 20503. {
I . General Instructions . i i.3 form has been pitially completed by preprinting, disregard instructions directed at entry of that infonnation l'
;already preprinted.
( l2. Enter
- Permittee Name/A!ading Addecss (and facility name/ location, if different)," " Permit ^ Number," and
*Dycharge Nmnht r" where indicated. ( A separate form is required for each discharge.) !
)
' 3, Enter dates beginning ud ending "3/cm/toring Period" covered by form where indicated. i
)
i
- 4. Enter each ?Paramacri as specdled in monitoring requirements of pennit.
- 5. Ecter "Samp/c A/wrcment" data for each parameter under " Quantity" and *Guality"in units specified in permit. .
%crage" is ncn@ arithmetic average (geometric average for bacterial parameters) of all samp!c measurements for ench paramctr obta'ned during "J/onitarmy Penod"; "Afarimum" and "A/inimum" are normally extreme high
- and low measuromnts obtaincd during "Atonttoring Pcriod." (Note to municipals with secondary treatment reqmrement: En:a % lay average of sample measuicments under "Arerage," and enter maximum 7-day average :
Eof sampid nicasur cmcn!s obtained during mon!!oring period under "Afarimum. ") '
- .c 6.~ Enter "Petun Rcqmerment" for cach parameter under "guantiry" and " Quality" as specified in permit
- 7JUnder "No &" wter ciunber of samp!c measurments during monitoring period that exceed maximum (and/or mirdumm or 7-day m etage as appropriate) permit regiairement for each parameter. If none, enter,"0".
8J Enter *Frcquency of Analysis" both as "Samp!c A/casurment" (actual frequency of sampling and analysis used
*' dbring themforing period) and as
- Permit Rcquirement" specified in permit (e g., Enter " Cont," for continuous :
monitoring. "l/7* Mr or:e day per week, */S0" for one day per month, "N90" for one day per quarter, etc.)- 9f Enter " Sample Tr;/ both as "Samp/c Alcaxurement* (actual sample type used during monitoring period) and as
" Permit Requ!rimmt" (e g., Enter " Grab" for individual sample; "2.t#C" for 24-hour composite, "N/A" for continuous monitonng, etc.)
'10. Where violations of pctmit requirements are reported, attach a' brief explanation to describe cause and corrective actions taken, and reference cach violation by date.
I 1. If "no discharge" occurs during monitoring period. enter "No Discharge" across form in place of data entry.
~
I
- 12. Entc; "Namemtie of Principal Erecutive Officer
- uith " Signature ofPrincipal Executive 0][icer ofAuthorized l
; Jtgent," " Telephone Number," and "Date" at bottom osform.
- 13. Mail signed Report to OfTice(s) by'date(s) specified in permit Retain copy for your records.
- 14. More detailed instructions for use of this Discharge Afonitoring Report (DA/R) form may be obtained from Office (s) j
- specified in permit. 2 Legal Notice j
, %d _ report is required by law (33 U.S.C.1318; 40 C.F.R.125.27).' Failure to report or failure to report truthfully can -l result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day-of violation, or by impriumment for not more than one year, or by both.
~
i 1: EPA Fdrm 3320-I' (Rev. 38-95)
'i 1
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r PERed1TTEE NAME/ADORESS(7-aideheryN== sert.c.u =gfD&w wP N?.TIONAL POLLUTANT DISCHARGE EUMWAMON SY; TEM (NPDES / Form Approved. NAME DeSCHARGE MONITORING REPORT (DMR1
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V 3. I. L E Y P ld C P 3 Tit!IJ' (?- 7 61 (77-79/ {?] I g 7(- - Stuppp OMB No. 2040-0004
- ADORES 3 p , 3, 13g a *^' ' Appm e se O M M 8
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(S tv g p pq) A**N; O i 9 I. 0 7PFD0"? PERMIT NUMBER DISCHARGE NUMBER p , 77y4{ g N
-iIPoIN ,P3.i! '? 15077 MONITORING PERIOD 9 33" w i r ?, y * * '/ t L L
- Y ? l) V P ? ^!tTT1i YEAR MO DAY YEAR MO DAY LCCA N FROM as t- 11 TO 2 :s ! !1 0$S :p a,73CaAaCC l 3CC
- s e m ., . n*y*n 3- er11r 420'211 122-231 124-251 426-271 128-29) (30u311 NM Reeniine& Won ~&M % %.
PARAMETER N 13 cent On&A QUANTITY OR LOADING (46-53) 154-619 I4 Mn&A QUANTITY OR CONCENTRATION NO. mEcufNcY SAMPLE (30-459 146-531 (54-619 oF 132-371 EX TYPE ANALy,S AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS , sus, gg,_,,, ,g,7o, SAMPLE ene-ey 3;3e~ 3339 . 33, 7 MEASUREMENT
]3{ }47 C g 29 301 1 3 ,
PERMIT 93eenc w m yy e ;3 ,,g m ,33 y 9 g ey, _, , ., ,. _
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REQUIREMENT ,.y,.,, 7, ,y j ,, ,g }j '"
; y [ t 0 7. , 3pgL SAMPLE 3eeen- p 3 % .- n- y n 3 f 7q) , ,1 :, arp MEASUREMENT QJ g'g y Q 17: ;; t ) ^ PERMIT oce9+e e c o g eE e c :e c o p a. c e; 33 ( g, p . g 7 .g et* e* -
3_--- 4 sp- REQUIREMENT m33 .) 3 ,3 g y. ,y ,, , 7 , ,, q g 7 n3 q- , s SAMPLE 2enne. n%=c- e c .; e c a -, 3 ( 1q
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7 p ,,; y 3 c ;. , MEASUREMENT gp g{ g s s s) y n - PERMIT e c o t e. e 3eecen c : r- a o e 3 ni y ($ 3g ~ gggy . g ;g nc, , , , -,,ee y;,g REQUIREMENT u ,9 .*n tv- Dafu nr nyt SM!1
'LaV, I; 23a rU!* ?s SAMPLE m e a:Necr e. - y e e r a t o c o r- .,
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MEASUREMENT PERMIT 4g7 4 gg ] "g gg 1 e t p3r
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" 3 r M' *Y Me? enh?d SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCFAL EXECUTIVE OFFICER 6 CERDFY UNDER PEN ALTY OF LAW THAT ; HAVE PERSON ALLY ERAMINED AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON ,' TELEPHONE DATE MY INQUIRY OF THOSE fMOtVIOUALS IMMEDIATELY RESPON98LE Fog A
r 3 ORTA NtNG THE INFORMATION. I SEUEVE THE SUBMITTED INFORMATION IS DdV[d VMulOTAc s TRUE, ACCURATE AND COMPLETE t AM AWARE THAT THFRE ARE [
/ / II- " / 'fg/
'/ //^ QQ' 90NWCANT PENALDES FOR SUeMITTING FALSE sNFORMATION. INCLUDING .
THE POSSteluTY OF FINE ANO IMPRISONMENT. SEE 18 U.S.C. 51001 AND 33 ' U.S.C. e 1310. r%nseuse antaler ehese seame mesy heeheds Anoe se em #FO,000 - SIONATURE OF PRINCFAL EdCUTfvE 12 ?93-5113 % 1i, h TYPED OR PRINTED _.: eraer-e a s enoaeas san s posras g ew er namnene== : .- OFFICER OM AUTHORIZED AGENT CODE M)MBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference edf ettschments herof EPA Form 3320-1 108-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHicet MAY NOT BE USED.) PAGE
, j) , q p ,j q , ,, 4 g OF
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Paperwork Reduction Act Notice - ~ -
-1 .
I 1 , . . jpublic repordng burden for this collection of information is estimated to vary fmm a range of to hours as an h '( average per response for mme ndnor facilities, to 110 hours as an average per response for sono nWor facilities [ t with a weighted average for major and minor facilities of 18 hours per responsem includmg tine 3or reviewing s
- instructions, searching existing data sources, gathering and maintaining the data needed, and comp!eting and l reviewing the collection of information. Send comments regarding.the burden estimate or any other aspect of 4 this colleclion of information, including suggestions for reducing this burden, to Chief, Information ' Policy ,
! Branch, PM423, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the !
; Office of Information and Regulatory Affairs' Office of Management and Budget, Washington, DC 20503,
}
i 7
-i . General Instructions t
. l. .lf form has been pa'rtially completed by preprinting, disregard instructions directed at ently of t'iat information [r
~already preprinted.
. (
- 2. Enter "Permitter Name/Afailing A ldress (and facility namc/ location, if diKerent)" "Pennis Number," and
' " Discharge Number" where indicated. (A separate form is required for each discharge.) .,
- 3. Enter dates beginning and ending "Afonitonng Period" covered by form where indicated. j
- i
- 4. Enter each " Parameter" as specified in monitoring requirements of permit.
,5. Enter " Sample Afeasurement" data for each parameter under " Quantity" and "guality" in units specified in pennit. ,
t " Average
- is nonnally arithmetic average (geometric average for bacterial parameters) of aU sample mcamrements 3 for cach parameter obtained during "Alonitoring Period"; "Afanmum" and "Afinimum* are normally edreme high a' and low measurements obtained during "Afonitoring Period" (Note to municipals with secoadary treatment ~
requirement: Enter 30< lay average of sample measurements under " Average," and enterm' vimum 7-day average of sarnple measurements obtained during monitoring period under "Afarimum.")
^
6J Enter " Permit Requirement" for each parameter under "Guantity" and " Quality" as specified in permit.- { 7..Under."No Er" cnter number of sample measurments during monitoring period that exceed maximum fand/or
. minimum or 7-day average as appropriate) permir requirement for cach parameter. If nonKenter "0"
- 8. Enter " Frequency of Analysis" both as " Sample Afeasunnent" (actual frequency of sampling and anaivsis used i during monitonng pmr'od) and as *Pennit Requirement" specified in pennit. (e g., Enter " Cont." for c6ntinuous < r monitoring, "h7" for one day per wcck. "1S0" for one day per month, "lM for one day per quarter, etc.)' ;
- 9. Enter " Sample Type" both as " Sample Afeasurement" (actual sample type used during monimnrsg period) and as i, "l'cnnit Requirement," (e.g., Enter " Grab" for individual sample, "N1/C" for- 24-hour composite, "N/A" for *
- ccmtinuous monitoring, etc.)
i f.
- 10. 'Where violations of perinit requirements are reported, attach a brief explanation to describe cause and corrective i actions taken, and reference each violation by date.
l f 111. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. { F
- 12. Enter "Name/Dtle of Principal Executive ODicer" with
- Signature ofl'rincipal Executive Oficer ofAuthorized
{ Agent,* ' Telephone Number," and "Date* at bottom of fortn.
- 13. Mail signed Report to OfDec(s) by date(s) specified in permit. Retain copy for your records. I
- .14. More detiiled instructions for use of this Dischargeifonitoring Report (DAIR) form may be obtained from Office (s) .
specified in permit. j L Legal Notice ! t l -t This report is rel1uired by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can ! I result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day j of violation, or by imprisonment for not more than one year, or by both. ; i r
. t EPA Form 3320-1 (Rev. 08-95) , f i
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[ PERedITTEE 98AldE/ ADDRESS 1A=heFed89#swiersma(fDWbru6 NATIONAL PORUTANT De9 CHARGE flmmNADON SYSTEM (NPDES / Form Approved. , NA0dE ,; y .) + DISC
- yjt /4L[ef p;yi* t- MONITORING REPORT,(Og , N, ; g 7 g y y <- o OMS No. 20404004 ADORESS ie 3. t s 1 i. + '8"' I"" ' ' ' ' '
( ", # f 0 " '5) E 4 7 y ; >sVT1 3L. D :) ' r PERMIT NUMBER DesCHARGE NUMSER p . p{y3( #
- pr,3 .s-.30- r , 3c-77 w. ' 'y g t Y
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FACILITY i r <n-ee ;-4 MONITORING PERIOD
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YEAR MO DAY YEAR MO DAY LOCATM FROM (- TO Mt
- t 4 , < ti N' i t C C12 P ;" l_l "' 0 3 ;
l , <py. 9ey- 9 , -\ m ', ' ggougg; ggg.ggy gg.~25) 126 279 126-29) 130'31I NON R*A W N f*'M-PARAMETER 13 ced on&s QUANTITY OR LOADING 14 cod Odyf OUANTITY OR CONCENTRATION NO. mEoUmCY SAMPLE I46-539 154-691 13H51 14 & 5 31 (54-619 09 (32-371 EX Analysts TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNIT'4 ass.sm ts+6ss 1s9 701 1 SAMPLE c33SP' e506*7 - , , - + nr-* -- - e "s *, s t MEASUREMENT 'b/
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b <'9 t ia r p, ; - - s'ERMIT - afgese? O Me t $ 6 e &- j,0 Ace te se- 9,3 gggvf 13g ; REQUIREMENT o.-. n ..e , .. c g: ,r,- ,cne y v g 7 ,* n u i *aYtweb 'u r<0 g h T r. . ~"'a' SAMPLE c a r-
- e r ^ root. 63erec gg e/ 24 !
1 *2
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i$- 1E I ' PERMIT ^ 'a r e e n tceene c 'r e 9 onevo 103 WICE/ O?P24 t? e . ;. o . :* ; t- 3, j $ L i. REQUIREMENT ,% e 3 33 gy- pgg py . g f ,, yqq.y _ . , 4, 7' T ' L 91 7; SAMPLE 0y ', ,, ( ,1) eene n e c eu anere -
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3 tr - , ,2 . . - - p ;, 4 , - MEASUREMENT C < < - Ui V -L / R- U b7_. t ' 1 7 ) PERMIT ^ + imm- e t rT r y -- g e e r: e e o c e n e .t -o&Occo- the e gigg/ 3 ; I .; g r . 3-. 7it REcutREMENT 39 g g, ; 33 p y Ng . 3 gu ,,g g SAMPLE MEASUREMENT T PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMtT ' REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT e NAME/ TITLE PRWCFAL EXECUTIVE OFFICER I CERT!FY UNDER PEN ALTY OF LAW THAT 4 HAVE PERSONALLY EXAMINED AND /' TELEPHONE DATE AM FAMtUAR WITH THE INFORMATION sVDMtTTED 94EREIN; AND SASED ON - a/ f-MY INQUIRY OF THOSE INOMDUAls DMMEDIATELY RESPOMsIGLE FOR - g ,' y NW N OGIO Gg OSTAtNING THE INFORMATION. I SEUEVE THE sueMITTED INFORMATION ts N TRUE. ACCURATE AND COMPLETE. sGN PENALTiE I AM AWARE THAT THERE ARE /4 ' ,N, / /- 412 393-5113 46 11
'b C wnist ry Manar,er TwE ,mCAN.T,uTY 0s Oe rw.s FORIMPRISONMENT.
E ANo sueMITTING FALSE sEEINFORMATION, is u.s.C. iooiINCLU0eNG ANo as u.s.C. i tate. #ReamMee ener wisse esmane saer hcemie see se so s 70,000 88088ATURE OF PRIIOCIPAL EXEb TYPED OR PfWITED : erserweae e ==asne saa s Pears; AhEA NUMBER MO ead er ameanien L -- omCER OR AUTHO4tZED AGE 9fT COOE YEAR DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# errechme-ts here/ EPA Form 3320-1 (0s-95) Prev 6ous editions may be used. (REPLACES EPA FORM T 40 WHICH MAY NOT BE USED.) PAGE OF 3 y , . _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ . ______ ________ _ _________ ____ . ~ . , _ .-- . ~ . _ . . _ _
l 7 , ! p m._ _ _ _ m . , _ _ , l i .
~t Paperwork Reduction Act Notice; - -
^. - ,
PtMe rqortieg burden for tM ceWetion of infunnation is estirru:ed to vary from a range $fl10 hwrs as an t : Lwty peirdp nus for smne minor f&cihtim, to 110 hours u an averege per repenw for some mejor facilities,; -!
!' with a wqh4d avnsp fc1 u@ ad .raino( fxiiitietot ]$ hours per.rerpunv, including time for . reviewing 5
; b suais , warchhg nUng daa cum, gatkdny and _ trdotamin the 6ta amled, and compktirig and I
~
t !
'saiming th 9p&cuca of adanac. kd conum 2 erns zg the bmkn entirrate or any other aspect of -
- j. tili eduoaix of infanndiw, khai nq m;; +hu .. for odacmg this bmd:ac ta Chief Infonnation Policy Pie Pt.b223 U.S. Ecvhwet,1 precnon Army,401 M Sueet, SW WaJungmn, DC 20460; wJ to the
)
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- p. j 00ics of inf6rnadoo and Reph.rory Affairs, OHico of Metagement and Budget, Washington, DC 20503) l - - .,.
____,_ _. w _ _ _ _ _ . _ . _ _a . ' i General Instructions :
- t 1_, if fcnn has twn partiaHy wyktad by pepriuing, disregard instructions directed at entry of that information 1 already preprinted. )
1 2; Enter "Pennittee NameJ!arling Addren (and facility -nmne/ location if different)," *Pennit Number " and .
"DnchargeNwnber" v here sedicatcd. (A r.eparate form is nequired for cach disclarge.) j 1 Enkr daics beginning und emhng "Abmtormg Period" cmmd by farm w here indicated.
t i l
- 4. Enkr cath "Paramcier" as specified in :numtoring requiremente of permit. l l A Enter "unr!e Alcmuewm" dat a for each puameter under "Gua,Mty* and "(!uality" in units specified in permit.'~
"Awray" is normany uidstic a cope (gcuneuie average for bactesi rurameters) of all sample measurernents 4 l fderb parameur c6ned th: . y "A!"nimrm : Pern l";a'A/mmum" and *Alenmum" are normally cAtreme high !
I and 19 w on uremcW bNiacd danna, *Wmtonny /Vriod (Note to mimicipals with1 secondary treatment ! reijo h t met: Ena Wny averg af cunple mcuurements under Werage." and enter maximuni 7-day average ' of sampk rummema.a chined duang manihnin;; period under "Afarimum ") L Euter *Perrut Reprow:t* for tacn panuncwr under "Quan::ty" and "Quahty" as specificd in pennit. i 7, Oader *Vo &" car menbcr M vi gle mwurn.cr<ts during monitoring pcriod that exceed nmimum (and/or i rainimum t r 7-dn u , Kayerriac) p.nnis rapitement for each parameter. If none, ente: "0", ' I li Enigt ."T' regency ef Anc/ph" both as "hp/c Alcasurtnen!" (actual ficquency of sampling and stulysis, used l during monitaring pcde:f) and as Teemu /a quironent'specifhd in pernut. (e.g., Enter " Cont," for continuous txmmring.?//P for one d . per t week, "!Su" for one day per inonth, "lM0" for one day per quarter, etc.) .
- 9. Enter 'Wample Tvrc* both as "Xvnrlc Afcasuvment" (actual sample type used during monitoring period) and as "Pcomt Rcrpirement," -(e g , Enfer '" Grab" for mdividual samp!c, *24/K.* for 24-hour composite, "N'A" for j t continuous monitoring e;c.)
10', Whde violations of permit acquiremnts are reported, attach a brief explanation to describe cause and corrective etions taken, and reference each violation by date. j I i1,l If'no discharge" occurs during monitoring period, enter *No Ducharge" across form in place of data entry. i 12 Entct "Name/Dtle v) Pnncipa! Etccutar Oficer" sith " Signature of Pnncipal Erecutive Oficer ofAuthorized i Agent " " Telephone Kwnber
- and "Date" at bonom of fornt
- 13. Mail signed Report to Offia(s) by date(s) specified in permit.: Retain copy for your records.
i
- 14. More & tailed instmetmus for use of this Diuharge Afrmitwing Report (D5/R) form nuy be obtained from Omce(s) specified m penmt.
. Legal Notice T!lis {epart is required by la (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can j result in eini penhies not 9 cud $10,000 per day of violation; or in enminal penalties not to exceed $25,0C0 per day I of.viuhdon, or by impriswmer,i for not more than one year, or by both. l 1
+ j i
i' l ! EPA Form 33201 (Rev. 0%95)
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PERuiTTEE NAME/ ADDRESS (biaMereeyN==.'Lormea(D@ ww/ c:ATtONAL POLLUTANT DISCHARGE E1.tMINAT104 SYSTEM (NPDES) Form Approved. NAME , ; e _ ., s , T
' s OMB No. 2040-0004
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I1 ~*!" '3 W*: ~. s Approval expires 0531-98 f.DDRE;3 s , 3,
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(7 sb) t. 34 > cw_ . r s / yn .. ,n7 PERMIT NUMBE'1 , c:$ CHARGE NUMBEM p , . . \ ,, .
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FACILITY MONITORING PERIOD .* (y- V** .Y ;)9- 7 A_
- T ' YEAR MO DAY YEAR MO IDAY , , . .
LOCATION FROM *
- 1^ 4 TO ; t
- l
*
- 1- ,i*'
t -'1A .. I t, r<^ a v . , , ' (20 211 122-231 (24-251 126-271 (28-291 (30 311 NOTE:...Reed inetructione before'c5mpleting tNo form. PARAMETER '# Cd on41 QUANTITY OR LOADING I4 Cerd on41 QUANTITY OR CONCENTRATION N O. FREQUENCY SAMPLE 146-531 (54-619 136-451 (46-531 154-619 oF 132-371 EX Analysis TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS stem fgg7a fuf SAMPLE . ~ , r s - r-~: : e* ( i't q p/ MEASUREMENT s' ' ,{g b,/f, a g 2M I ,. n L,
-y PERMIT 4.- -6* eta e ,n +ec 't 7.P
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REQUIREMENT i!C[/ c., . , , 3 y7,7. m ,,
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REQUIREMENT
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+ - ', , . i MEASUREMENT , gg j ::;
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_ REQUIREMENT ,, 39- n,yyy ,, 2+. - _ s7 z SAMPLE
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SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT e HAVE PERSONALLY EXAMtNED AND TELEPHONE DATE AM FAMiUAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON k)f
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MY INQUIRY OF THOSE INDIVIOUALS iMMEDIATELY RESPON98tf FOR / ,' ORTAINING THE iNFORMATION. I SELIEVE THE SUBMITTED INFORMATION IS David C I' D'! G r f TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE 9GNIF; CANT PENALTIES FOR SUBMITTING FALSE INFCRMATION. INCLUDfNG f['l /--'-e 'M / s Y( y 4 g
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,m,- - ' -avee i on. THE POSSSIUTY OF FINE AND IMPRISONMENT. SEE to U.S.C. t 1001 AND 33 *
't i C -3Y~JI 3J tb ,1 4b U.S.C. t 131o. a%,we e sawer e=se seneres mer wnwe o nnes ao re s F0.000 SiONATURE OF PRINCIPAL E'XECUTNE g TYPED OR PRINTED arw or m====== :_ ; er a rwe a a maae>e amt a reern s OmcER OR AUTHORIZED AGENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# strachments heraf dee abel d np N'i otuamp h M EPA Form 3320-1 (08-95) Previous editions rney be used. (REPLACES EPA FORM T-40 WHICn MAY NOT BE USED.) s , , PAGE , OF
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l Paperwork Reduction Act Notice - i Pubbe reporting burden for this collection of iriforination is estirn&d to my f o.m e range of ID h< ers tn nerege pr response for some minor facilitic . to i10 !mers as an average per responw Im ena m ' faibtic i with a weighted neuge for nujor and nunor facibSes of 18 hours pt r rc p nc, inclu hng tir f or revi- ong '
, instrmtions, sarching existmg data wurces, ratheong end maintaming the data rwed d, n.d conye:iny and reviewing the collection of information. Send comments reprding the burden estinute u aa Ghri ept of l this collcction of information, incluJmg suggntions for reducing this burJen, to Clid, Inf anmt.on Pdity ;
Branch, PM-223, U.S. Environmental Protection Agency,401 M Stred, SW Wamingtm, DC MMD; and to th- j l Office ofInformation and Regulatory Affairs Office of Management and BuJget, W u.hington, DC 20501. l l t __ __ _ _ _ _ . . . _ . _ - _ _ _ _ _ _ .__. - General Instructions
- 1. If form has been partially completed by preprinting, disregard instructions directe.J at entry of Omt infornution already preprinted.
- 2. Enter *Permittec Name/ Alm!mg .tJJeen (and facility name/ location, if ditTerem)," "P rest Num ber." and "Dac harge Number" w here indicated ( A separate form is icquired for cach dischargen
- 1. Enter dates begmmng and endmg "3/ondormg Pcrmd" cosered by form where mdicated
- 4. Eruer cach "Parmncter" as specined in :nonitoring rerptirements of pennit.
- 5. Enter "Nampic Alca3urement" data for each parameter under "(knn/F anc "(balay" in unn sprificc: in pentit
'Avemgc" u normalh arithment nerar.e (geometne average for h *crial parameten) of nu ' .uppl: rum uremans for each parameter obt;uned dunny "Mrmrormy Permd", "Mamum" an "Um inu n" .re a nuaHy evimme i.ich and low measurements cbtained during '%mtoring Permd" (Nmc to municipale with semadary uentnant rCquirement: En'Cr D-{}.i) nVerage of Sample mea 5UrCm0ntS UndJr
- j wrgr;" and enZr m3 MU'u 74, aVCr3ye of sampic measurcments obtained during m natonng period under "M.u mmm ")
- 6. Enter " Perma Rcquirement" for each parameter under "(Jaant ty" and "Ou:;/uy" as specified in p niit
- 7. Under "No D" enter numbci of s;uuple menennents dunng ummtoring penod thnt excnd mnimum OeWor minimum or 7-d iy aserage as appropriate) pcrmit requirement for each parameter. If w , , e n '
- T.
S. Enter " Frequency of Analysis" both as "Namfd e A/carurment" (actual hequen;;, er umphng and una!) sis owd during monitoring pu od) and as " Perma Rerfinremcrd" speciDed in pennit (e g . Fn:cr 7 ' nt " for contmwus monitoring. "U7" for one day per ucek, "100" for cue day per mcnth. "120" for one day per quarter, etc )
- 9. Enter " Sample 7)pe" both as "Nample Meanrement" (actual samp!c type m,cd duram, monionng permd) and as "Pcrmn Rcquirement " (e g.. Enter "rirab" for indmdua! sample "NIK'" for 2Lhour t ompostfe. "N A" for ContmuouS monitoring, etc.)
- 10. Where violations of permit requirements are reported, attach a bnef explanation to dr.cribe cause and correctise actions taken, and reference cach siolation by date.
I1. If"no du. charge" occurs dunng monitoring period. emer "No Ducharge" across form in place of data entry
- 12. Enter "NameTitle of Principal Executwe 0]!:cer" uith "Nignature of Prmcipal Excatire @cer of;f uthorired Agent *
- Telephone Number," and *Date" at bottom of fortn
- 13. Mail signed Report to Office (s) by date(s) specified in permit. Retam copy for your records.
- 14. More detailed instructmns for use of this Divharge Afonnoring Rejmrt (DAIR) fann may be cManed from Officep) specified in pennit.
Legal Notice This report is regnited by law (33 U.S.C.1318; 40 C.F.R.125.27). Fadore la report or failure to report truthfully on result in civil penalties not to exceed $10,000 per day of vin!ation; or in criminal perudties not to ett ed $25,(XO per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95) s N
PERRAITTEE NAME/ ADDRESS (J=dede Fordry Ne=wlerersee efDdbrent) N.%TIONAL pot,LUTANT DISCHARGE ELIMINATtON SYSTEM (NPDES 1 Form Approved. ' NAME , j , 7 j , ,. DISCH RGE MONITORING REPORT (DM >. . ,, - OMB No. 394 Approval expires 0S31-98 ADORE:23 o , ') , , s( 4
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(2021) 422-231 12*25) (26-27) 428-2.91 130"319 NOTE: Reed inetructsone before completing thie form. PARAMETER (3 Card Owyf QUANTITY OR LOAD!NG (4 Card On/yi QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE (46-63! IS&6 t) (38 4 S? 146-531 IS4-G 99 OF (32-371 EX ANAtyss WPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ms; fgg.gg; fg7g r, , , e 1 -- i s
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, ;,, , , REQUIREMENT ,, 3g , , , , , , ,, , .w 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 CtRTIFY UNDER PENi T i F LAW THAT I H AVE PERSONALLY ERAMINED ANO TELEPHONE DATE AM FAMIUAR WITH TN 4 MFORM ATION SUSMtTTED HEREIN; AND BASED ON 3 MY INQUeRY OF TM ,C INDIVIOUALS IMMEDIATELY RESPON98tE FOR e
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l e d i3 d' 'g OSTAINING THE INFORMATION, t BEUEVE THE SUBMITTED INFORMATION IS TRUE, ACCURATE AND COMPLETE. 6 AM AWARE THAT THERE ARE SIGNIFICANT PENALTTES FOR SUBMITTING FALSE INFORMATION. INCLUD*NG
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THE POSSIBluTY OF FINE ANO IMPRISONMENT. SEE to U.S.C. $ 1001 AND 33
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VU 1,1 3 D U.S.C. e 131s. srenew2 anMer mese sisans ener hebwe snee se to s 70,000 SiONATURE OF PRINCIPAL EXECUtfVE TYPED OR PRINTED eas or medmen Hwse _ ear er betweee a menes ans s v aras OFFICER OR AUTHORIZED AOENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a$ ettschments here/ h), f' i
- PA Form 3320-1 (08-95) Previous ediocns may be used.
(REPLACES EPA FORM T-40 WHICn MAY NOT BE USED.) y ,/ ). PAGE OF
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1 Paperwork Reduction Act Notice i' l l 1 l Pubhc reporting burdtn for this collection of infornathm n estimated to vary from a (W , 10 . t r* b . I aserage per re'ponw for some rninor facdities, ta !10 hours as an averap ;n r respon im amt @ imbe 1 with a weighted awrage for nujor and tanor fadlities of 18 houn per rcynse, indu.i e g tir f m reva w mg i l instructions, tearthing exhting data sources , rahnny and nuintaining the dsta necd f. W unpc mt and e I n.viewmg the collection of infonnation. SenJ coruments reprdmg the burden cAtinut: or ec Mbe uF:t of i thm collettioe of infonnation, indudmg suggestions for nxiueing this bmden, to CR f, InbanAou Nic) 1 Branch, PM-223, U S. Environmental Protecnon Agency,401 M Street, SW Washingtaa i)C W60; and to the Office of Infonnation and Regulatory Aff airs, Oltice of Management and 13udget, Washirgton, DC 20503. l l General Instructions ! l l
- 1. If ionn has been partially completed by preprmting, disregard instmetions directed at entry of that infornunon I aheady preprinted. l
,2. Enter "Permutec Namedfaihng Addren (and facility name/ location, if di!!crem)," *Pi reur Number." and "Dncharge Nmnber" where indicated ( A separate form is required fur ca h discharge.;
- 3. Enter dates beginmng and ending "Afonnormg Period" cmered b) form w here indicated
- 4. Et;ter each " Parameter" as specifid s. mon %ng, requirements of pennt.
l c Enter "Namp/c Afcasurement" data for cad param:tcr under "(unnty" md "tAnlue" in un:t poiGa a onn 1 !
"Arrape* is norma!!y arithmetic ascrare (reom fic avempe for bacria par.unders) cf 2 Tn.pl: ne: mema hrr each parameter obtained danng "Alcmaormx Permd"; "Afaammn" arri "Almim mt a re r3 m,aHy ex1ieme M@
and low measurements ob!am<;d during '3/on'laring Termd " (Note to maniapair w ith , m iiiry
- r cat n a ' t l requuement Enter 30-day aserage of s:auple measuitments imir ".1wrage." and em.r m rimu n 7-h awrage ,
of stunple measurement.s obtlined durmg moniturmg period under "Afaumam. *) ! l
- 6. Enter "Perunt Reymerment" for each p uameter under "Osantay" and "pvahty" as spec hed in grnit i
- 7. Under "Ne E1" eniCr rlumber OI S3mpl0 mC hurnP;nt$ during rlWnitPru g p:riod th::t execM anoJmurn (a"Sor !
mimmum or rday uverage as appropriate);wrmit requirement for ca;h parameter. If omu en 4
- T. l
- 8. Enter "Fretivencj of Aalym" both as "hnple A/cawrment" (rtu;d frequency of amplin :md ,m:=h sn md l during momionng pJod) and as "Tcrmit Rcqmremern" mccified in pctmit (e g , Fa: "f &t " for contmn m monitoring. "la" for one day per week, "/do" for one day per momh "/00" for one da per quiuter, etc 1
- 9. Enter "Senple 7)pe" both as " Sample Afeamrcmcru" (actual sample npc used durno, mom:onng peried) and as
" Permit Regwrement * (e g., Enter "Grah" for individual samp!c, "N/R ' for 26heur reqcsite. "X A~ fer continuous monitoring, etc.)
- 10. Where violations of pentut requirements are reported. attach a brief explanation to descobe cause and correc!he actions taken, and reference cach violation by date.
- 11. If % discharge" occurs during momtoring perioct enter "No Discharge" across form in place of data entr>
- 12. Enter "Name? Title of /*rmcipal Erecutive Officer" vith " Signature ofTrmcipal Exenais e Oj!!cer of hthort:cd Agent," " Telephone Number,* and 'Date* at bottom of form.
O Mail signed Report to Office (s) by date(s) specified in penuit Rctam copy for your records.
- 14. More detailed instructions for use of this Dacharge Af<muoring Report (DA(R) form may be owned from Ofikc(5) specified in pernut Legal Notice Tls repnt is reyt. ired by law (33 U.S C.1318; 40 C.F.R.125.27). Fadure to report or fadure to report truthfu!!y can result in civi! penalties not to exced $10AXO per day of siolation; or in crirmal penahies not to excoed $25,000 per day of violation, or by imptivmment for not more than one year, or by both.
,/~ 'N ,s EPA Forrr 3320-7 (Rev. 08-95) h
PERMfTTEE NAE /ADOfGS (D=Me Ferary Namelecenes (l@reerl NATIONAL POLLUTANT DtSCHARGE EUMcNATION SY? TEM (NPDES / Form Apswovesi. . NAME ,n ,, , g3gLpy pgye3 5 7 g ,, ) .. Ny. MUNG NT (D fI7 11; S y ,3 p ;, , r r 3 p M No.p4064 AoOREm ,,, , .
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n,w m ^ w* w os m a 3y--; qgy;n ptpgey PERMIT NUMBER otSCHARGE nuMeER g , ,7s3g , 1 T '"/ I 9 ; c 0 L T a 1S:?' MONITORING PERIOD i\D
- i i t t E -l / T2 L L -C f P34F7 '
- A "I 1i YEAR MO DAY YEAR MO DAY ._ .
6 LOCATION FROM TO o6
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1< t; e 's i na pIOC4g?O* } l eS a ; 4 e~8 . r . t ur i ' n. : a e (2021) (22-23) (24-259 126 27) (28-29) (30"391 NON N*A N *** WN I**** PARAMETER (3 Cerd orvy) QUANTITY OR LOADING I4 Corer On/yl QUANTITY OR CONCENTRATION NO. FREoufMCY 146-531 (54-691 130 4 51 146-531 (54-691 or SAMPLE (32-37/ EX ANgyms TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,s2.e3, gg,_,,, f,37, 4 SAMPLE g 2 e, s s er f r, 9 , y ., , 3 3 . { 3 y) / f MEASUREMENT 7eO f JUd '
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1, . MEASUREMENT 6 f' ) . M 40 7, h / e, t 3 y PERMIT .m e n. p p.c re c p . :n rf 33 ;g p ggy q43 I e.., c 7,,. ,j 3 7 n , REQUIREMENT 73, y ,g q,y 7 ,, y y .g p ,,,,.f qq, re y n. y SAMPLE egeene e;n n e e Medoe i [ 34 / 31) n "; 173phh;t*PL 9* MEASUREMENT O,60/ O 66[ '
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SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE , MEASUREMENT - PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAMEIT1TLE PRINCIPAL EXECUTIVE OFFICER a CERTwY uwDER PEN ALTY OF LAW THAT 4 HAVE PERSONALLY EXAMINED AND -- TELEPHONE DATE ! AM FAMfUAR WITH THE INFORMATION SUOMITTED HEREIN; AND BASED ON I y MY fNQUIRY OF THOSE INDIVfDUALS IMMEDIATELY RESPON98LE FOR f David ornderf OSTAmmG THE WFORMATION, B BEUEVE THE SUBMITTED INFORMATION IS -
/
diCn L 8 L I 'f Me.nli j',O r TRUE. ACCURATE AND COMPLETE. t AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUDMITTING FALSE tNFORMATION, INCLUDING /
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'A ' 12 393-5113 46 11 '*%
THE POSSIS 4UTV OF RNE AND IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 U.S.C. s 1318. e 840 NATURE OF PftINCIPAL EXEkkf7NE g TYPED OR PRINTED saa er man *- en :.Mandsee_.:anser snese sseems er eerween e nionene mer an,uew, sriee ses so s70,000 s years.s OFFICER OR AUTHORIZED A6ENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference of ettschments here/ EPA Form 3320-1 108-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
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__.____._.______________________.__________n____.________________.__._____ . - . _ _ _ _ - - . - - . - ,_ . _ ________..__AA______
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- i. 4 'a Pacerwork. Reduction Act Notice '
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hshh6 repmting l>urd- .h r this callection uf information is estimated to vary from a range br 10 hours as an
"; ' 7 3 l art rage per arponse i 1 wme minor facilities, to 110 hours as an average per resp 5nse for sor6e major facilities, Lr = '
- j. , with a wMded averm for major and minor facilities of 18 hours per responsefincluding time for reviewing '
; ; %tructicus, umhiny aisting data usucces, gathering and maintaining the data needed, and: completing and t p l reviewing ihuollecti; d infornation. Send comnets regarding the burden estimate or any other aspect of
! tu collection of infamaum,' including suggeaions for reducing this burden, to Chief, Information Policy L i Branch, PS223, U.5 Environmental Protection Agency, 401 M Street, SW Washington, DC;20460; and to the "
' Office of Inkrmation ed Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. :
N _._ _ i t i !
, e General Instructions '
i 4 -Ibf form his been partially completed by preprinting, disregard instructions directed at entry of that infori Mbeady preprinted. - d . 2EEnter Permittee Vamca/aihng Address (and facility name/ location, if different)," " Permit Number,"_ and ' 5 7 Discharge Number' u bere indicated. (A separate form is required fdr each discharge.) -
. . t
, 3. Enter dates begimg and endmg "Afonitoring Period" covered by form where indicated. 5 l
f . 4. Enter each "Parawer" as specified in monitoring requirements of permit. . ~
)
< . 1
- 1 Enter %mpic Afarement' data for each parameter under " Quantity" and " Quality" in units specified in pernuts "Accra;f' ss ncrrWv mthm(tic average (geometric average for bacterial parameters) of all sample measurements '
fue chch paramcto rblained during *Alonitor/ng Permd"; "Afaximum" and "Afinimum" are normally extreme high ; Land low measun.rcnts ci tained during "Alonitoring I'eriod." '(Note to municipals with secondary' treatment rtqmrement: Enm Aday average of sample measurements under " Average," and enter maximuru 7-day average ; df rampic measur. vnts obtained during monitoring period under "Afariman.") ' 4 - , - . . i ,
% Enter " Perma Rep n rvnt" for cach parameter under " Quantity" and "guahty" as specified in permit.. -!
.7..Under "No &" ever number of sample measurments during monitoring period that exceed maximum (and/or . !
3 minimum or 7-dyb crdge as appropriate) permit requirement for each parameter. If none, enter "0"; ;
. - i S. Enter _ *Frequeno rf.dnalvs s* both as'" Sample Afeasurment" (actual frequency of samplisig and analysis used : l citing monitoring period) and as " Permit Requirement" specified in pennit. (e.g., Enter "Omt " for contmuous : ;
lmomtoring, "U7' for one day per weck, "l/.10" for one day per month, "U90" for one day per quarter, etc.)' ; f i 9; Enter *Sanple 7)p " both as "Xample Afeasurement"^(actual sample type used during monitoring period) and as
" Permit Requirewnt,":(e.g., Enter "Grah" for individual sampic, "NHC" for ~24-hour composite, "N/A" for . 1 continuoits monitoring, etc.) ' '
l 110. LWhere violations of permit seguirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
# l11, if f no discharge # occurs during monitoring period enter "No Discharge" across form in place of data entry.
- 12. Unter *Rame!Tiildof Principal Executive Oficdr" with " Signature of Principal Executive Oficer ofAuthorized Agcnt," " Telephone Number," and "Date* at bottom orform.;
- 13. Mail signed Report to Office (s) by date(s) specified in permitL Retaint.opy for your records.
,14. More detailed instructions for use of this Discharge Ahmitoring Report (DAIR) form may be obtained from Office (s) >
specified in permit. H Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125,27). Failure to report or failure to report truthfully cr.n
; result in civil penalties not to exceed $10,000 per day of violation; or in criminal penahies not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both. ,
r , _ EPA Form 3320d (Rev. 03 95) , a i
PERMITTEE NAME/LDDRESS(red =4rFare#yName/Lecamen(D tdbww) NAT ONAL POLLUTANT DlWARGE ELIMcNAMON SY*TEw (NPDE31 Form Approved. NAME DISCHARGE MONETORING REPORT (DMR/ OMB No. 2040-0004
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[3gpp yh) D j'f NW a!!4; ^t7I3 **%D0"F PERMIT NUMBER orSCHARGE scVMeER p , py34, g 59If P f NPOhT Pi ! S :) 77 MONITORING PERIOD 'A33I ** FA N ; r *, y e 7 alley p mr r q 5Eh7I3" YEAR MO DAY YEAR MO DAY LOCATION FROM ,3 1 9i TO wn ]. I;
$N& 69 0I$Cri95r l NOTE: Reed instruc6ene before~
} O$t completing this foil m.
8
,e-4 na srS a 0 -; , , n . (20'21) (22-231 (24-257 (26-2h (26-2s1 (30'31/
PARAMETER (3 ced on&i QUANTITY M LOANG (4 CoM On&J QUANTM M CMCENTRATION NO. MEOVENCY SAMPLE I (46-539 t5461y 130-45) 146-531 (54-611 op (32-3n EX ANALys: TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXtMUM UNITS ,ross, gggg,j gg,.7g 3 ' SAMPLE 33+ee- e .+ c * ~ t s3333, . ( ;y R MEASUREMENT L / f( (, {[ 9 So $Q 172n: y S 3 PERMIT _ c et g e a n - +ncarce e -ge ,,p coccce 1,3 - gygg/ ,gp'
.e.., c1 . , , . - f.,, REQUIREMENT 33 g67g, ,gqgg ya m 7g T77AL SAMPLE e y e.
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MEASUREMENT / f,f J{p h 30 r/C 3 3 r, y g ; S o PERMIT . c u e r- eseMc c 1.:: = c m ef t 33 g - yIcg/- osp.e
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477 ,, r f 7 ., 3 79
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MEASUREMENT C, gyg 7 in is{aririr PLis. O, gg 73- . J g, s ,
,)1iq 1 1 3 PERMIT - ; , q q J .. n ~39 7 C'??Ohe ' M S O$ c- ( C M c h tv @ .) gm Q3q0
,,=ye -s,ei REQUIREMENT p , y , .7 77 ,n g ,g
, , 7a 4 99 797 7 , p p' , SAMPLE sca^e+ weeney *vecen ( 10) ,/
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+ 7 eggg n a y s {e MEASUREMENT g, / g v, y; (gg
,34 3 6 } ;, 4 PERMIT c a c e tt s e e e e.c 0 3ne coewt gep347 ;r3 pap; ~
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- r;o c er :H3 w3tn. REQUIREMENT w33 ,g3 .p 'yg.ty'ygy
. yf t pgg 3: T y .3 r
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MEASUREMENT C ( l j)
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- 3 PERMIT - o m te ecetto e :~+ neeOc? ?p0 - v t y* v / g GM/ KAH
= - q;,p 1 7 m r g, REQUIREMENT +,ye - y ' q3p i t) n y g pyrg t1 J , ,: 2r ggp;7,;- SAMPLE ;*-n i o n *^te ? ?. S 0 0 3 - - y(
( 19) ,
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MEASUREMENT 71 7p 7- d M i-
,; ] 3 p FERMIT nuct?- - e c c o rt e f 3: : 00ersto 3: 50 v1U4/. g : ,1% t
-:t,ev ;a3< y 3 ,q REQUIREMENT 3oe y m. g g yIy 3g/L g yj y 3 a 7_
SAMPLE s MEASUREMENT PERMIT REQUtREMENT NAME/ TITLE PRINCFAL EXECUTIVE OFFICER a CERnFY uNoER PFNALTY OF LAW THAT t MAVE PERSONALLY EXAMINED AND ,' ' TELEPHONE DATE
- AM FAMlUAR WITH THE INFORMATION SUBMITTED MEREIN; AND BASED ON MY INQUIRY OF THOSE INDtWDUALS #MMEDIATELY RESPON98LE FOR ,O I
,di1V k d UN5OI. g^
OSTAINING THE INFORMATION, 4 BEUEVE THE SUBMITTED tNFORMATION tS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE , h y! ^ - # ."j SIGNIFICANT PENALTIES FOR SUBMITTING FALSE fMFORMATION, INCLUDfMG #' " r
THE POSseIUTY OF FmE AND 9MPRISONMENT. SEE 10 U.S.C. 51001 AND 33 / ~ **l'., 3g3 ,5113
. Q6
- 11 -? o' u.S.c. a tsie. an aww.e s snow wiese seame nor sicA,ne mies e, se s70,000 " stO" NATURE OF PRINCIPAL EXf'CUTIVE g TYPED OR PRINTED anderme 6 nsC : er eerween s menete amt 5 yearms OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e6 ottechments herel 1 L
EPA Form 3320-1 (06-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE , OF
.) 3 4,.y 7 3 4 7 g 3, .3 g 7
I _n -
"= ; : Paperwork Reduction Act Notice -
4 - z .
'Public reporting burden for this collection of information is estimated-to vary fmm a range of 10 hours as an
" alerage pe'r response for r.ome minor' facilities, to 110 hours u an average per responAe for unac m:tjr,r facilities, with a weighted average for major and minor facilities of 18 hotirs per respons includmg'titue for Ereviewing instructions, searching existing data sources, gathering and maintsming the data needa!, and wmpleting and reviewing the collection of information. Send comments regarding the burden estimata or any otha aspect of - this collection of information, including suggestions for reducing this burden, to Chief, Inforrration Policy
- Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
- Office of Infmmation and Regulttory Affairs, Office of Management and Budget, Washington, DC 20503;
- ' , . 2 ---- - - -
General Instructions m. j41f' form has been partially completed by preprinting, disregard instructions directed at entry of that information .
- already preprinted. _ - - -
- 2. Etiter "Permittec Namedfailing Address (and facility' name/ location, if different)? "Perrut Number," and
}ischarge Number" wfere indicated. (A separate fonn is required for each discharge.)
3, E{ iter dates beginning and ending "Ahmitoring Period" covered by form where indicated .; 4, Enter cach " Parameter"..as specified in monitoring requirements of permit. , 1 Enter " Sample Afeasurement" data for cad nameter under " Quantity" and "Gualsty" in unhs specified in permit:
" Average" is normally arithmetic average t metric average for bacterial parameters) of all stmph measurernents - for each parameter obtained during "Afomionng Period"; "Afarimum" and "Afinimum" are nunnally extreme high
- and low measurements obtained during "Atonitoring Period." (Note to mmdcipals;with scoondary treatment f requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average of sample measurements obtained during monitoring period under "Alanmum ") _
- 6. Enter " Permit Requirement" for each parameter under " Quantity" and "guahty" as specified in pennit. ;
- 7. Under "No Er" enter number of sample measurments during monitoring period tlut exceed diaximum (and/or-minimum or 7-day average as appropriate) pennit requirement for cach parameter. If none, calct *0".
S. Enter ' Frequency of Analysis" both as "Sumple Alca.mnnent" (actual frequency cf sampling and analysis used during monitoring period) and as " Permit Requirement" specified in pennit (e g., Enter
- Cont? for continuous l monitoring, "u7" for one day per weck, "/60" for one day per month, "1/90" for one day per quarter, etc.) l
- 9. : Enter " Sample npe" both as " Sample Alcasurement" (actual sampic type used during monboring period) and as
" Permit Requirement," (c g., Enter " Grab" for individual sample, "24HC" for 24-hour composite, "N/A* for continuous monitoring, etc.)-
- 10. Where violations of permit requirements are reported, attach a brief explanation to desenbc cause and corrective actions taken, and reference cach violation by date.
; I 1, If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
- 12. Entet 'Name) Title of Principal Executne OJ]iar" uith " Signature ofPrincipal Executive 0))icer ofAuthorized Agent * ' Telephone Number," and "Date" at bottom of form.
; i_ _ -
- 13. Mail signed Report to Ofnec(s) by date(s) specified in perniit. Retain copy for your records.
- 14. More detailed instructions for use of this Discharge Afonitoring Report (DAIR) form may be obtained from OITice(r)
, specified in permit.
Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can 2 result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by toth. EPA Form 3320-1 (Rev. 08-95)
PERMITTEE NAW./ ADDRESS (Far6.hFereber5.=.'t.cen =(INfh r/ NATioNAt. POLLUTANT DISCHARGE EUMIN ATION SY~ TEM (/VPOfS/ Fofm Appf0Ved. MUNG MT (D
- NAME gpgy. . y,,g( 7 pgy ; 3y4pyjq NT. ft7 y31 gce7gs; y ;- M No. N
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'7vM; 217T^ O'-sD0t? PERMIT NUMBER Dt2 CHARGE NUMBER y .r7y4{ 4 s y 7 p e ! r,3 p 7 2 7 et i3??T I MONITORING PERIOD *dM *
.(%/'l YALLPT P O 'i I 1 3 ? IL TTl- YEAR MO DAY YEAR MO OAY LOCATION
- FROM 4 :- +' TO uA i it ?c$ o3 . I3OAnG( t % ece NOTE: Ned c
instructions before~c3mpleting this form. a* . ma ;v a 3ma,,<- 12a2ti (22-23) (24251 t26-27; t28-291 t30'31p PARAMETER 13 Cod OnM QUANTITY OR LOADING to Cod onM QUANTITY OR CONCENTRAN NO. '"f0W"CY SAMPLE 146-53) 154 61) 430-45) 146-539 154-691 oF (32-371 EX ANALYSIS TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,e2.sm ,gge, gg,7o, 4 S AMPLE . e ce6+ geene- entote MEASUREMENT { 17}
,339- { '3 PERMIT ft:3nge cr-ggeg g ,9c ,g eggece j, n y g;; gg- ggp
,eg,~ey 7,qs f,tc, REQUIREMENT g33 3 7 g y ,, ,. y , , y 7 , q, y g gg g SAMPLE ra
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MEASUREMENT 2aev- e e r. c 9 'e c e * ( 17) J :; P 9P"* 7 ,yn S ^ PERMtT cseece 9eceu & :e c et@Sch 19 100 ' 3 REQUIREMENT WICE/' R%B
- 3r s. 1 ' a _, ~ yry. 333 .e q ._ y 7 p a y, y ay .c/e +3yM SAMPLE nnne+-
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- :- n n jr 13~+ y g r. o r REQUIREMENT e f. y og gyn ng7Ly yy 7f; ?SuTu '. 0 4 , Ii 2BOU!T O, SAMPLE g q 3} cascow scenea c3egee 7
4: n Tr-r rMcsy u t p, 3 ; MEASUREMENT b.) O / O A./ ' 36 5' i S O PERMIT q' ppy p"M 7 = estoch cepe W O e ry f ase - wicy g;gg
.v. , ,% REQUIREMENT ,, ylp gge
, y,,,3 p , 7 y ,,, - 47 -) ,q y g SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT .
REQUIREMENT , SAMPLE MEASUREMENT PERMIT REQUIREMENT
^
NAME/ TITLE PRMCFAL EXECUTIVE OFFICER I CERTIFY UNDER PEN ALTY OF LAW THAT t HAVE PERSON ALLY EXAMINED AND i TELEPHONE DATE AM FAMeUAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDtATELY RESPON99LE FOR : f 08TAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS um. ACCURATE AND cmETE. AM AWARE MAT MERE ARE y g David Orndorf soNmcANT PENALnES FOR SUBMITTWG FALSE WFORMATION INCLUDING '3 - f -,
. M M 3 'a 113 9(3 11
+ 2 f>
( *l , "- g n t. , p , .,,. 3.n.,- . ,, - I THE POS9estlTY,OF u.s,c, e i3ie. p Ft.NE
. ,,w,AND ,I,M,PRIS,O,N,,ME,N,,T.,SEE,,1,8
,, ,, ng, , U.S,nC,,.,9 g o,oon 10,0,1 A,ND 33 SiONATURE OF PRINCIPAL EX('CUTIVE TYPED OR PRINTED a,W or merenisw a .: et serween e manma erw s years.s OFFICER OR AUTHORIZED AGENT YEAR MO DAY ARE A l NUMBER CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# strechmerr!s heref N f) I bl. V r4 t' .. 3 EPA Form 3320-1 (06-951 Previous editions may be used. (REPLACES EPA FORM T 40 WHICH MAY NOT BE USED.) PAGE OF a
30133/951001*3'130 l
1 _ ; I[
~
. Paperwork Reduction Act Notice - " E_' .
t
, t ppHic repWting turd. n in thh collection of infornution is estimated to vary from a range of 10 hours as an j : avpage per responw Io amm minor facilith to 110 hours as an average per response for some major facilities,
!t with a weightml neuw fr! major aad minor facihties of 18 hours per response, inchiding time for reviewing ,
t
- instructiony, rearching akting d3ti marces, gathering and maintaining the data needed, and completing and
, reva: wing the col!ceti;a et inforaation. Scoi comments regarding the burden estimate or any other aspect of i ;this collection of inf. tmfjen, including nu gstions for reducing this burden, to Chief, Information Policy l Brarwh, Pht-223, U,$ Ensironmental Protecuon Agency,401 M Street, SW Washington, DC 20460; and to the iOffice of Infornation id Regulatory Affairs, Office of Management and Dudget, Washington, DC 20503,
. L n .;.,. . .. -n.~.
. -+..,.--w_ _ . _ ~ . - - , .
_) General Instructions
' L If form ias been prtially completed by preprinting, disregard instructions directed at entry of that information
'already preprinted,
.2. Unter *Pe'rminee Name/Afailing Address (and facility namc/locatior., if different)," " Permit Number," and
' Discharge Numb r' u bere indicated. (A separate fonn is required for each discharge.) -
2 3. Enter dates beginning acd ending "Afonuoring Permd* covered by form where indicated. >
- 4. Enter cach "Paratur" as specified in monitoring requirements of permit.
i
~ 5. Erder "Sanrpfe A/o trement' data for each pararrser under "Guantity" and "Quahty" in units specified in permit.
"Arcrage" n nona 1:y arithmetic average (geomeh- avera);c for bacterial parameters) of all sample measurements der each paramely cttained during "Momtoring Period"; "Marimum" and "Afinimum" are normally extreme high -
+
- and low measuruents obtained during "Mrmitoring Period." (Note to municipals with secondary treatment - i rainirement: Enb %iay average of sauuple measurements under " Average," and enter maximum 7-day average i of sample measmrtacnts obtained during monitoring period under *Afarimum ") ;
l
- 6. Enter " Permit Repiremen!" for cach parameter under " Quantity" and "Guahty" as specified in permit. j J.Under?"No Er" mter number of samp!e measurments during monitoring period that excech maximum (and'or -
miniinum or 7-day ' average as appropriate) permit requirement for each parameter. If none, enter "0"; _ f Enter "Frcquency -f fraly;is* both as " Sample Menmement" (actual frequency of sampling and ' analysis used
' - :d ; ring mohiforing period) and a3 " Permit Requirement" specified in permit. (e.g., Enter " Cont " for continuous monitoring, "l/7" for one day per weck "l/30" for one day per month, "1/90" for one day per quarter, etc.)
9.' Enter " Sample 7)p" both as Wrple Alcasurement" (actual sample type used during monitoring period) and as L" Permit Regttiremmt," (e.g. Enter '* Grab" for indnidual sample, "2.IllC" for 24-hour ' composite, "N'A" for continuous monitoring, etc.)
- 10. LWhbre violations of penuit requirements are r wted, attach a brief explanation to describe cause and corrective
' actions taken, and reference each violation by date.
I1. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. ,
~
- 12. Enter "Nomemtle qilnncipa1 Executive Oficer" with " Signature ofPrincipal Erecutive Opicer ofAuthori:ed l Agent * " Telephone Number," and "Date* at bottom of form.
- 13. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your records.
- 14. [More detailed instractions for use oflhis Discharge Af<mitorhrg Report (DMR) form may be obtained from Office (s) specified in permit.
Legal Notice
. This report is required by law (33 U.S.C.1318; 40 C.F.R.125,27). Failure to report or failure to report tmthfully can reduldn civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,'
or by imprimnment for not more than one year, or by both. I m e EPA Form 3320-1 (Rev. 08-9_5)
PEssesTTEE NAndE/ADORFES thshManesyNamvimes== (thp-d esAnossat PottutassT DescManeE EuMWAnoes SYSTEM lhPDES/ Form Approved. p DISCHARGE MONITORBIG fEPORT IDAWF/ i
.* E'i V T R TEl-LZT %% D 3 M T I J) N - (2-rar tr 7-rst 211 T 2J it 3 I ri F M L D:; ~ M No N
"*"' W '# 39i ADDRESS? 3. O{ q *
(5Uh? O$) ^EP'*"!' f
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4 I" #
" 9 E P P r e tt F S 9 * ' ,
SA 1SF?? MITMM PEM U33" * , M"AVr1 V$LLCY ?ydE9 ' 3 ?i?I3
- YEAR MO DAY YEAR MO DAY LOCATION FROM 9s 19 ,i TO o *. 19 <v M 0 ' go n i g;i p p d -. [Il' M F ,
, e v.
- nny9m hnun<ay t202rl 122-239124-25I 120-279 r20-2sr tw3rl NOTE: Reed inaowmenene m'e5nipionne niin W PARAMETER (3 Corut %I QUANTITY OR LOADING (4 Carut on&# QUANTITY OR CONCENTRATION NO. nieouescY gggyLE 146-55 154-611 130-451 (46-5 3 156411 or (32-37j EX ,,,gyg,, TYPE AVERAGE MAXIMUM UNITS ' MINIMUM AVERAGE UNITS
, MAXIMUM ass-ssu , Iso-sei (Wor SAMPLE 3 7 p. a. 3 s. e o e e ; , eecn a "rT ~ [1g
&rd 3
/,) 1/7-4 MEASUREMENT ,h ) Sr / *
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- 5400 q PERMIT ;gma 1 2 3 pee p -; c 't
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,33- y,;4 , REQUIREMENT 3 ,, 3 gggy ,4yggg .g j SAMPLE
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( 13) g s/- W4 p
. J, S P F .1 D S O ggy; W 3 sac 3 PERMIT ' sce tu . tMo n A ma 'c* p M .
1 3 REQUIREMENT (3 !Q fp t e , n .r . + -aqq- 7g,, m 3 ,. .g.,g: 43 g g. ,q iT L A 'i D '; ? ? A G F SAMPLE , 3ppe- n,,eg3e 7, h g) 7, g g7 3, MEASUREMENT b.C 7, 6 I O //[ hh 1 y PERMIT pecey . g o e g g s, , e .. f. a
- "t 'i % f. 1 39 33' , pg O ,*' N A 0 ,.
3 cur er u,-e 3r,u REQUIREMENT - m.#
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+
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' L 5 4 , Ts C M 13 I f L O n, SAMPLE - .
9y 3 m 33 p33g mm h g MY F '? r it M T V C 9LAsr MEASUREMENT (),CG/ (h 60/ ' h' 350 1 1 3 PER M : pgpgyp pqppy ggg gg .egggng ;gggggg ,7 p g .
'g y' p, Q y '. I p
~,11t y a 9, y , REQUIREMENT n,7,, ,,; n 4 eerteauv , y ,,
SAMPLE MEASUREMENT PERMIT :. t REQUIREMENT < SAMPLE MEASUREMENT
' PERMIT .- ,
REQUIREMENT SAMPLE
; MEASUREMENT PERMIT :
4 REQUIREMENT - p psAMEmTLE PfWGCFA4. EXECUTIVE OFFICER I CEnnFY ussoen PensaLTY of LMF THAT I HAVE PEnsoNaLLY EXahmesED aND ' TELEPHONE ans paamuan witn Tne esponesanose suommTTro wesites: amo eAsso oss / DATE MY mQulfiY op TMoSE weosViDuals te4MEDeATELY RESPoseSleLE Fon Bavid Orndorf oeTassmo Tut wronesAnoes, i neutvt Twe sumamTTro esponesafiose is vnue. accunate amo consetrTr. - e aM awasie Twar Twene ane
. s/
e' . Chemistrv Mana9.cr SiessiescamT rewatnes ron sumamTTuse rater lesrosiMarioN. ItsCluDIsso Tur possesuTY or ens _ . . ;.u : .T. ser is u.s.c. iooi ano as [2 M3-3113 )6 11 h u.s.c. e isie. stammis.asso ww r an . sensuom se s m,oop 88000ATURE OF PRNICIPAL EXE , m
~
TYPED OR PHINTED aan er ==.e =.= ~- _ : eraeswesa e menen , awsusw ans. aan s ms AREA NuadBER OFFICER OR AUTHORIZED A CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference et effechments here/ EPA Form 3320-1108-95) Previove editione mey be used. IIIEPLACES EPA FORM T-40 WIGCH MAY NOT BE USED l PAGE OF
- - . - - - . _ _ _ _ _ _ _ . _ _ _ - - _ _ _ - - - - - _ - _ _ - _ _a
-"]'
.i -
Paperwork Reduction Act Notice " - . . pede reperting Earda fcc this colimion of information is estimated, to vary from a range of 10 hours as an , avuage pdr repense f wme minor facilities, to 110 hows as an average per resp 6nse for some major facilities, l nith a weighted aven;N fcr nujormd. minor facihties of 18 hours per responsefincluding tInd for reviewing
~
)
, iininu;riou, tearching sting dea 2curces, gathering and nuintaining the data needed, aryl completing and j ' reviewing :the colhtti m of infonutica. Ser.d comments regarding the burden estimate or any other aspect of t
this co!(ection of inf"rmat:en, including sugge:sticas for reducing this burden, to Chief, Inforcution Policy
'13 ranch. PM-223, U.S. f'nmonmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
, : Office of Information 2rd Regulatory Atfairs, Of6ce of Management and Dudget, Washington, DC 20503.
. . _ x-- - - - - . . - -
.,, General Instructions !.
> 1. If. torm has been partla!!y completed by preprinting, disregard instmetions directed at entry of that.information already preprinted.
- 2. Enter *Penettec Ncmed/ ailing Addrest (and facility namc/ location, if different)," " Permit' Number," and
Di3 charge Number" n bere indicated. (A separate form is required for each discharge.)
- 3. Enter dates beginnmg ard ending "3/onitonng Period" covered by form where indicated.
- 4. Enter cach "Paranrter' as specified in monitormg requirements of permit. ;
- 5. Enter 'Samp/c A/. c urenrent" data fer each parameter under *(?uantity" and "Guality" in units specified in permit.
% ruc# is ncnt43 arithmuic average (geometric average for bacterial parameters) of all samp!c measurements
- fm exh paramder Wamed during "Alomtoring Perrod"; "Afarimum" and "Alinimum" are nonnally extreme high and low measun mnts obtained during "3/cmtoring Perind" (Note to mimicipals with secondary treatment requirement: Enkt 70. day aserage of samp!c measurements under " Average," and enter maximum 7-day average of sample measurements obtaincd during monitoring period under "3/aximum ")
- 6. Enter "Fermit Reefmercent" for each parameter under "guantity" and "Qualitv" as specified in permit, I l
'7. Under ."No 8" M r rumber of sampfe incasurments during monitoring period that exceed maximum (and/or ;
minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0". , SJ Enter "Frequem of balysis" both as ".bple A/easurment" (actual frequency of sampling and analysis used Gring momtoring p:riod) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont," for continuous monitoring. "l/7" fer one day per u eck, "/dG" for one day per month. "M0" for one day per quarter, etc.) 1
- 9. Enter "Sampic Dre" both as " Sample Afcasurement" (actual sample type used during monitoring period) and as l
" Permit Requirementf (e.g, Enter " Grab" for individual sample, "N#C" for 24-hour ' composite, "N/A" for '
continuous monitoring, etc.) l 1
,.10J Where siolations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
l
)
i l11. If"no discharge" occurs during monitoring pericd, enter "No Discharge" across form in place of data entry. l
- 12. Enter "Namenitte of Pnncircil becutive Oficer" with " Signature of Principal Executive 0))icer of Authon ed l Agent " ' Telephone Number,* and "Date* at bottom of form.
I
- 13. Mad signed Report to Office (s) by date(s) specified in permit. Retain copy for your records.
)
'14. More detailed instructions for use of this Dircharge Afonitoring Report (DAIRJ form may be obtained from OfIice(s) l specified in permit. l Legal Notice l This ' report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can !
result in civil penalties not to exceed $10,000 per day of violation; or in criminal penahies not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95)
ERM;TTEE NAME/ADORESS(fare.d FerderNo /I cers =lfDWs wit / s:f.TIONAL POLLUTANT DISCHARGE ELIMINAT ON SYVTEu (NPOESJ Form Approved. , NAME DISCHARGE MONITORING REPORT (DMR1 s 47: yg, evr ung- e 3 --' f n e ( ?- 7 61 (r 7-19/ :q ? e 1 cnq' * ;; J ' n OMB No* 2040 0004 ADDREOSc ,3 , j37 [ ' = " ' ' ' 'S ' f5hpq N 'f EE# '
'*!!; '? A V I O 3.1 ' D 3 71. PERMIT NUMBER oi; CHARGE NUMeER
,, , p7yg ,
e
- y pyv3p3ip c. 1,n77 i ^55'N
- FACIUTY MONITORING PERIOD
,,w y,, .Y r 3 y i.' s ;*ge7 3 qq g y qq g m ,
LOCATION . evn , 33 yv., ,- ae e FROM i > , (2G27) (22-231 (24-251 st TO w (26-271 (28-29/ (30-371
- 1 +; o^t yn p i !; - s . ? " ',' 7 NOTE: Read instructions before completing this form.
IM '.4 8 PARAMETER (3 cent on&# QUANTITY OR LOADING I4 cent any/ QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE 146-531 f54-619 13e-451 (46-631 154-6r9 OF (32-371 EX an,tysis TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 5243; fg4_ggf g 7, SAMPLE + .s - < e e f. e .s ~ oc: 3- ( ;3 MEASUREMENT
, .-- ; 3 PERMIT yennya *
- r- u 3 3 ,,p 9% m ),g gy y yg
,g . -. , , REQUIREMENT .~3 y(7yy ,,
,, 3 y 7 y g. p 3 g .,, ,
3g7; , 3e4g SAMPLE - se~r, er^$3m ;g+ee3 { i .;)
, s ,_, MEASUREMENT in.$ j ,
PERMIT . Ot3:n
- 9+eMe -
n 3sep 13 t, n n ggj . q 43
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u . e ,
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- REQUIREMENT 3- 3 -n 3 7;; ngyty ug n7fg ,g yp
?
Y ; T ') 5 > ;J T 7 , , SAMPLE [ + .3 % e : ; ^ + ~ :: - ec:< nr
, _- 3) 3 q ,- g;7 ,1 MEASUREMENT f ), y p- / pj ,4a f m '
PERMIT 1 anw- n r tr e n ; actMe ce t 'r e :: e 3. c ~ g e 0:e , j- c g t ; w t- t
,.s ,, - , y3, , REQUIREMENT .m 1 *r ~ r t t t.V 4)
SS1 SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERDFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE AM FAMILIAR WITH THE INFORMATION SUBMtTTED HEREIN: ANO BASED ON , . , MY INQUIRY OF THOSE INOtVIOUALS IMMEDIATELY RESPONStBLE FOR . OBTAINfMG THE fNFORMATION I eEUEVE THE SUBM:TTED INFORMATION IS N hiV LG U rildO U [ h s TRUE. ACCURATE AND COMPLETE. s AM AWARE THAT THERE ARE SaGNtFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDfMG
- ,- ,'2 *
,' -f ' ~'
s.'hetii 3 t r'f Ilan aEc i' THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 51G01 AND 33 # 9 3 0 3.; } } } $ 4h Il 7h U.S.C. t 131s. spwuvo e anwar snese sesame mer hoewe miss se e s r0,000 " SIGNATURE OF PRINCIPAL EXE6 AREA TYPED OR PRINTED ew or menen :_ .: eraerw s momne aw s v.ars.s NUMBER YEAR MO DAY OFFICER OR AUTHORIZED AGEST CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# stischments heref
. ,,.. 9 EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T 40 WHICn MAY NOT BE USED.I PAGE , OF q,;1 7 ._ g, _.-
.2 _,__.__...a _ .n- ,
- Public reporting buroen for this collection of information is estimated [to vary from a range of 10 bot;r3 as an l average per response for wne minos facilities, to 110 hours as an average per response far some major fxdities, .
with a weighted average for nujor and minor facilitics of 18 hours per res;mnse, including time for reviewing instructions,' searching existing data sources, gathering and maintaining the data needed, and completing and
; , reviewing the coHection of information. Send comments regarding the burden estimate or any.other aspect of
; this collection of infonnation, including suggestions for reducing this burdeur to Chief, Infoniadon-Policy
; Branch, PM 223, U.S. Environmental Protation Agency,401 M Street, SW Washington, DC 20460; and to the
. Office ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503l
- n
.{
I u-
- General Instructions '
' l. If form has been partially completed by preprinting, disregard instructions directed at entry 'of that information l]
already preprinted. . t .
- 2[Ehter "P$rmittec Name/Afailing Address (and facility namc/ location. if different)." "Mermit Number," anil
;" Discharge Number" w here indicated. (A separate form is required for each discharge.) , 1 1
r
~
- 3. Enter dates beginning and ending "Afonitoring Period" covered by form where indicated. '
l i
- 4. Enter each " Parameter"_ as specified in monitoring requi'rements of permit. >
)
1
- 5. Enter " Sample Afeasurement" data for each parameter under " Quantity" and " Quality" in un!!yspceified in penuity )
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all t, ample measurements j
- for cach parameter obtained during "Afonitoring Period"; "Afaximum" and "Afinimum* are normally extreme high l and low measurements obtained during "Afonitoring Period" (Note to municipals with scandary treatment, l requirement: Enter 30-day aserage of sample measurements under " Average," and enter maximuut 7-day average ' 3 of sample measurements obtained during monitoring period under "Afarimum ") l 1
- 6. Enter " Permit Requirement" for each parameter under "Guannty" and "puality" as specified in penmtc ;
- 7. Under "No Ex" enter number of ' sample measurments dunng momtoring period that excced maximum (and/or l minimum or 7-day average as appropriate) permit requirement for each parameter. Ifr,one, enter Ja",
8? Enter " Frequency of Arialysts" both as " Sample Afeasurment" (actual frequency of sampling and analpis med during monitoring per;od) and as " Permit Requirement" specified in permit (e.g., Enter Tont," for continuous
- monitoring, "l/7" for one day per week, "u30" for one day per month, "l/90" for one day per quarter, etc.);
9 Enter " Sample 7)pe" both as " Sample Afeasurement" (actual sample type used during monitoring period) and as !
" Permit Requirement," (e.g., Enter " Grab"- for individual sample, "24HC" for 24-hour composite, "N'A" for ;
; continuous monitoring, etc.) l 10JWhere' violations of permit requirements are reported, attach a brief explanation to describe cause and corrective !
actions taken, and reference each violation ty date.
- 11. If"no' discharge" occurs during monitoring period, enter "No Discharge" across fonn in place of data entry.
l ( 12. Entet " r/ Title of Principal Erecutive Oficer" uith
- Signature of Principal Executwe Oficer ofAuthori:ed Agee :lephone Number," and "Date" at bottom oiform.'
- 13. M j,ned Report to Office (s) by date(s) specified in permit. Retain copy for your records. j
- 14. More detailed instructions for use of this Discharge Afonitoring Report (DAfR) form may be obtained from Office (f)
( specified iii permit.
. Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penshies not to exceed $10,000 per day of violatian; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both.
EPk Form 33204 (Rev. 08-95)
- i. _v .
.--l-num ici y l
L_______________________._____________________________________________ __ _
PERMITTEE NAME/J.DOREOS(r us.edeym.vt.e.a vo@ w) FATiONAt POLLUTANT Ot7 CHARGE EUMtN' TION sv5 TEM (NPDES) Form Approved. 'e 4
!3 V 3 f 5 T. " ; Y P74# 1 C7A'13r -F tt7 3 4 ! *' 2 )C7 3) LI,eg Oh8 ^ No.20 ADDRESS p , .3, *"".r1 ' 1N* *Pd' '*
_1 g 3 = (3yy? S $) PERMIT NUMBER DIKHARGE NUMBER p ,y 4
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,5n5- ,,ty'- **
a.mo a 'w'
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MONITORING PERIOD *
': *AV: 7 A L L '{ Y PW 7E I ? A
- I ., ' YEAR MO DAY YEAR MO DAY 4 LOCATION FROM at TO q* ;1 8 45 1. . i1 e o tr 9a Reed0 { e; 5 A r g E [
inetructione befor[e ( & e 'e completing ne~e. mnyrn - , ' , ,c 3,? 120 21) (22-23) (24-251 t26 271 128-29) 130 31) NOTE: I3 Cerd On/vi QUANTITY OR LOADING I4 Caraf Only; QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE PARAMETER I46-53) (54-619 (30-451 146-539 154-619 oF (32-37; EX ANAty,5 TYPE AVERAGE MAXIMUM UNITS MIN! MUM AVERAGE MAXIMUM UNITS M2e (64-88J 16s-7ar
,j g g 9 5 , r3p3, SAMPLE rr o er S
- S tenA>: e d .S t- c 3 ( 19}
MEASUREMENT TSpEs ,c0 3r , , 3 PERMIT ggeese eer% p $ .93 . c c t o rr e 33 103 ' WICr/ pA3
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. ne - 1 3 .r PERMIT r;c o e p t w e r; 3 e tz .c3 w e e .91r 5 yg , ;ygy/> t,J g e .. o , ;3 7n REQUtREMENT ,1 9 ,, n ,y, p37 7 gy .py f3c. ._77
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%)
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- 33. , , ,
3.) , 9 3,,, ; SAMPLE MEASUREMENT PERMIT REQUIREMENT l SAMPLE MEASUREMENT PERMIT REOutREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE ' MEASUREMENT PERMIT - REQUIREMENT l NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERDFY UNDER PEN ALTY OF LAW THAT I HAVE PERSONALLY EKAMINED AND TELEPHONE DATE AM FAM1UAR WITH THE INFORMATION SUBMITTED HEREm: AND EASED ON MY INQUIRY OF THOSE INOfVIDUALS IMMEDiATELY RESPON98LE FOR David 0rndori OsmNmG THE mFORMADON, t WEVE NE SUBMITTED INFORMATION IS ' I TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE ( 4f. Chenistry Manager ****' CANT PENatTiES FOR sUSMirTiNo FALSE eNFORuATiON. eNCouDiNo s.i THE POSSIslUTY OF FfNE AND IMPRISONMENT. SEE to U.S.C. 51001 AND 33 4L2 393-S113 96 il 26 U.S.C. s late. immames emmer sw es.ame mer some nn.e se se sto. coo SiONATURE OF PRINCIPAL EXE TYPED OR PRINTED mad or m====n= : AREA NUMBER
- er eerwe. smanen,omtsy rms OFFICER OR AUTHORIZED AOdET CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY Vf0LATIONS (Reference e# ettechments heret b C / S ( h Cr. / / #
EPA Form 3320-1 (06-95) Previous editione may be used. (REPLACES EPA FORM T 40 WHICH MAY NOT BE USED.) , ,. PAGE OF
. r i Paperwork Reduction Act Notice .
! i~ >
Ptshe reporting 1 urd< u fu this cdlection of informat;on is estinuted to vary from a range ' of 10 hours as an
, , aurage pr respense 1 : a me ndoor facilitics, to 110 hours as an average per response for some major facilities, j with a weighted averaM r major and minor facilities of 18 hours pcr response, including time for reviewing
- i instruction:4, wrchiny exkting dau sources, gathering anJ maintaining the data needed, and completing and l : roiewing the ca!!cctien 'of~inforuwion. Send termnents regarding the bmden estirnate or any other aspect of this collection of inforunt:en, induding suggestions for reducing this burden, to Chief, Information Policy I Bnmch, PM-223, US Emiromnental Protection Agency,401 M Street, SW Washington, DC 20460; and to the f ;3 Office of Information md Regulatory Atfairs, Ollice of Management and Budget, Washington ,
i 1 4 y .~ , , . . . . _ , _ _ . . m. _ _ , . . - , . - - . . _ . _ - . . . _ i General Instructions , i1. If form has Ncn partially completed by preprinting, disregard instructions directed at entry of that information already preprinted. i
- 2. Enter " Permittee Name 2/ading ,1ddreu (and facility name/ location, if different)," Yermit Number," and
" Discharge Number" where indicated. (A separate form is required for each discharge.)
- 3. Enter dates beginnmg ud ending "Afonitoring Period" covered by form where indicated.
- 4. Emer cath "Pararmier as specified in monitoring requirements of permit.
5 Entet "Samp!c Atommed Sta for each panma:r under "Guantity" and "Guality" in units specified in permit.
%cmge" is cco at;y arithmetic average (geometric average for bacterial parameters) of all sample measurements fer-rach parametm cbtained during "Alonitoring PenmP; "Afartmum" and "Alinimnm" are normally' extreme high and low mesurewnts obtained during "Afor:itoring Permd" (Note to municipals with secondary treatment requimnent: En:/ 30-day average of sample rncasurements under ",1rerage." and enter maximum 7-day average of sample measmu: ents obtained during monitoring pciiod under "Afarimum.")
.6. Enter *Perinit Rewerent" for cach parameter under " Quantity" and "Guality" as specified in permitf ,
f 7 'Under "No Ex" m r 'rumber of sample measurments during' monitoring period that exceed maximum (and/or . I trnmimum er T-dm mrage as appropriate) pumit ratuitement for each parameter. If none, enter "0". 8$ Enter " Frequency of balpis" both as "Samp/c Aleasurment" (actual frequency of sampling and analysis used dgring monitoring period) and as " Permit Rutuirement" specified in permit. (e.g., Enter " Cont ". for continuous monitoring, "l/7" or one day per weck. "160" for one day per month, *//90" for one day per quarter, etc.)
- 9. Enter "Sanple Tvec" both as " Sample Afeasurcment" (actual sample type used during monitoring period) and as l
, "Permet Requirev: nt." (c g., ~ Enter "Grah" for individual sample, *241/C" for 24-hour composite, "A%I" for contmucus momionng, etc.)
- 10. Where violations of permit requirements are nported, attach a brief explanation to describe c:mse and corrective stions taken, and reference each violation by date.
I1. If"no discharge" occurs during monitoring period, enter "No Ducharge" across form in place of data entry.
, . I2. Entct "Name/ Title ef Princtpal Erecutive Opicer" with " Signature of Principal Executive Oficer ofAuthori:ed Agent,*
- Telephone Number " and "Date" at bottom of fann.
'13. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your records. ;
- 14. More detaded instructions for use of this Discharge Afomforing Report (D3IR) form may be obtained from Office (s) specified .in permit.
Legal Notice This report is requir^ by law (33 U.S.C.1318; 40 C.F.R.125,27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not nere than one year, or by both. g- J
' EPA Form 3320-1 (Rev. 03-95) -
t ;,
PERW,'TTEE NAME/ADDRE?S a=eede Forsbay Name'Lecersee gfDggr sruer) NATION AL POLLt/ TANT OtSCMARGE EUMINAT ON SYSTEM INPDESJ Form Approved. NAME
- DISCHARGE MONtTORING REPORT (DMR/ OMS No' 20400004 *
- 18. V 7 2- L L " 'I 93.i"7 UTiTIL t ?-7 61 (7 7-F 81 OMIT I ") I L -C8' F "'
AcoREts ; , 3, ng n -- -"c'" ' ' ' ' * (30yP 35) APPY'N']
*73; 1 y, V I p 3 > t S. n ' r PERMIT NUMBE3 oisCHARGE NuMsER ..
,,, yyy4g A ,
,pI;-; - 30= cg i4a7? MONITORING PERIOD ~'30I #
EA
*V ? V A L L ;-: 'f POW 7 - 3 i' * " T ^* ' YEAR MO DAY YEAR MO DAY LOCATION g
pggy ,, 77, n3 yg y, ,, ,, 4g3 \g py37gjp3y i g 3e3 .
. u. -.- 8 me c , :: (20211 122-23) (24-25) (26-271 t28-291 (3t>31, NOTE: Reed inetructione before~ completing thie form.
PARAMETER (3 Ciud OnM QUANTITY OR LOADING I4 Cerd on47 QUANTITY OR CONCENTRATION NO. FREQUENCY 146-53) 15&stl 138-459 f4&531 15*sts OF SAMPLE (32-31/ EX ANALy,S TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,rs.es; gg#,,, ggg7a SAMPLE 3%- w .w + - n ge~~ ( em j/ } j
,mp MEASUREMENT PERMIT
( , f', 7 7 /3 O, Qg s
; 3 ee9*ee e .m e ; + , , r) .c e e e t 2 , e* ggy gg
, , , , , REQUIREMENT .s 73r,3, 7 3 , 7 q g ,, -n
,*y( SAMPLE :c$>- c.n ~ s 3 , ~ *; y ; -
;t T p ;,
,,, ,, MEASUREMENT {,2 /p.,1 g' 7 q) '
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m a PERMIT w ceo5 -oe m p 3 :c$e** l' 10.; my ,p p
,, ,. , . ,., ,,, , REQUIREMENT . , . . ,
.j 7 3 p 7g yy s c, 7 ,
SAMPLE .ynr, i I' 3s " , ' A .3 7 seg3 . , , ,' ( 19) g- / < 3, s 4 - e 2
, ,. MEASUREMENT <g gg 7 Wd 1 p PERMIT e-:eng w933 ," mm ,,, , ',
y' ~ ' " * ^ ' ' ' ," ,? < EnLY g y, q r- , ,t 7, ,- REQUIREMENT '- ,
- q / t, "9 1 't ~ 75ttf er 1
y ^gr - 3 SAMPLE e. e n e 3. y 3 9 9 , $ ,, yggg 1 i.,, ( 33)
, , ,7$ ,. ;;j , MEASUREMENT g,9gg , 7- g, gg g /
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- e 3 3,, 9 gn3 , p. 9 3 y g g 3ng }, ' ,'
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gee SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER s CERnFY UNDER PENALTY OF LAW THAT I MAVE PERSONALLY EXAMINED AND " i TELEPHONE DATE AM FAMlUAR WITH THE INFORMATION SUBMfTTED MEREIN; AND BASED ON N MY INQUPRY OF THOSE fNDIVIDUALS IMMEDIATELY RESPON98LE FOR
/
/% \ ,
t
/ 'k
=
OBTA!NING THE INFORMATION, t BEUEVE THE SUBMITTED fNFORMATION tS '
'-#, /
di1V id U rth.!O r1 TRUE, ACCURATE AND COMPLETE. t AM AWARE THAT TMfRE ARE SIGNtRCANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING - [ h' ,1 -- , -pf
~'
3 %', 9f
~' '. ,,
THE POSSIBfUTY OF FtNE AND IMPRISONMENT. SEE 18 U.S.C. s 1001 ANC 33 1 a. ~b1lJ g g} g 'y 'J U.S.C. s 131s. sPoammes ener snese seen,eee mer echare snee se se s70,000 ~SiON"ATURE OF PRINCIPAL EXECttTIVEg TYPED OR PRINTED a w er meneneen : -- -- : ef terween a menes ener s yearms OFFICER OR AUTHORIZED AW NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e,7 strechments here) EPA Form 3320-1 (08-95) Previous editions may t>e used. (REPLACES EPA FORM T 40 WHICH MAY NOT BE USED.) PAGE
,3 n _
3,. n OF
, , c ;
.~.-.m.-+._
J Paperwork Reduction Act Notice m d-
'Public reporting burden for this collation of information is estimated to vary from a renge of 10 hours as an
~
average per response for some minor facilities, to 110 hours as an average per response faisoire rrojor. facilities, [
~
'with a weighted average for major and minor facilitie.s of.1_8 hours per response, indudmg titx for reviewing ;
! instructions, searching existing data sources, gathering and maintaining the d4ta need-d,. and completing and
; reviewing the collection of information. Send comments regarding the burden e. stimate.or any othef aspect of
[ this collection of information, including suggestions for reducing this burdenc to Chief, Information Policy , IBranch, PM-223, U.S. Enviromnental Protection Agency,401 M Street, SW Washington, DC 20460; and to the
' Ofrece ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. }
l _____..a General Instructions ' I
.t- .
4 ,1. If. form has been partially completed by preprinting, disregard instructions directed at entry of tha't information already preprinted.
- 2. Enter " Permit /ce Name/Afa!/ing Address (and facility name/ location. if differens)," " Permit Number," and
."lpscharge Number" where indicated. (A separate form is required for cach discharge.)
- 3. Enter dates beginning and ending "Afonitoring Period" covered by form where indicated
~4. Enter each Tarameter" as specified in monitoring requirements of permit.
- 3. Enter "Sampic Afeasurement" data for cach parameter under Guantity" and "puolity"in units specified in permit.
"Averaxe" is normally arithmetic average (geometric average for bacterial parameters) cf all rample measurements '
for cach parameter obtained during "Alomtoring Period"; "Afaximum" and " Minimum
- are normally extreme high and low measurements obtained during Wonitoring Period." (Note to municipals with secoadary ireatnient
, requirement: Enter 30-day average of sample measurements under " Average," and enter muimu-n 7-day average of sample measurements obtained during monitoring period under " Maximum.")
- 6. Enter " Permit Requirement
- for each parameter under "Guantity" and "Quahty" as specified in permit.:
7< Under "No Er" cater number of sample measurments during monitoring penod that exceed maximum-(and/or: i minimum or 7-day average as appropriate) permit requirernent for each parameter. If none, cmer "0" i
- 8. Enter " Frequency of Analysi3" both as "Nample Measurment" (actual frequency of sampling and analysis used during monitoring psriod) and as " Permit Requirement" specified la permit. (e.g., Enter Tont " for continuous i monitoring, "l/7" for one day per week, "l/30" for one day per month, "l/90" for one day per quarter, cfc.) : i
- 9. Enter " Sample Type" both as " Sample 3/casurement" (actual samp!c type used during manitorirg period) and as ;
^
" Permit Requirement," (e g., Enter " Grab" for indisidual sample, "2-t#C" for 24-hour composite, "N/A" for continuous monitoring, etc.)
t
- 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
- actions taken, and reference each siolation by date. -
' i1. If "no discharge" occurs during monitoring penod, enter "No Discharge" across form in place of data entry. ,
- 12. Enter " Kame / Title of Principal Executive 0))icer" with " Signature ofPrincipal Executive OJJicer ofAuthori:ed ,
Agent," " Telephone Number
- and "Date* at bottom of Conn.
- 13. Mail signed Report to OHice(s) by date(s) specified in permit. Retain copy for your records. !
- 14. More detailed instructions for use of this Di3 charge Monitoring Report (DMR) form may be obtained frem Office (r) specified in pennit. :
o Legal Notice ! This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27), Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both. ! i EPA Form 3320-1 (Rev 08-95) l
~-_._.- ...- --
FEnterTTEE NAndE/AODRESS thheFereyNeavfaces==(Dqm-d KAnoNAL PottuTmv DescMAmeE EuumAnoN sysTEu /AFDE31 Form Appnwed-NAndE A N q g 7,~ q 7 7, L L y pg j pg 3p3773s ,W NN N[,W,f 3[g 7ggg37 g gg g . yM@ M4 i ADORESS P , -),
'i ) ; a ^**9"r** 1' 4 U88 7
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'P' f 1 T T *f ; ' 3&V[0 3R400RT PERMIT NUMBER OtECMARGE NuwtER -p p{qge d 1g .
5HIPPIi3PJE! P5 15S7' ~ 33I
;RAVFd N L(f Y P Ihi F' i? 3 T A Y I 7 MONITORW4G PERIOD .
~4 LOCATION YEAR MO DAY YEAR MO DAY ._ 4 FROM +4
- TO t1 00& 5Q 0 , 43 1 31 o4 ,
I T sf 4 9 r; e l R*** M & ~ Wl
's & e . n,y7n munan>r t2S211 122-231 124-25I NOTE
- _[
(20-21s 128-2s) isosti *'I* f*"*- ' PARAMETER 13 Cow on&i QUANTITY OR LOADING (4 Cad onM QUANTITY OR CONCLMTRATION 146-531 154-619 138-45) NO. mEcuENev SAMPLE (32-37f 146 5.11 154-619 or AVERAGE EX TYPE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS s,s.es, ANays,s *
,g, ,,m 4 SAMPLE gypse a. 3 e n e ; a. g pgyet -
( ^~) 17 # ' . MEASUREMENT d *b. 'T'
400 L
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e r y n =qzc y 3 v. n e REQUIREMENT ,3 g ,. 4 7 y r q v- y 3 LIDS, 7 ") ?
- L SAMPLE pe333 33ygg;73 MEASUREMENT
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3,93ey 4 h7 4 h, gq ) j -
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- PERMIT "
1 REQUIREMENT
- m 333 - e r. p n e 333 mom ;y ,p g, gg'
- c. ; 7 g ,,, -, 7,7 37 ,333 .
g , if L t;D GqM 3C SAMPLE ene%~ e. ec3g g33y yq Jg om u n -y; m c: r . . MEASUREMENT PERMIT .cugn
<$. 4 b., . 7/[ W
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Annes o 43 nem3 g y) p .gy gg
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'L14, IN 03NSUIT O F.
^
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*q 3 a,. 3 p guc; $3ng /- ,
T r (I T*"?t01C47 PLAN? N PERMIT mpp
.7050 1 3 ?
REQUIREMENT 33pp - ;ppppq7 - 9 3 g g.m f u gg ; m .t g gy ggg
- s e r a e w r- -, goc ygu: qq , p., n , 7 g ,, , ,,3 m yeg SAMPLE MEASUREMENT
' PERMIT :
REQUIREMENT SAMPLE MEASUREMENT PERMIT . REQUIREMENT SAMPLE MEASUREMENT PERMIT. - REQUIREMENT - _m NAME/ TITLE PRWCFAL EXECUTR/E OFFICER I CERMFv uMOEM PENALTv OF TAW THAT I HAVE PERSo#ALLv EX AMiNED AND / A 1 TELEPHONE DATE Am FAmiuAn wtTw THE meonuAnON sOOMtTTED MEREn: AND SASED oN '
/
David Orndorf uv moviny or mosE moviDuAts suwEDiATav nEsPoNastE con / osTAmma THE meonuATioN. i eEuEvE Tut suomirTED mronuATioN es
'E. ACCURATE AND COMPLETE. '(, "
/
- d /
ChenistrY ManaEer9 I AM AWAME MAT WEME ARE s"eaNmcmT PENAonEs con sueuiTTwo FAtsE seconuArioN. emetuDiMa -- -
- - /' -A (+12 393 2113 96 LL 20 THE PossueIUTv OF fin u.s.c. e isto. speamm.E.AfsD IMPRISONMENT.
.mewee m.s,EE 18 U.s.C a com sa e 81001
.e sAND 33 ro. cop S10 NATURE OF PRIIOCIPAL EXE TYPED OR PRWTED me er -
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.ra ee.n s en.nsne and a yemen.s AREA OFFICER OR AUTHORIZEO AGkfET CODE NUndBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# ettschenents here/
EPA Form 3320-1 (08-96) Previous odetions may be used. IREPLACES EPA FORM T-40 WDRCH MAY NOT BE USED.) PAGE OF
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. Paperwork Reduction Act Notice = ~'_
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i ? Public mpdrting t:un!- kr.this cc!!ection of infonnation is estirnated to vary from a range of 10 hours as an .
! ! average per remonse im vnw minor fxilities, to !!O bours as an average per remonse for sorde inajorfacilities, N.
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With.a weighted avera;;cfer. major and minottacilities of 18 hours per response, including time for reviewing
,instructinsis, hearching exitting data murces, gathering and maintaining the data needed, and completing and "
- reviewing thA callecti .n cf.infornution. Send comments regarding the burden estimate or 'any' other aspect of
' 4 lthis collection of infmnbt;on, including suggestions for reducing this burden, to Chief, Information Policy i
1 Branch,- PM-223, U.SJ Envimnmental Protection Agency,401 M Street, SW Washington, DC-20460; su2d to the y ! Office of Information ed Regulatory' Af fairs, Office of Management and- Budget, Washington, DC,20503, _ . _ _ . _ _ . a. _ _._ . _ . _ _ . _ . General Instructions 3
- Df form has hnen partially complcted by preprinting, disregard instructions directed 'at entry of that information a ready preprinted.
~
- 4. Enter
- Permittee Name/ Mailing Address (and facility. name/ location, if different)," " Permit Number " and . '
" Discharge Number" where indicated. (A separate form is required for cach discharge.) ,
3.' Ester dates begimEng and ending " Monitoring Period" covered by form where indicated. > s ! c
'4.'Erder eacli" Parameter" as specified in monitoring requirements of pctmit. +
- 5. :Er;ter " Sample Afmerement' data for cach parmneter under "Guantity" and "Guality" in units. specified in pennit r "dwrnge" is nonxmy arithmetic average (geometric average for bacterial parameters) of all sample measurements - l r
4 for ta;h paramets chtained during " Monitoring Permd"; "Marimum" and "Afinimum" are normally extreme high - > and low mentirements obtained during "Afonitoring Period." (Note to municipals with secondary treatment l frequirement: Ener ^.Hiay average of sample measurements under " Average." and enter maximum 7-day average , i of sampic measutsucnts obtdined during monitoring period tmdct?Marimum ") i6. Enter "PJrmit Reywrement" for cach parameter under " Quantity" and "Guality" as specified in pchnitf f
~
- 7. Underi"No Ex" crer number of sample measurmcots during monitoring period that exceed maximum (and/or l
' minimum or 7<!ay e crage as appropriate) permit requirement for cach paiameter. If none, enter "0"s
- 5. Enter " Frequency q/ Aralysis" both as "Nesnj>Ie Measurment" (actual frequency of sampling and analysis used - !
Waring monitoring penod) and as " Permit Rcquirement" specified in permit. (e g., Enter " Cont," for continuous i monitoring, "UP for one day per weck, *//30" for one day per month. "#90" for one day per quarter, etc.) . !
~
_ 9. Enter " Sample Dre" both as " Sample Measurement" (actual sample type used during monitoring period) and as
" Permit Requirement,"- (e g;, Enter " Grab
- for individual sampic, "24#C" for 24-hour composite, *N/A" for ;
i
; continuous monitonng, etc.) i I
, lof Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective !
actions taken, and reference each notation by dat i 11, If"no discharge" cccurs during monitoring penod, enter "No Discharge" across form in place of data entry. ! 12, Enter "Namemtie of Prmeipal Executive Oficer" with
- Signature ofPrincipal Executive ODicer ofAuthorized I
Agent, " Telephone Number," and "Date" at bottom of form. - (
, 13, Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your records.
- s. _ ,
R 14. More detailed instructions for use of this Discharge Af<mitoring Report (DMR) form may be obtained from Office (s) i specified in permit. i Legal. Notice ; Dis report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can [ result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day __ of violgtion, or by imprimnment for not more than one year, or by both. Q
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EPA Ferm 33201 (Rev,08-95) t t
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PEReMTTEE NAME/ADORESS(FacteMecerpAans/lecenau(fD@sar) $ FAT *ONAL POLLUTANT OtSCHARGE EUMfMADON $WTEM (NPDES / Form Approved. e NAME DtSCHARGE MONITOIUNG REPORT (OMRf OM8 No* 20N4 4+9%vr it,LLEY PN E9 '; T A T I 7 % 12-1 8/ 177-181 an?'ALL
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(30pp SS) N O PERMIT NUMBER DISCHARGE EUMBER y . 9gL
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J* i d i P P I $ ; ? 'J P T 'A 15377 MONITORING PERIOD "IU N
.EFV~' 7 h', LEY POWFR TT\*[7) YEAR MO DAY YEAR MO DAY __
LOCATION FROM a r, TO 8 tn 31 !s !/ 31 ces ;3 D i s r s A p '; c l So^
=**v.. *Tn a r t n 3 :. . (2G211 (22-23/ (24-25/ (26-27J (28-29/ 13!>31/ NOTE: Reed instructions before"EE.lAting this form.-
PARAMETER (3 ced on&s QUANTITY OR LOADING I4 ced on&# QUANTITY OR CONCENTRATM NO. FREQUENCY SAMPLE - 146-531 (54-619 (3e-459 146-531 154-61) OF (32-371 EX ANAtygs TYPE AVERAGE MAXIMUM UNITS MINtMUM AVERAGE ' MAXIMUM ONITS ,es.88 164-asJ (6s-7e SAMPLE
' t 1, N I ? ? , ert~ ;;In, MEASUREMENT enete- e-eye. 09deo: g gg ( ll) ~2.
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' f. 'ync ,r,9 SAMPLE n e+o- He e - nMee ( 14) g C. I y O, l 3 0 (a,_ l { )' ~
MEASUREMENT Q 3 rm o s ,7 j r 3 q PERMIT . cecet +cotee c +e> c t: 3 4 t:0 en3qr fl y 0 S T ;,12 7, R30
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77 , REQUIREMENT . 73 p . g r; pg gy yp g r, f 7 ;.= g y SAMPLE cnc~e'
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7 PERMIT 2 3 9 0: e +cecto s entech . ng g py. up3 S p W IG 3 7, D . REQUIREMENT 9fygy py g;fr e ei 4 - a , n .- y37 is ,m3 9p3 p $7 - ggy SAMPLE MEASUREMENT PERMIT REQUIREMENT t SAMPLE MEASUREMENT , PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT ' REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT l NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTtFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EKAMitvED AND ' TELEPHONE DATE AM FAMfuAR WITH THE INFORMATION SueMITTED HEREIN: AND SASED ON A MY INOLeRY OF THOSE INDIV IMMEDIA e/ g/ I' RESP FO D M Ic) A . Or ador t camN*Na = 'a'FeaMAnoN. . I.DUALSEuEvE = Su.TE.LYM TTED -,ON99LEORMAnON.R TRUE, ACCURATE AND COMPLETE. 4 AM AWARE THAT THERE ARE S ys, )
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(31C/y); $ h G f 7/ l} ff"" sGNmCANT PENALnES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE POSSBsUTY OF FINE AND IMPRISONMENT. SEE 18 U.S.C.11001 AND 33 i u 6- ~ ~ t } 2,J s O/ hp [} [g U.t.C.1 1318. smeneewe enfor omae sesame nwy hicese Ibies se so i70,000 SiONATURE OF PRINCIPAL EXECUTNE g TYPED OR PRINTED sas or mensawn _ x oraerween s measts sad 5 yearmJ OFFICER OR AUTHORIZED AGEftT NUMBER YEAR MO DAY CODE . COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s#ettschments treref EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE . OF
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l Pubhc reporting burden for this collection of mformation ia estinu:ed to vary from a range of 10 hours as an ' average jwr response for some minor facilities, to I10 hours as an average per response fe m major facibiles, with a weighted average for nujor and mmor facilities of 18 hours per reepons inclu. ling time for reviewing
, instructions, search:ng existing data sources, gathering and maintaining t!m data needed, and comp;eting and j reviewing the collection of information. Send conunents regarding the burden estimate or any odict aspect cf i
I this collection of infornution, including sugge.stions for reducing this burden, to Chicf. Information Policy
- thanch, PM-223, U.S. Environnwntal Protection Agency,401 M Street, SW Washingtoa, DC 20460; and to the Office ofIr, formation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
General Instructions l
- 1. If form has been partially completed by preprinting, disregard instructions' directed at , entry of that infornuttion already preprinted, i
- 2. Enter " Permittee Name3/athng Address (and facility name/ location, if different)," " Permit Number,' and I
" Discharge Number" w here indicated. ( A separate form is required for cach discharge.)
{
- 3. Enter dates beginning and ending "Alonitoring Period" covered by form where indicated )
- 4. Enter cach " Parameter" as specified in monitonng requirements of permit. l
- 5. Enter " Sample Alcaturement" data for each parameter under "puannty" and "Guahty" in univ. Sp<xified in pennil.- l
%erage" is nonnally arithmetic average (geometnc nerage for bacterial parameters) of al! nmple measuremnas !
for each parameter obtamed during "Monitonng Perm #; "Ahmmum" and "Ahmmum" are normally estreme high I and low measurements obtained during "A/omtonng Termd" (Note to municipals unh scaudary tJeatment ! requirement: Enter 30-day average of sample measurements under Werage," and cmcr mdmum My average ' of sample measurements obtained during monitoring period under "Alaronum ") . j
- 6. Enter "Pern a Requirement" for each parameter under *guantay" and "Gaahty" os speedied in pen,it.
- 7. Under *N r enter nundier of sample measunnents dunng ruonitoring period that excced maximum (and/or I minimum c -day average as appropriate) permit requirement for each parameter. 'If nane, cmer "T. j i
- 8. Emer. "Frr y of /nalp!s" both as
- Sample Afeasurment" (actu:d frequency of sampling aad analysis used I during mcr. ng pdod) and as " Permit Acqwrement" specified in pernut. (e g., Enter Tont
- for contmucus .
monitoring, ' i " for one day per week, "/S0" for one day per month, "1$0" for om: da3 per quarter,etc ) J
- 9. Enter " Sample 7)pc" both as "Samp!c Afeasurement" (actual sample type used during monitoring period) and as "Penmt Requircment " (e g , Enter "Grah" for indisidual sample, "2JHC" for 24-hour composite, TA" for continuous monitoring, etc.) !
i
- 10. Where violations of pennit requirements are reported. attach a brief explanation to desenbe cause and corrective actions taken, and reference each violation by date. j
- 11. If "no discharge" occurs dunng monitoring period, enter "No Discharge" across form in place of data entry
- 12. Entet "NamcHale of Principal Executwe Officer" with " Signature of Pnncipal Execunve Of;cer of Authori:ed Agent " " Telephone Number " and "Date" at bottom of fann.
- 13. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for 3our records.
l 14. 'More detailed instructions for use of this Discharge A/omformg Report (DAIR) form may be obtained from Office (s) specified in permit. Legal Notice This seport is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to xport truthfully can l result in civil penalties not to exceed $10,000 per day of violation; or in cnminal penalties not to excml $25,000 per day of violation, or by imprisonment for not more than one year, or by Imth. EPA l'orm 3320-1 (Rei,08-95)
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PERWITTEE NAME/ADOMSS WFeeskeyNo 'Lecersen(f&furwer) NATIONAL POLLUTANT OtScHARGE EUMeNAftces SYSTEM (NPDES / Form Approved. . NAME 4 ?AVi : ' Y 1 L 1. E Y POM'w2 ~. I* 3 I I y ~ DISCHARGE MONITORING REPORT (DMR1 (2-t er (t 7-79) M h r
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! T[i; 31./[D 3R4009y PERMIT NUMBER DiscHARot tuMsER p ..pgggg o ,
m a r i * [ 9 ; e 1 a ;* 'e 1;"7' MONITORING PERIOD "^3M 4 '"# :, f \ 7 Y ' 7AL1LT r3W 3?ATI3~ YEAR MO DAY YEAR MO DAY LOCATION FROM ,e *~ - TO ws ;a tt 633 .n a ! $ ~ '8 g ? C I' ( { 70$ ,' .-% . ~,ser4 , n, . r-(2G21s (22-231 (24-251 (26-271 (28-281 (30 3tj NOTE: Reed ineeuctions tiefere[. completing this foFm. (3 Cent On/pl QUANTITY OR LOADING I4 conf Oa/rs QUANTITY OR CONCENTRATION PARAMETEP' 146-531 (54-619 (3e-461 NO. mEoumcY SAMPLE 146 631 (54-619 OF f32-371 EX TYPE ANAty,3 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS m.as, toe-sei res- m
.a SAMPLE 339yee anti 3e +;;e; 4 ;;)
MEASUREMENT
} PERMIT e.ngp e I ' 329- [ } - 3ep%e .o 13 ,,9 mp; ggp g <
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REQUIREMENT rr.,, m ,, 93, ~ge y s ,. ,y 3 gg g yg py ,
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,3 sc 3 3 9 PERMIT q ega+ rear, 7 v ceenes a c e :: *- 0 e -y e o w set 3 3,g L t 37I;4
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3,3e 93,,: REQUIREMENT ,3 py- p 3 7, y yg ,n to?2 SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE i MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT n NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER 8 CEMT5Y UNDER PEN ALTY OF LAW THAT I HAVE PERSONALLY ERAMmED AND ' TELEFNONE DATE AM PAMtuAR wtTH THE INFORMATION SUSMfTTED HEREM: AND SATED ON MY INQUetY OF THOSE fMDIVIOUALS IMMEDIATELY RESPONWBLE FOR p
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IJ av l u, DeTAmmG THE INFORMATION. I BEUEVE THE SUBMITTED WFORMATION tS / Urnder1 TRut. ACCURATE AND COMPLETE. t AM AWARE THAT THERE ARE '!- SIGNIFICANT PENALTTES FOR SUBulTTmG FALSE WFORMATION, WCLUDmG g -, t I /7 , Chenistr.y Etnager T -" ~~ i 17 101-;i1] % }l "h THE POssetUTY u.S.c. e 13to. aa OF FmE AND IMPRISONMENe. s mer icae mien seSEE so s19 U.S.c. 91001 70,000 "SIONATUREANO 33 OF/ PRNOCIPAL EXECU't.fVE 4 TYPED OR PRINTED maa er mensmen n mas. m. eseasw r a.rw. ewee. e monene scene saa s yearmJ OFFICER OR AtJTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# effechments herof
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1 i<ej. y - EPA Form 3320-1 106-96) Previous ed tions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
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....--%-...-p.-.,m.%+-4 ~.a.,w - #. .~- , , . . - . w w.c ,-+-@- ---3 Paperwork Reduction Act Notice a 'f-i
!public reporting burden for this collection of infornution is estimated to vary from a sange of 10 houn as an i ia% rage per responw for mme mim facilities, to 110 hours as an average per response f ar somo msjor facilities, Iwith a weighted average for major and minor facilities of 18 hours per response, includmg titz for nviewing l
- instructions, searching existing data murces, gathering and maintaining the data needed, and annp;eting an.1 i
, reviewing the collection of information. Send comments regarding the bun'en estinute er any otha aspect of {
- this colkrtion of information, including sugge2.tions for nxiucing this burden, to Chief, inf ormation Policy Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC MW); and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20$03.
General Instructions i
.e
- 1. If form has tem partially completed by preprinting, disregard instructions directed at entry of that information already preprinted.
- 2. Enter "Permitter NameiAlailing Address (and facihty namcilocation, if difTerent)," " Permit Number,* and .
"hischarge Number" where indicated. ( A separate fonn is required for exh discharge.) l i
e i
- 3. Ehler dates beginning and endmg "Afonitanng Period" covered by form where indicated
- 4. Enter cach " Parameter" as specified in monitoring requirements of permit.
5 Enter "Samp/c Alcamrement" daa for each parameter under "(!aannty" and "Guality" in unds rprified in permit !
"herage" is norm tlly arithmetic average (geometric average for bacterial parameters) of all imple neasmements ,
,. for each parameter obtained during *Afonitoring Penod"; "Afartmum" ;md "Afinimum" are rnrraally extreme high t and low measurements obtained during "Afumtonny Permd * (Note to municipals with seccndary treatment ; requirement: Enter 30. day average of sample measurements undct "Awrage." and en:ct muimmu 7-dzy average of sample measurements obtained during monitoring period under "Alarimum ")
- 6. Enter " Permit Requirement" for each parameter under " Quantity" and "()aality" as specdied in penoit. ;
,7.. Under "No Ex" enter number of sample measurments during momforing period that excced rbaximum (and/or .
minimum or 7-day average as appropriate) permit requirement for each parameter. If rione, ent:r 'tr.
- 8. Enter *Tecquency cf Analysis" both as " Sample Alcasunnent" (actual frequency of sampling aad analysis used ,
during monitonng pdod) and as "Penmt Requirement" specified in permit. (e.g., Enter
- Font " for continuous ;
, monitoring, "//7" for one day per week, "ld(r for one day per month, "130" for one day per quarter, etc )
- 9. Enter " Sample 7)pe" both as " Sample Aleasurement" (actual sample type und during monitoring period) and as !
."Permit Requirement," (e g., Enter "Grob" for individual sample, "J.slK'" for 24-hour composite, "N/A" for contimious monitoring, etc.)
- 10. Where violations of permit requirements are reported, attach a brief explanation to describe cmtse and corrective actions talen, and reference cach violation by date. ,
i1. If"no discharge" occurs during monitoring penod, enter "No Disthame" across form in placc of data entry.
- 12. Enter "Namemtle of Principal Executive Oficer" with " Signature ofPrincipal Executive Ofiar ofAuthori:ed
-Agent," " Telephone Number," and "Date* at bottom of fann.
- 13. Mail signed Report to Office (s) by date(s) specified in penuit. Retain copy for your records.
- 14. More detailed instructions for use of this Diuharge Afonitoring Report (DAfl0 form may be obtained from Office (r) specified in permit.
Legal Notice his report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penaltics not to excmd $25,000 per day of violstion, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95) ,
PERMITTEE NAME/ ADDRESS (Fwh6herpNewEarer#me(fD@wer) 3:ATIONAL POLLVTANT DeSCMARGE EUMWATiON SYSTEM (NPDES) Form Approved. M
- N2.ME $pqg y . , , ,g .g 3 . 7-.
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LOCANN
-. 3iy- 3 3,sn,3e FROM t fio2rs r22-23; (24-251 TO ar 1 .
(26-271 123-2s/ (3&3,j i; e er & 4; n T : . O g i n r c. [] NOTE: Reed instructions before completing tNo form. MN , r3 cmf orWs QUANTITY OR LOADING #4 Cent 0,Ws QUANTITY OR CONCENTRATION NO. mEowNcY PARAMETER or SAMPLE (4 & 5 31 154-691 (3e-451 f46-c3) (54-671 (31-371 EX myS,3 TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,es.sm gg,_gg, fgm
, SAMPLE ne+e- #- o 'r ? ; r $$ aw wr { 12) ~
MEASUREMENT l 3 3, ; , PERMIT y e. e p , 934.95 e .3e ,,g- c em 7 ); y,- - ; ;pty7 qq e ; -. . . , . , , . y3 . , - REQUIREMENT gy $7,73yy a3y73g, ,p 7 ;, r p m , a g r *, L SAMPLE r ee-~~ 3 ,. ~ 3 y c e, 3 e 2 3 ( igy 3pq MEASUREMENT
$ 373 [ T 9 PERMIT ' enecta $3+cao e 3- c o g n e r; ;3 ;g7 , aggy ggg &
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77 g4p ,gg3 r MEASUREMENT neett3 ( 74) (* .) N ~- t r q. .r,,,ty is, 395e [ ] p PERMIT en9 ?
- S M ) 6 1 ) *- 97?a06 '% ?Q .
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MEASUREMENT se+3e3 e >+ $ y e -; t e e g 3 ( 19)
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ntnmer .33n, g e ,y m ggg. y ,. 3 y7 g-t . .- 33, ,, , ,i REQUIREMENT x , q9 3 , ,. , ., 7 ,;3 y
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,aws' [ 1 PERMIT eeeP& *c*AMt t;r 'Se cc$Ser* ),3 [ , j r, 3gLg .4 g 3 cp, , p , ,- r3, g; REQUIREMENT r33 4q g 7 r; 7yq py . ., j p NAME/TTTLE PRINCIPAL EXECUTWE OFFICER e CERTWY UNDER PENALTY OF LAW THATI MAVE PER50 NARY EXAMMED AND TELEPHONE DATE 0,2v id p _ t.ndo r i e
AM FAMtuAR WITH THE INFORMATION SUBMITTED MEREiN: AND BASED ON M,Y,,I,NQUIRY,o ,yy,OF fMDIVfDUALS IMMEDIATELY RESPONSISLE FOR
,THOSE i.
[h I o OmaATiON. SEUEVE THE SUBMITTED INFORMATION IS M. m m. ACCURATE AND cOMmTE. AM AWARE MAT MERE AnE ' chenistrv Mannber s SIGNIFICANT PENALTTES FOR SUBMITTING FALSE INF081MATf0N. INCLUDING j . /gg - TwE POssieruTY OF emE mD iMeniSONMENT. sEE is u.s.c e tooi mD ss ; 41nt .M .3-51L3 96 11 96 u.S.C. e 1 sis. sRea pri.e e,Mer snese seerwee, mer sicaww sa se so a 70.000 SIGNATURE OF P9tWOCIPAL EXECUTNE gg,, TYPED OR PRINTED mat er manenee's ! : steerwesa s mearns amt s yearms OmCER OR AUTHonlZED AGEAT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# ettechments herel E F ' 5 4 .', T ' ' (4h 3n"75 TA - ) 4 E T ) 'I 4 ' ?" '
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lAdC bf Auf A b; 3 IE3.-7. 3 [ N ', ()& , EPA Form 3320-1 106-951 Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF cF197/ %13'i-09t1 1 _ --_m_ _ . _ _ _ _
( - 1 i l 1,aperwork Reduction Act Notice . . _ 1 NW reportig Lunt n i thk conection of information is u.tinuted to vary from a range of 10 hours as an
! rn t rge pa resjenae f ; 9 me, mmor frilitics, to 110 hours as an average per response for some major facilities.
{ l
; v.uh a weidted a crg - is ma;or and minor facilitin of 18 hours pcr response, including time for reviewing l im nctions, mothin: sting M sources, rathering and maintaining the data needed, and contpleting and ; mimiy Jhe cal!ctra of infurn.rion. Send umunents regarding the buden estimate or any other aspect of ; ; thh m!!a tion of inham.u on, h& Jing suggestions for reducing this burden, to Chief, Information Policy l i Bomth, PM423, Ul Envuomncntal Protectwn Agncy,401 M Street, SW Washington, DC 2040; and to the l
r Office of Information ed Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
.. . , _ . , -m _ - . . . _ . . _ _ . _...m.-.
General Instructions
- 1. If form ha been pni;dly empletcJ by prcprinting, disregard im,tructions directed at entry of that infornution aheady preprinted.
- 2. Enter "Permitrec .iotec %failmg .f./ dress (and facihty n:une/ location, if difTerent)," " Permit Number," and
"/Aschmge Numb " u hcrc indicalci ( A separate form is required for each discharge.)
- 3. Er r dates begme. y and ending "Afonitormg Period"coscred by form where indicated.
- 4. Enter a h "Porm.,crer" as spe;.ified in momturing requirements of permit.
- Enter %npt Af cr< ment" d na fu coch panmeter under "Quantay" and "Guality" in units specified in permit 1 m u e' 's non 9 .nuhnxIk acranc (gemoctoc average for bacterial paramden) of all sample measurements ;
fo. cat h paramet - ALmied dming "3/mitoring Perm /% "Afarimum" and *Afinimum" are normally extreme high an ! inw measurs - "ts obtained during "A/vmtorine Period" (Note to municipals mth secondary treatment rapmement. Enr % day nerap of suupt: measuren,ents under "Arcrage " and ceter maximt.m 7-day average
- of sample measuu ants obtained dunng munitoring period under "Alaximum. ")
k Emcr"Permn Re pnem n! fer crmh parameter under "guantay" and "(haldy" as specified in permit. i
- 7. Under "No Ev" u nun,tcr er sample me.nurments during snonitoring period that exceed tunimum (and/or l minhnum or 7-de .n crage as appropriae) permit requirement for each parameter. If none, enter "0".
8, Enter "l rapwnq drah w both as "Nmnple A!cmurment" (actual frequency of sampling and analysis used I uaring mondorms penod) a. m */'ermit Requircmcnt" specified in pennit. (e g., Enter " Cont," for continuous ! momtming. "10* er one day per week, "b30" for one day per month, *l/90" for one day per quarter, etc ) j l
- 9. Enter " Sam;>lc &; ^ toth as %m/ eJMcawrement" (actual sample type used during monitoring period) and as i
" Permit Requircms nt.* (e g., Et:ter " Grab" for individual s;unple, *24/IC" for 24-hour composite, "N/A" for I contmuous monitosing., etc.) !
' ltt Where violations of pennit requirements are reported, attach a brief explanation to describe cause and corrective actions talen, and reference exh violation by date.
I1. If "no discharge" ou:urs during monnoring period, enter "No Discharge" across form in place of data entry. ! i' 12 Enter "Nwne 7'ale n] Prmcipal Execzaive O/Jicer" uith
- Signature of Prmcipal Executive OjJicer ofAuthori:ed Agent,*
- Telephone Number,* and *Date" at bottom of funn. ;
1
- 13. Mail signed Report ta Office (s) by date(s) specified in permit. Retain copy for your records. j
- 14. More detailed instnctions for use of this Diuharge Alomtoring Report (DMR) form may be rhtained from Office (s) specified in permit.
Legal Notice This report is required by law (33 UAC.1318; 40 C.F.R.12.5.27). Failure to report or failure 'o report tmthfully can result in civil penaltic.s nat to exceed $10,000 per day of violation; or in criminal penalties not to e tcml $25,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95)
PERMfTTEE NAME/ADDRE23WFeresphwl.mne (Debmw) ut.TIONAL POLLUTANT OFSCHARGE ElmAWAT'ON SYSTEM (NPDESJ Form Approved. , NAME 5 g. fyLL g 7,; ;og.y,. DISCg E MONIMING REPORT ttr(Dg OMB No.;2040 COO 4 a tE mr ,, t t -se APPv '"P 'ee i oS a AcoRE p , n ,; ,
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- YEAR MO DAY YEAR MO DAY LOCATm FROM sx * ,
i, TO 4 > 1 1* tcS .7 J ! e C H P , ^, 5 h j ^cc e . --- . e4 3 , ,3 -r (2G2TJ (22-231 (24-251 (26-271 (28-29/ (30'371 NOTE: Reed instructione beforeE atbii this form. ' (3 Cod Orvyt QUANTITY OR LOADING I4 Cod On/yf QUANTITY OR CONCENTRATION PARAMETER (46-531 (54 61) NO. FnEOurNcY SAMPLE (3e-459 (46431 (54-6 t9 oF (32-37j EX ANAtyS,, TYPE AVERAGE MAXIMUM UNITS MIN! MUM AVERAGE MAXIMUM UNITS c.43' (s4-esi (63-7cp
; SAMPLE +37,~ e~33- ,. ~ ; 7' y7g MEASUREMENT 33, -j PERMIT 935 . .
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; i; I 3. PERMIT u t n e .= + yn-ees ; .$- O * ? $ c- r- t3 yyLy L;3
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, PERMIT ~.;ey. a. #. *, 9 S e- u l'~ t- ? $ a.
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REQUIREMENT n e n. c t. $7733
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7,r ; , , , , n,,,y ,_ yp e SAMPLE MEASUREMENT PERMIT . REQUIREMENT s SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CENTIFY UNDEM PENALTY OF LAW THATI HAVE PERSONALLY EXAMtNED AND 1 1 / ) TELEPHONE DATE AM FAMlUAR WTH THE INFORMATION SUBMtTTED HEMi!N; AND BASED ON .1 ) I Dayid Orndorf MY INQUtRY OF THOSE INDIVIDUALS fuMEDIATELY RESPONSIBLE FOR CeTAINING THE WFORMATION, a BEUEVE THE SUBM!TTED INFORMATION IS 'd#-j t.heul s t ry Ilem.igGT
, Tnut. ACCURATE ANo COMPLETE. I AM AWARE THAT THERE ARE SIGN'FICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING # (~' " ) A
[2 393*)113 lb 11 2. b THE POSS!SillTY OF FfNE AND IMP 9USONMENT. SEE 18 U.S C. 91001 AND 33 U.S.c. 9 1318. #Asammes enwar e=se scannes mer hireme Kswa se so #F0,000 SiONATURE OF PRINCIPAL EXEh pg TYPED OR PRINTED w ormsnmium w .-. .: er eerweea a mamn w s yearms omCER OR AUTHORIZED AGElkT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# sttschments here/ Q } b C l% <t r m t' EPA Form 3320-1 (08-95) Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
'?11't/7611S] *! 33 1
y .,A..~_ , . . , - _ . .~ . _ . _ . _ - _ _ _ ~ ~ . - - . - e W-~e -p g**q l Paperwork Reduction Act Notice - . 4-puH . re;istir g burd.- fa this wilection of mfonaation is estinuted to vary from a range of 10 hours as an
- awog per rup<mse f, wmc minor facilitics, to 110 hours as an average per response for some major facilities, i ub a weighted avmp k r major and ndaor fxilities of 16 hours per. response, including time for reviewing
! in Uructions temhiq rtioing data snurces, patbering and maintaining the data needed, and completing and i . reviewmg the udlectior. c! mfondion. Send commer.ts regarding the burden estimate or any other aspect of this co!!u tion of infanntion, irz!uding suggetions for reducing this burden, to Chief, Information Policy l
Branch, PM-223, U.S En.ironmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the LOffice of uformation wJ Regulatory Affairs, Office of Management and Budget, Washington, DC 20503,
- l. -_ __ . _ . _ _ _ _ _ . _ _ _ . . . _ ~ _ . . . _ _
, General Instructions
- 1. If form hu been arti.dly completed by preprinting, disregard instructions directed at entry of that information aheady preprinted.
- 2. Enter "Perminee NamccMmling Address (and facility name/ location, if different)," " Permit Number " and
" Discharge Number" dere indicated (A separa:e form is required for each discharge.)
- 3. Enter dates beginWg and endmg "Monitormg Period"cmered by fann where indicated.
- 4. Enter each "Paramtcr" as specified in monitoring requirements of permit.
- Ercr "Lmfelc M _ vrement' data for each parameter under "Guantity" and "Gunhty" in urdts specified in permit.
"has " *s nono n y anthmaic averagc (gemnetnc merage for bacterial pararneters) of all sampic measurements foru n parameto cMrned daing "Momtoriog Permd" "Maumum" and " Minimum" are normally extreme high and low mcasurenats obtained daring "Momtormg Period" (Note to municipals with secondary treatment requit ement: Enm % day average of sunple meannements under " Average " and enter maximum 7-day average of ample measwaunta obtained during mamtoring period uudct "Mariman ")
f> L Emc r "P,* nut Re fc reu nt" for cach parameter under "(Juantay" and "Guahty" as specified in pennit.
- 7. .Under "No &" ,er mm;ber ci s.unple measurmcms during monitoring period that exceed maximum (ank%r '
minimum or 7-d;g, netage as appropriate) pctmit requirement for each parameter. If nore, enter "0". S. Enter */hquency of Aralpn" both as %np/c Menniement" (actu:d frequency of sampling and an:dysis used uring monitoring good) and as " Permit Rrquirement" wecified in permit. (e g., Enter " Cont," for continuous monitoring, "19" for one day per weck, "lSU" for one day per month. "l/90" for one day per quarter, etc.) 1 Enter Wnple 7)pe' both as " Sample Measurement" (actual sample type used during monitoring period) and as "Pcennt Requin mcnt " (e g., Enter " Grab" for individual sample. "24/IC" for 24-hour composite, "N61" for contirmous monitoring, etc.)
- 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions takt n. and reference cach violation by date.
I
- 11. If"no discharge" omurs during monitorin3; period, enter "No Discharge" across form in place of data catry.
- 12. linter "Name'7itle of Prmcipal Erecutwe Officer" with " Signature of Prmeipal Executive Oficer ofAuthorized Agent " " Telephone' Number, and "Date* st bottom o[ form 4
13, Mail signed Report to OfDee(s) by date(s) specified in permit. Retain copy for your records.
- 14. More detailed instructions for use of this Discharge Momforing Report (DMR) form may be obtained from OfEce(s) spedfied in permit.
Legal Notice ; His report is required by law (33 U.S.C.1318; 40 C.F.R.125,27). Failure to report or fadure to report truthfully can resu!t in civil penalties not to exceed $10 000 per day of violation; or in criminal penalties not to exceed $25,000 per day of vhylation, or by imprisonment for not more than one year, or by both.
+
EPA Form 33201 (Rev. 08-95) i
l PERw:TTEE NAME/ADDRESSGaru,Fershe=N =eweene= gfD@eWJ NAME.NaFtVC{ (ILLLET PTt"P i'\"[JJ IMTIONAL POLLUTANT DISCMARGE ELrumATIO8e SYSTEM (NPDES / DISCHARGE MONITORING REPORT (DMRf (2-7 61 (77-791 JSIT 1 SFRE*E 9 LV -- s g g ggg ' g
~ Form Approved.
^PP l ADORE 03 ;j 3. g)y :3 r*'*'CC' E C"9 '
(SUM' ^ 5) Y. 'I A ? I' N ; 3 A tr I O 33100 ;p PERMIT NUMBER DrrewARGE NUMeER l p ,-p{qg( -- l 9 '! I ? S [
- l i' O D " 3 1 $ 7 7 MONITORING PERIOD E3 %
FACIWW j q.3973 g3LL{y ,3y7, ;7g.I3* YEAR MO DAY YEAR MO DAY % LOcATm 1 a a I e ~ e ; a 1 *- lh.l oe? FROM ., ;. i1 To a, 1 ti t*: ,j \ #vvu. nnyTs n; ,,n * (20 211 122-23) (24-25) 126-279 (28-29) (30"311 NOTE: Reed m MM %% % Mm. PARAMETER 13 Cerd Ontyl QUANTITY OR I.OADING I4 Cerd Ontyl QUANTITY OR CONCENTRATION NO. MEQUENCY 14 s-5 31 (54-61) 13e-461 146 531 154-6 tl CF SAMPLE (32-371 EX analyss TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,Es.43) inses (s m
-) } [ q : , *)p3g SAMPLE 3**r- >1 e e t t : ~;-w;;s ( [qg '
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SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT - REQUIREMENT SAMPLE s MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT, NAMERITLE PRr1CFAL EXECUTIVE OFFICER e CERTIFY UNDER PENALTY OF LAW THATI HAVE PERSONALLY EKAMINED AND TELEPHONE DATE AM FAMILIAR WITH THE MFORMATION SUOMITTED MEREIN: AND BASED ON O DOV1d O!'UdOT( MY INQUtRY OF THOSE INDIYtDUALS IMMEDIATELY RESPON98LE FOR 08TAWWG THE WFORMATION, t BEUEVE T)*E SUtutTTED INFORMATION IS --[ // j h' V/
/
TRUE, ACCURATE AND COMPLETE. ChCINPlTV M 3D ft{ O F I AM AWARE THAT THERE ARE 9GNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDWG .
! /k' A" -g- " #
# 4 t
Tsf Pos9etWTY OF FWE AND IMPRISONMENT. SEE 18 U.S.C. 9100,1 AND 33 seONATURE OF PRINCIPAL EXECUfNE
+-2 .W3-5113 96 !'- ?n TYPED OR PRINTED u.s.C.
ene e 131o. er mese =en sesa
- Mee- easw swee asunme e menenor.e Nr aca,se remssw is, n sto. coo g
_ ; er eerwe OmCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference of ettschments herof 27 fh~ f /f $ .. s A EPA Form 3320-1 (06-96) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE g) ,ggz y OF
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Paperwork Reduction Act Notice .4 L. - Pubbe reporting burden for this collection of information is estinuted ta ury f rom a ange d to hours n an , average pu response for some rninor facdities, to 110 Inurs as en average per response f ar wna nojor f acilities l with a weighted everage for nulor and minor faalities of 18 hours per respon.tc. including tire for avising instructions, searching existing data sources, gathenng and nuintaning the data reedd and cmrp4etieg and l reviewing the collection of information. Send corrunents regarding th: burden catinute or 2:n cdwr vrut ut l l this collection of information, including suggestions for redacing this bu den, to Chief, InW4 mat,an Policy l l Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, r>C 20460, and to the l Office ofInformatmn and Regulatory Aflairs, Office of Management and Budget, Washir gton, DC 20'.0L L __ ___ _ _ . . _ __ . _ _ _ _ . _ _ _ _ _ . _ _ . . . _ . _ _ - _ _ . _ _ _ General Instructions
- 1. If form has been panially completed by preprinting, disregard instructions directed at erary of that infomution already preprinted.
- 2. E ter "Permince Name Alm!mg Address (and facility name/ location, if different) " " Permit NomAcr," and
*Dixharge Number" w here indicated. (A separaic form is required for cach discharge )
- 3. Enter dates beginning and endmg "A/omtormg Permd" covered b3 form u here indicated.
- 4. Epter each " Parameter" as specified in roonitoring requirements of pennit.
5 Enter "Sampic Afeau.rement' data for cach parameter undcr "Unantay" and "pvality" in uns specified in pcnmt.
% crage" is normaHy anthmetic average (gecatric average for bacterial parameters) of all mraph meawematt foi cach parameter ot) tamed during "Afamtormg Pcrimt , "Afamen" and "A!imm.d are rormally evreme high and low measurements obtained during "Alemuormy Permd" (Note to muniapak with setoadm nentmem reqmrement Enter 30-day acrage of samp!c mesurements urider "Arcr2ge." and enar maunnon 7-dc average of sample measurements obtained during monitoring period under "Afaumum ")
- 6. Enter " Permit Requirement" for each parameter under "guantay" and *puality" as speafied in penait
- 7. Under "No Er* cnter number of sampk incasurments during monitoring penod th t excced maimum (aalor rninimum or 7-day average as appropriate) pennit requirement for each pa<ameter. If r.one, en:er "0".
- 8. Enter "Frequemy of Analysiv both as " Sam;de Afeasurment" (actual frequency of sampling and analysis used during momtoring p.r od) and as " Permit Requirement" specified in pamit. (e g, Enter *t bntf for continuous monitoring, "l& for one day pcr ucck, "1JU" for one day per month, "lMU" for one day per quarter, etc.)
- 9. Enter " Sam;)!c 7)pc" both as "Samp/c 3/casurcment" (actual sample type used during monitoring period) and as
" Permit Regwrementf (c g.. Enter " Grab" for individual sampic, "211K" for 24 hour cnmposite, 'NW for continuous monitanng., etc.)
- 10. Where violations of permit requircruents are repyled, attach a brief explanation to dscribe cause and corrective actions taken, and reference cach violation by date.
I1. If "no discharge" occurs dunng monitoring period, enter 'No Discharge" anoss fonn in place of data entry l2. Enter *Namemtle of Prmeipal Executwe Officer" mth " Signature of Principal Executive 0lYicer of Athori:ed Agent,"
- Telephone Number," and "Date" at bottom of form
- 13. Mail signed Report to Office (s) by date(s) specified in penuit Retain copy for your records.
- 14. More detailed instrucuons for use of this D3 charge Afom!oring Report (DAIR) fann may be obtained from OfficeO) spectfied in pennit.
Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can resul:in civil penlues not to exceed $10,000 per day of violation; or in criminal penalties nut to exceed $25,000 per day of violation, or by imprisonrnent for not more than one year, or by both. EPA Form 3320-1 (Rn,08-95)}}