ML20138G170
| ML20138G170 | |
| Person / Time | |
|---|---|
| Site: | Beaver Valley |
| Issue date: | 03/31/1997 |
| From: | Legrand R, Orndorf D DUQUESNE LIGHT CO. |
| To: | NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM) |
| References | |
| NPD3VPO:0669, NPD3VPO:669, NUDOCS 9705060190 | |
| Download: ML20138G170 (63) | |
Text
{{#Wiki_filter:- . - - , - . . . - ~ .. - . - . _ _ . . _ - . . - . ~ . _ ~ _ . ._ -- ._ _ a j^ Beaver Vs ley Power Station Shippingport. PA 150774)004 i 1 RONALD L L eGRAND (412) 393-7622 Division Vice President - Nuclear Operations and Plant Manager Fax (412) 393-4905 April 28,1997 NPD3VPO: 0669 l 1 i l 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. I and No. 2 BV-1 Docket No. 50-334, License No. DPR.66 i BV-2 Docket No. 50-412, License No. NPF-73 i i
Dear Sir:
Enclosed is a copy of the NPDES Monthly Report as submitted to the Pennsylvania Department of Emironmental Protection. Sincerely.
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Ronald L. LcGrand Division Vice President Nuclear Operations j i f SLV/tts I
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cc: D. A. Orndorf ! J. A. Cool R. K. Brosi Central File DEME 0NG l OUALITY 9705060190 970331 PDR ENERGV
" ADOCK 05000334
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. Beaver Valizy Power Station Shippingport. PA '507764 RONALD L. LeGRAND (412) 393-7622 j Division Vice President - Fan (412) 393-4905 Nuclear operations and Plant Manager April 28,1997 NPD3VPO: 0670 4
I United States Environmental Protection Agency l Region 111, Pennsylvania (3WM52) i 4 Water Permits Branch l Water Management Division 841 Chestnut Street Philadelphia, PA 19107 i i i EPA Permit No. PA0025625 Reportable Occurrence l
Dear Sir:
As required by the EPA Permit No. PA0025625, the following information is provided in regard to a reportable occurrence at Beaver Valley Power Station. On March 3,1997 the pH limit for the effluent of Discharge Monitoring Point i13, exceeded the allowable muumum of 6.0, when the pH was measured at 5.48. 1 1 Investigation into the incident revealed that nitrification is occurring in the treatment process and resulted in the abnormally low pH. As a result, we have initiated a program of adding sodium bicarbonate to the Unit #2 STP aeration tank for stabilization. A subsequent sample on March 4 had a pH of 6.48 and the system has remamed in compliance since that time. 4 0EllVERING Q U A LliV ENERGV
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]; . + i t ! I i April 28,1997
- NPD3VPO
- 0670 Page 2 j If you have any questions concerning this report, please do not hesitate to contact David A. Onxiorf i
- at (412) 393-5113.
I Sincerely,
- C0 rn. y , .
Ronald L. I#srand l Divison Vice President
- Nuclear Operations i
.; SLV/trs i i cc: D. A. Orndorf i J. K. Cool j R. K. Brosi Central File - Keywords: NPDES Reportable Occurrence 4 I f
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. .vir Vallsy Power Station SNppingport. PA 15077-0004 RON ALD L. LeGRAND (412) 393 7622
. Division Vice President . Fax (412) 393 4905 Nuclear Operations and Plant Manager April 28,1997 ) NPD3VPO: 0667 ; 1 l l , 1 3 I United States Environmental Protection Agency l , Region III, Pennsylvania (3WM53) 1 Water Permits Branch i Water Management Division 1 4 841 Chestnut Street l Philadelphia,PA 19107 l 1 NPDES Monthly Reoort. EPA Permit No. PA 0025615 i
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. 6 Sincerely, h, .a f4 Ronald L. LeGrand
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Division Vice President Nuclear Operations 4 4 SLV/trs
! Attachment 4
cc: D. A. Orndorf J. A. Cool [ R. K. Brosi Central File DEllVERING ENERGY
j sea <srvs.izy pour station i Shippingport, PA 15077 6 4 1 1 RONALD L LeGRAND (412) 393-7622 j i Division Vice President - Fax (412) 393-4905 Nuclear Operations and Plant Manager i ! April 28,1997 NPD3VPO: 0668 4 Attention: "DMR Clerk"
! Department of Environmental Protection Bureau of Water Quality Management 400 Waterfront Drive Pittsburgh,PA 15222 NPDES Monthly Report. EPA Permit No. PA0025615 Gentlemen:
NPDES Monthly Report for Duquesne Light Company, Beaver Valley Power Station for March 1997 is submitted for your consideration. Sincerely,
- a fy ~
Ronald L. LeGrand Division Vice President Nuclear Operations SLV/tts Enclosure cc: D. A. Orndorf J. A. Cool R. K. Brosi central me DEllVERING ENiR6Y
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COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refererece s# stischments herof i EPA Form 3320-1 (08-96) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE
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' 2. Enter " Permittee , Name%ihng Addren (and facility name/ location, if~ different)," " Permit hber." and ;
if>iScharge Number" w hete indicated (A septuate farm is required for exh discharge ) 3 - ! 4 b , 3DEnter dates beginning and ending "Af4mitormy Period" covered by forrn w here indiced , ,
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l %rrage" is normally animatic mrragr (geometric hemge for bastial pn -ters) of au swple tosuramee j ! for each parameter obtained dunng Sfomtarme Ferm#, Starrmm" mid "t/nN are nondnUy cite:x idth i and. low inemurements obtained durir:g 3/mitsring Period" Obr t, mm e:ipi ubh r ett7 tratmeri: y recour: ment: Enter 304ay xcrage of sample maturements unir Werny." acci emcr mnimurri 7Cy avenn of sunple meanucmcas obtained dunng monitoring p:nad undct S /atme 1 l
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- Kame 7 hie of Prmcipal Execuuve Officer" with' 'Sgnature of Prmnpal Erscwe nyrcr W Arthome:i i l Agent * ' Telephone Number.* and *Date* st tns:am of form l i
! 13; Mail signed Report to Officc(s) by date(s) specified in p:rnut. Retain en;ty far your recorn ' l
- 14. More detailed instructions for use of this Dischcq Afo utorag Rc;st (D3fR) farm may be o%iNd i:om Oke; specified in permit.
p j Legal Notice ! l Thifreport is nx;uired by law (33 U.S.C.1318; 40 C.F.R.125.27). Fadere to r port or fadure to report rmthf any can [ result jn civil penalties not to exceed n10,000 per day of viabtion; or in crimiral p:nalties not ta exced $4000 per day f- of vichtion, or by'imprisonnwnt for not more than one year, or by inth. i j V EPA Form 3320-1 Otcr. 08-95) !
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Branch, PM-223, O.S-. Envirdamenbl pmtection Agency,401 M Stred SW Wubbr.w. DC ?ma eM to the j Othde of Information and Regulatory Affaint, of fice of Manapment and Budget. Waaintn DC 20503: l _ a
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General Instructions ! r- l L11 form has been partially completed by preprinting, disreptd instaktions dicatal at entry of tbd mformation j
~ Already preprinted. i l
{ Enter " Permittee Name Maximg Address (and facility namellacation, it bilesent): "PermHINend.crl and l "Ducharge Number" where indicated. (& separate form is required for och discharge.) , l
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- 3. En er dates beginning and endmg "Monuoring Permd"encred by fonn where inMid f J
4 Enter each " Parameter" as sp<xified in ponimring requirements of permit. t,
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- 5. Exter "&m/ de Memuremera" data for cach parameter undcr "gunmin" and 'N6g ' ia units gecifirti in parm.t -
"Averace" is normally mithmetic accrage (reometric average far L:criM par:r J:m of Mi simpY rauremen9 fer each paratileter obtained dming "t/cmlamp Permd",fMane " ml "M" j
' ~ MSrn dl.i oircrat hirl and law measuremcats obramed during "M:muurmy Peruni" (Note to ro -ipa uith emch: 1:r.:dmt re !
ren,wrement Enter 30, day average of sample- umamrements nuir "Acra- " rd em r umiu mu N q mrare l orsaru;4c mcasuremcots obtained during monitoring period under "Marm m "1 j
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(,. Edter (Permn Reptremfn!" fer each parametes un&r "puxt;tf and "On!W us qmucd ir rent )
? Undcr "No IY enter number of sample e murmen's dmmg raonnming permd iH eM nterri Andbr f
. minimum or 7 day average as hpprepriale) pennit requirenx:nt int en:h panmeter. Ifi me. ener "D1 j i
- t. Enter; 'Frepency eg Analysit both as " sample Meaurment" (xtuu! frwu :ncs er : npher ind m alp r med }
'during monitonng period) and as "/irm!t Reprewv specined i n pom ' ic e, , ' nrer "f W:f fr cWimen- !
memtoring, "19" for one day per weck, "idO" for one dg per me ch. "i W fcr me d w per qTWr, :J j
- 9. Enter " Sam d / e 7)pe" buh as."&mple Mcamrement" (actual ampk ty;x sed durir mnimma p iod : nd : !
" Permit Requirement? (c g , Enter "Gr# tor indinduM mmp!c "R
- for RMor runyntc ' ' a" f u l continuous monitoring. etc.) 4
, i f ! 10. Where violations of permit requirements ;oc repmted, attach a brief c3 ' mtimt to &!ih c me n d arectiv l i acuans talen, and icference cach violation by date l
- 11. If"no dacharge" c.ccurs during maritormg permi enter "No Dahary? m s form m p!are of a 4 e er t r3 ;
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- 12, Enter "Name
- Title of Prmcipal Execuine ofcer" wnb "Spature & rw ar>c! !'se a w < W n o b: st:. !
- Agent? " Tele;> hone Nunher
- and "Date" at bottom of form.
- 13. Mail signed Report to Omce(s) by date(s) specified in permit Retai opy for your ret crd:. l
[ l 16 More detailed instructions for use of this Discharg4 Wuormy Report (IWR) fonn my (< Wained f.m Omcen; , j specified in permit. l t
- Legal Notice j e
{ This report is nfdred by law (33 U.S.C.1318; 40 C F.R.125.27). Failure to repon or failare m report tnithf Mly car ; result in civil penalties not to exceed $10,000 per day of violation; or in uiminM p-cahies not : 4 mW D5 099 per day l j- [ of violation, or by imprisonment for not more than one year, or by both. l i I i ! o, s 9
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RE M EM M _ SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE l MEASUREMENT PERMtT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT I CERTIFY UNDER PEteALTY OF LAWW THAT e HavE PEnsopeALLY EXAhAINED AfED TELEPHONE DATE NARAE/ TITLE PRNGCFAL EXECUTIVE OFFICER Asa FAnaeuAR wiTH TwE isseosesAriose suenerTTEo MEnEise; ANo sano oss e. MY INQUlftY OF T9oSE IIIOtviDUALS Inse#EDaATELY _ EE FOR <- Dayid Orndorf / ouTANNe THE asFonnaATioN. I eEutve Twt suommTTEo moosenAnoes is ! TRUE, ACCURATE AND COesPLETE. I Ams AnnesstE TMAT THERE ARE g/ [ s
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5 ChertiSt.ry ?!ailager SIGNIRCANT PfleALTIES FOR SUSAstTTimeG FALSE IIePolesAT1008. IIeCLUDING seefeAM NMAL E3kN THE POSSIGIUTY OF FINE AND . - .- _ i T T. SEE 18 U.S C. $ 1001 Afe0 33 ,- - , TYPED OR PRNETED u s. s 131o. as. amuse eseA.sr samme.u.messe s,w c.rmenen = s
. r ese. s an.mne mer siv aessesst yours smise ey se s70,000 oFreCE91 OR AUTHOflBEED AGEffT j NUndGER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af effechmerres herof NBA Form 33201108-951 Previous editions may be used. IREPLACES EPA FORM T-40 WIGCN MAY NOT BE USED.) PAGE OF 19332/07011F~0017 1
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_._ .w,___ _ . _ _ . ._. _ Panerwork Reduction Act Notice I r - I i j P. A .m d sJ 14M u fY h eC im cf n:6rmation b estim*d to wy fmm a runte of 10 hoari, y an ! { @ e, p ' r m rg :wns & r > v omnr L 3DX to 1 m hours a< an avqe per impome for um'e m,nor fui!) des. ! t u M i. s , EtM pc - Fry 9n id inwir beh M 13 huun p r respmse, inchling Ume f6r reykwing i u N:M LorW n n vn J' au K g & der Jd mirddng the data m:afedl snd qsmplek and l
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l 2]Entnr "r m metre % ' A!mling M!rc s (and facility namcf!acation, if difTctent),*
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N J g 3 - Cnw am bremvinn od ending *\ fonitorira rmnd* cm cred by form whe:c indscated j l3 1 i 4. FN r erb "?ar:mn cr" r, neciPd in matut9 dog requhements of permit l I - 5 i E t ' r "< y!r M l r+" dm f v crh r emcD:r im&r *puanuty" and " Gun /ity" in units specified in permit. ;
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.Ltex. p rn te At md ?e rm mn d h daim Wm>rg Pcrm / " (Note to municipais with seconitry treatment !
r we m+ Fr E h ner ~cfa nb m :nuremerm, un&r werege," and enter maimum 7-day mcrai;e ' i ef p:W rn n m > ; ci 'ch c1 am ne tring per:od un&r "A fadmum ") ) 1. t: ,M hH< < or' -
'fr 4 pnr ~ a er a "@ actity" and "p:zality" as speedied in permit ,
t J We a u r t +r v m .y n < i , *n em em daring momtoring period that esceed umimum fami'or l m H"?; r- T-N : e m n~ ~ pre y permi remnrerrent t f or each parameter. If none, enter "0" I i " l 5,. * * * @;p!- qi !; gf- FM- " unj ,;. Tfmorment" (adual ficqdCDCy Of sampliOg 3Gd WalySISILMCd , j ecy 7 , pn ., p -
. 4 ga, *py, e/ / pirows" sp:ciDed in permit (e g , Enter "Gmt," for continuous )
- m. y o "1~rre , pm o et e / 93" f r or e day per onmk "1 '90" for one day pcr quarter etc ) !
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- a *" fc l' wrme# (act r:d sample type used during monitoring pence) tu,d as i jw:- 9 w ,7 ,, s f l , Fern;# br i4Mnl sampk, "Af!!C far 21 hour composite. "N?t" for t ,
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l l m W1-x W '*dp:.H rW r mn are n; ported amb a brief esplanation to descobe cause atW corrective cc%s t? ~ rd r? m ea ~ mh%o tr d e O"Ad M w " m > " d e e t, m e i p id erfer "Xo Dacharge" across form in place of data entry, I l 12, C y 3"n N > t I l ~ m.M i a e & 0" w ' sith "Simature vf Prorcipal Executin Office, qf Authori:ed y:-,,
- mipp , y rN c4 "pp" at wuem et fa7m
, n M M 6-d Pvt a TMs) b de:'.s) s#cif:ed i9 permit P,etain copy for your records.
I t. M r: d n&d Indmetr 9 f;* ine c# tus Dm ha?c Afmitoring Report (DA/R) for m may be obtairwd from Office (s)
, wx&riin ms : wit y . Legal Notice J
'th rzw! iv 1%unnt by hw (31 US C 1310 40 C.F,lf.125.27). Failure to report or ta.hne to report truthfully can rmM idcivil gMt;in not ta o cred !!OM p-r day of viohtion; or in criminal penahies not to exceed $25,000 per day of '.ichtm er by imprimetwt f,r rot inore than one year, or by both, n
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FACILITY g e 4 y q p yg(Lyy ppvp 3;37I3g YEAR MO DAY YEAR MD QAY -- l LOCATION FROMi *i as N < TO <e P.5 %it h * "- 50 D I SC 9 4. W E l__l @* * ; t=*n: 3 n Y r 6 3 n n n 3 't r - 1 9 211 122-23I 124-25'- 120-271120-2st t34311 NOTE M M " * * % (3 N N L I4 NO. N SAMPLE d PARAMETER 146-53P ts4-sti (3p-457 (46-53r 164 471 OF li (32 371 EX As gys,s TYPE . AVERAGE . MAXIMUM UNITE MNMUM AVERAGE MAXIMUM UNITS *
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- Oc SAMPLE ( 13} 00 W *i e*MCP * * "0 A/ f t4e r m r m a vLAr MEASUREMENT O,Cyl/ 6, C 7[, MO M/ - {
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PERMIT-REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/TME PRueCFAL EXECUTIVE OFFICER I cERMY uNDER PEMALTY OF UWW THATI MAVE PERSONARY EXARAusED 20 TELEPHONE DATE AM FAMIUAR WITH THE INFOlWWATIOB0 suBRNTTED MERON: AND SAsED Ole '. MY INOulRY OF TMOst WIDtVIDUALS ItsMEDeATELY _E FOft [ms' OSTAf808886 THE INFOIDSATtose, t SEUEVE THE steamTTED NIFOfMATION IS y - 4 4 w _ David Orndorf AccunATE asso cOesFtETE. Ass Anweit THAT THEnE AnE / cet L w d j' , q7 0+ Tnu.E. so meant eta =Tes FOn summernme F=sE anOnanAnOn. secuano 7 *l*,, 393*A13 , t b. Cbcrii s t rv M an n c,,r THE PosslesuTV OF ruse,Asso espuesOsensENT. sEE ease te U.sA ay 31001 Asso sa 88888A M OF M N TVMD OR POWOTED u s.c. s tste. smussen
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winnr seems sensus aer aune er een=s= s meaans av s venas se aroase erretER cm attveessurEO AeEast g NuadBER YEAR MO DAY COMhENTS AND EXPLANATION OF ANY VIOLATIONS (Retsrence af ereschments heret - EPA Form 3320-1108-961 Prowoous odetions may be used. tREPLACES EPA FOfmA T-40 WWDGCM MAY NOT BE USED.) ~ -
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f c. - General Inst ructions
- 1. If foon hat hrn partially tornpided by prerrinting, dnreprd im,tnatinn - an c tM a c:.:ry of d -t mf.4rudon alreaJy prrprita:J.
- 2. Enter * / 'ermince Name 3fmlzng Addecss (and fa. ably rumcilotatmn. i f d " ~c r e . 0," /'r o :t W "r ' > " and
'Dochar;ce Yumber" n Lere indiented ( A sep irate Lo, : is requned f or e,n.h d? ' rr - )
3 1 Enter da!cs berinning and ending ".!"mtor:v A r, .1" cm c<cd tm form w! : : ' u.A .
- 4. Emer exh "l'armnen r" as s;rcafkd m mo nerior teriuirca:a ', eip.os '
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- 14. More detaikd instructions for use of thu !?whr;;c !./w v me e //cjx et @ /< 0 Thnu m. b< Atm A 0" specified in Irrmit Legui Notice This repart is rtyuixed by law (33 U.S.C.1318: 40 C.F.R.125.27L Fmic: - !a r pon or f n: 'a- ,
n te n W Q c. result in civil penahies nor to execed $10,090 per day of viola: ion; ur 1r o n .bu ;- W :nm o : ! " W ' pt r 6 of violation, or by imprisonment for not more than one ycar, or by M'h. EPA Forrn 3320-J (Rev,08-95)
PEntrTEE NAGE/ADORESS thebe Ferday hLoremee (fh' NATIONAL POLLUTANT De9 CHARGE RIMESATICW sysTtu (APDES) Form Approved. NAME W RGE MONRORWG N,ff M , OMB No. 2040-0004 i
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l l SAMPLE I MEASUREMENT ! _ PERMIT l REQUIREMENT SAMPLE i MEASUREMENT , PERMIT i REQUIREMENT ! SAMPLE l MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PEN ALTY OF LAW THAT I H AVE PERSONALLY EXAMtNFD AND TELEPHONE DATE AM FAMILIAR WITH THE INFORMATION SUBMITTED HER(pf; AND BASED ON ./ MY WOUIRY OF THOSE INDIVIOUALS IMMEDIATELY RESPON99LE FOR 1 CeTAINING THE INFORMATION. I BRIEVE THE SusMITTED iteFORMATION tS / O s M[! DJVid Ornd0rf TRUE. ACCURATE AND COMPLETE. StGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUD!NG I AM AWARE THAT THERE AAE E'
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u.S POf981UTY s 131a. m.m. OF ameer RNE.ANO e IMPRISONMENT. amrue., nwy m rm.e se SEE se1e U.S.C. a10,000 91001 AND 33 OF PIhfedPAL ENCUTIVE mg TYPED OR PRINTED aad or med=mr :- er eerweae 8 moams sad a y ors s OmCER OR AUTHORtZED AGENT CODE NUMBER . _ . YEAR MO DAY , COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s// ettechments herel
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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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. > Weady preprinted.
2 M ] e' 24* *EoMr Mirtre Sam Madw <tddren (a d . faciFty name/ location, if difTerent) " " Permit, Number," and ' h:6arge hber" where ininted. (A separate form is required fer each discharge.) - t j ' 3! En6: dates tecm nan ;md ewing ". fem / wing Permd* covered by form where indicated -
. rege%~ m sysca ,eminmgements of permit -,
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- t r5 pr.pb ip pe nenL und; r *,1wrag" and enter maqmum 7_ day gycygge
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- ;ri 4dP e m :~Orib A tS dr.t11 Tnt 0 d iti permit itetain copy for your records.
I 14. b m f thzd ir.stn ethns ff ne of thh Dur/wrpe M wi=g Rc/wrt (DMR) form may be obtained from Office (s) l f mNd ingnvc l Legal Notice !
^ ;
4 I j h rewt tis recunni t y im (33 USC.1318; 40 C.F.R 125.27). Failure to report or f ailure to report truthfully can j tm!t inhd pmha e n'u ta t wd 51W gr Jay of vi.dationior in criminal penalties not to exceed $25,000 per day ef vio%% or by imptiummmt for not nyare than one year, or by both. 1 ' i 4 s - i D'A Form .3320-1 Oln, M41) - i )
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P9thAITTEE NAM /ADOfE7S onddrFeeeryName'imenos 44W NATIOseat POLLuTAfrY UesCMAnOf smarion sy<ngM SJ Form Agipftved. NAW 3agyrq ygg(gy,p9gpg z pg 7 717g [ l g,07 ,9j A ij y, { 9 7 ), z y 3C y g g %$4NN4 ADDRE23 P ,3. 974 4 'E3 EAT 4 # ^ (5 G S :I O$) 2
*. ? T M ; 3A(I9 O R ** D O p e PERMIT NUMBER DeCHAnGE NUMeEn y I { { ,y { { ,
5%io?I4G90R7 ' .A IC17' pr MONITORWG PERIOD ' Ft.C:LITY 6( 3E%VC9 73LLEY F3M?h ! T R " I Tz g g g g g m e LOCA M _ FROM ti WS A il TO ri A5 N 5J.% CM #9R*** G I S M A Rf'E l_l *00 e
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(4 cent onsys QUANTITY OR CONCENTRAM PARAMETER (3 cad44g_g3 ontra, OUANTITY OR LOADING qse.gry g3p.4g; gas.y39 gge.gry NO. entoutNcY SAMPLE f32-37) or AVERAGE MAXIMUM IX ANALYSIS U
' UNITS MINIMUM AVERAGE MAXIMUM UNITS nr.ess g,,. ,f gas.7a, SAMPLE ??-acos es c o co
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j REQUIREMENT SAMPLE MEASUREMENT PERMIT . REQUIREMENT , =- g. SAMPLE MEASUREMENT :* PERMIT - ! REQUIREMENT ! SAMPLE MEASUREMENT ' i ' PERMIT - REQUIREMENT
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SAMPLE : MEASUREMENT PERMIT , - REQUIREMENT ra SAMPLE I MEASUREMENT PERMIT - REQUIREMENT
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NAME/ TITLE PRWWCSDAL EXECUTMfE OFFM:ER I CfnDFY uMOEn PENALTY OF ter TH AT t HAVE ; ..MLY EXAMPeED AfdO m eaMeuan wiTu Twe meonManose suonarTTeo seeness: ANo emeo ose m - TELEPHONE DATE ' MY INQulnY OF THOSE WEOeVIOUALS IMMEDeaTfLY nESPOSIsleLE l'On 3 i J/ V , ? n' avid orndorf " "^
- - i Tnue."'Ac'cu"nAT' '"'a"No "coMeteTs.' eauve me susMirm meonMamm is ca i m awant m aT Twent ans eNattus con svenmTTues raise inPosiMariose esectuaisio x -/s . -
u t7 / ;., 7 ; 1 4 L'lTeni st rY Manaaer 6 8'88"p"ossn"e'su'TY OF Fleet Af00 IRAPnisOesMENT. SEE to U S C. 61001 AND 33 THE ..
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u.s.c. s tais. sumaduse asumer ansse asseusse mer ausense one en se sto,aso Stef0ATUIE OF PRWICEBAL EM"CtmtfE TYPE) OR PfefTED ==r er manens== _ ercesween a nis=M sur s vens) OFRCEft Oft Atmanasysn AGEEIT hg NURSER YEAR MO DAY t COMDENTS AND EXPLANATION OF ANY VIOLATIONS (Retsrence e# ertschments heref I i ( i EPA Form 3320-1 108-95) Prewous editions may be used. IREPLACES EPA FOfWI T-40 WIGCH MAY feOT BE USED.) PAGE OF ry73ypf7 qg5.pq.7 t
4 e (-- Pdperwork Reduction Act Notice _ - . L f t
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; b{dic reforting burdco for thh; collerunn of infMm;$ou is rMim2B113 nry frun a rang d W) c m o n
' nGrap per re#ome far mms minor fcilities, to 110 hom as en nen p ps r rk e 0>r sorrr.C J nmOm f w! h-a wd t ttui unre for major and. minw fapUtje. of # he m pu e p . Jrdo D.3A L., g-wg f , , inructions warching emting data vwem ptherig and rrramninig Ch & e rded ad m,pt et}g ed (
rsye,nng dr. mucction of infornution. Sand wmmems reprdmg the i ud m ehdMt er m & < rpt of 1- int 'co!!ection of infonnation; induding mggstione far rufoci.y this burde s b hL 1*mmtiiPohcv i j .j Bramh, PR223; U.S. Environmental Protection Apney,401 M Street. SW hUnden. DC 2d260; rn$ to iS ,
;. Otfite of infprnution and Regulatory Af fJrs, Offke of Manapnwnt and Bmipt, Wadungm, DC 20$0L -
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' i 1.k form hu been partiakly completed by preprinting. disreprd instmstions dinted ut entry of thd information xIready prgirintu!.
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- , 2r Enter
- Permittee ' NameSfailin;r Addrest-(and facili*y name/ location. if dJferent)? "Pdma! Ahhcr/ and
. , 'Derhange Number" where indicated (A separate form is required for cach dhcharge.)
' a s .. ; .
L 3 Erter dates beginning and ending *Moniformg Permd" coven:d by form'where indicafed ,
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' 4f Enter cach "lbrameter" as specified in momtonog requirements of perynit.
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I 5. Erar %mple 3/eanremem" data for each parameter under *R;mantP and *{W/it? in umtUpeci&d in pennit j %yroge" b normany arithmenc ascrage (geometric merage for brterial raramrtfr4 of all vgk,imst=mdre ! for each paramelet obtained during "Momtormy Per:mf", "Marim:m und "Her:M at: mrmr4y estrne high y and low metsurements obtain:d during " Mon 9aring Pefod" (Note ta m midrofs Mth Feendig tutmdu regsrernent Enter 3G-day average of sample measurements untr %rra " d mer nminnur Ma mra. >
~
- of rampic measutements obtained durmg momtoring p^riod umkr *f.!cramm "j, l
Y' fx Entet "Pernu Rergmn mem" for each parameter untr *Ormfit'P an f "Q:m!y a". spmfkd in p u j 7. OMer % IY enter number of sampb measurments during ncailariry period da em! nmimm Cnd/or . i;dnimum er 7-day ascrage as appropriate) pent.it recpirement for sxh Mrameter If nm enter "r 4 4 B. Etact " Frequency of Analysir ich as % ie T Memurment* uctual freqvwcv vi ampHey ud valps used -
+
t dmmg monitoring perkxt) and as " Permit Pe:fairrmem* sp~&! in permu. (e g, ! nyt "I'onf." fu cammwm-
. < monitating, *u7" for one day per wcck, "l'30" for one day per month. *vW far one d u per qm rttr, m) i- 9. Enter, hpfe ~1)pe" both as " Sample Measuremenf* (xttui campk type tsed darin. mor Umng prird and ; _
} s Ter"Ut. Rey:nrementf (c g.', Emcr " Grab" for indivum! r. cmp!:, "N!b
- for R Mur mmw " ' C f. -
l continuous inonitoring, etc.)
- 10. %1creyiolatious of permit requirements are reported, r;xh a b&f cyptmunn to d sc4: c m : ,4
- vor actimts thken, and refcience each violation by date.
f' i1. If"no dischargc* occurs during monitoring penod, enter "No Descharge' crinss fann m pbcd M Dr r try i
'l2, Enter *Nanrenstle of Pnntipal Decutive Op;cer* wnh %gnature qf Prie:ijsof De:vnce of& n' 4 tiwn:cd
-JAgeny.' ' Telephone Number: and *Date' at bottom of form.
? 13. Mail signed Report to Omce(s) by date(s) specified in permit. Retmn copy fc# pr reccid4 i' 1{ More detalicd instructions for use of this Discharge Ahwitwmg Rrport fDMR) form mafbe oWined Tom Omccm
~
3 specified m permit. [ Legal Notice p
'llis report is raiuired by law (33 U S C 1318; 40 C ... ... F R 125 27) Failure to report or taibre to rrport uuthfo'ly car-
] ratdt in ctvil penalties not to exceed $10,000 per day of siolation; or in criminal penalties not to excwd 5M.00': pe r day j of violation, or by impristmment for not more than one year, or by both.
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EPA Feem J3204 Oter.08-95)
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PERealTTEE NAhE/ADOfESS tassani.Feeshey#sswinessn e gfDrJhrom@ NATIONAL POLLUTANT ud - ^^M EUMINATION SYSTEM MFDES/ Foefvi Approved. DGSCHARGE MOMTORING REPORT OM OMB No. 2040-0004 NAME (2-f 61 (17- F91 3yy* yg73e-T*VT' V 1 L L ;' ? "isP i Tt"I7! -
, <. , Approval cupires 05-3148
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SAMPLE MEASL*BEMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY 08 LAW THAT 4 HAVE PERSONALLY EXAMINED AND AM FAM1UAR WITH THE fMFORMAT!ON SUBMtTTED MEREINl AND BASED ON r TELEPHONE DATE MY tNOUIRY OF THOSE tNDtVIOUALS IMMEDIATELY RESPONSDSLE FOR r" ,
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D3Vid ()rndorf OSTAfNING THE INFORMATION. I SEUEVE THE SUSMITTED INFORMATION fS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNtFICANT PENALTIES FOR SUBMfTTING FALSE INFORMATION. INCLUDING (( ' ;
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[ ChOMiSErV Ila n a r t' r THE POSSIBILITY OF FINE ANO IMPRISONMENT. SEE 10 U.S.C 91001 AND 33
' slONATURE OF PRINCIPAL EXECUTIVE u.S.C.e 1ste. a %.M. en sier swee sarna mer miename an s se se asom TYPED OR PRINTED sat or merams e - n- .: **etwe a e asoaen saw s remre.7 OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a#strechments herof b,
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EPA Form 3320-1 106-961 Previous editions may be uSed. (REPLACES EPA FORM T-40 WHICH MAY NOT BE UsrO.I PAGE OF
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e 1 , Papenvork Reduction Act Notice n.. .
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3 Pjhy rwxMt; krM b>r thb.phti.m of d ameioa b estimated to vary fmm a nnge of ;10 hours as en * { e rg : per 7 ppd ihr mme mirm fui% s tn IJO tvers e an awrga per rnponse for mme ubjnr fritides. l
.. Nith a v.thfed e me - fa nupu d nnt faltc of 13 hNf 5 pr frSpOn50, 5Mh!ing time Ib TOyihiUg '
ml'nism 4 wenin) em;b O.a wur- ', phirme anu maMiaining' thi data en d6J.fand coiripktirg and ! r% v.w tW eenegrp o%re pg Send (n:mure o;prdim; the1.burden estimate er any oder epott of - ~ - .. .. . o Sis Miepai infonMrm, in!admn wgytipns for redpang this burden. to Chief Info,rnation. fobey '
- j. Opph. PM 123 U.S Enqronmental Pecetma A;ercy. 40? M St cet: SW Washington, DC '2GM0; and to die ,
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OtG#f InfornMon nl Restarcry Af fa ", Office of Management and Budget, Washington. DC 2050L - t 1 2- - ,
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c i 1 General Instructions < L If Drm hw han prthMv comph ted by preprinting, disreprd instructionrdirectext at entry of that information [ already preprjntel. . 4 ,
& a 2.'Inier 'Permittre Nmw%ilin, Asbess (and facihty namellocation, if ditTerent),*
- Permit' Number,' and EDivhree Number" v here indkmed ( A vzparate fcrm Is required for cach discharp.) ,
% Emcr dants beginmng and end;ng "Afoniturmg Period" cm cred by form u here indicated- - . , ,
j 4 ' Em#r rah #ParanWr" as .occi&l in mnnhoring requirements of permit ' ' i
, j r ' r(nm *Nuy! A t emcm" d r. for cach paramer un&r "Guantity? and "puality" in units specified in permit r
".) M
- h y o n M , %w :n m:r (g ometi herar for bacterial parameters) of aH sampic measurernents ,
- in en .yarp w ,& vA c&ve M hmi < > m Pers)"; 9,tnunwn" and *Afinimum* arc normaUy extreme high gd kn . ma,rrc& W ethind Jariv Si "iNri:tx /Wo./" (Note toL mtmicipals with secondary treaturnt i tw < ~ c et , Een v ,!g :n eu : ci synpic re:wm mts mder Bf verage " and enter maximum 7-day average '
ds M: rie mem ehsd Ntiw mosting period under *3/anmwn ') > g 9 l 13 ~ t M ' m + f v mn pmmer em!er 'ynnatir.? and "gualay" as specified in permit. ,. -
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"W W t.m? rd er c' m ; M mcxuiments during monitoring period that execcd maumum und/or i q-, m e 1.&we w m nwe o pme r rnnremeryor each pammeter - If none, enter "0". ' r4 ,
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* " '.o,. i e+y 7;: -o4eaa ? (M "Nde f my -
Af. am s wnF hetual f equercy of sampling'and analysis used - E.ng.+.
.,, 4,..g p .pjmye,,P spniikd in pernut (e g , Enter
- Cont.* for continuour j rx^ % 9""Ucm6vn cd. *I5 fwone @ per momL 9. 9rr for one day per quarter, etc ) !
5 0 pg .b " ryf- l i - "tt', %
- O WncrimvenF pctu d sample type used during monitoring period) and as' f g e,r g.m.-g - gy Enm ~,m!." fm edumt amph: "2 HC" rar M hout compcsite, "VW for m4 mys egnNm.y m)
- w m m vin ns o' ;ec . rg & M car rgod WM a bncf explanvien to describ
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a i11 IT 4 d3d rf earn Ormg imiwin perm cmcr % Dischmyc* across form in pEce of data enuy. 12 U m % rm Tj" n rl ya [Dcurn (We' unh '% mature of Principal Execut w Ojjicer of Authorized j
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t 4.: t in d:Mgistrectms fr tg en.hh Dircharge Mmyoring Ryort (D3IR) form may be obtained from OfDce(s) .
! emfled in p"rmi!' ,
is0 gal Notice , 1 Thd r~wrt te requi. red by tw (D U.S.C. 1318; 40 C.F.P. 125.2'ib Failure to report or failure to report truthfully can l e<d!t ip cied pmitis not t, neced $10.000 per day of nobtion;"or in criminal penahies not to exceed $25,000 per day
] of violatiowbr by imprisonnent far not more than one yeart or bf both. , ,
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PERMIT NUMSER DieCHARGE iss aansq (%E9 SS) 123t5-
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3%/!i V'LLE7 SO4*R S T1TI 7' YEAR SD DAY YEAR MO D DAY
.m LOCATION FROM a, ,j, ( n, TO on av 3,A so- ., ,r-r--13 e-" e.
t t l w**n. n1~rs %oe,,o, t20211 IH-22 124 25I (26-27) 128-299 t%31) ~ - PARAMETER (3 Csed Ont; QUANTITY OR LOADMG E4 caret Ors &s QUANTITY OR CONCENTRATM8 (3p-45# 15HF1 NO. 'REoutieCy ggg I res-s3p . rs4-ars E48-53 EX Ase vSrs TYPE ! AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS es eas f,4.ag, fa ,.7ar I I
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( 19' # s t yAf A - 1 t e ' s. PERMIT 3egee 33%dp :t*e ; *x ey g g e o J. q N { ti' 00=p2 3 4N , q g' , e [- : 3,nr y3,. REQUIREMENT e . ,. 3 n ,y - pm&*, 2 - i, 'np+ r /' SAMPLE c ' 14 ' IV ,, { q ,, ) n eest ette?' n4ecce '{ p}hq eggghgggj' 310 h ti l , dMEASUREMENT y ' g, g,, z g g c" h Me , e KSog ) .n PERMIT g g p p p 'i U W 97; 1-;t64tC4 W 37# ,18e M C !^ ': ^ 3 0 i Y ,- r , a) m e ;a,ee REQUIREMENT EC' 15E3R i. y *i ,p 3,7,, ,, y , . , , *_,.3 SAMPLE eenac~ 9.n"gyyr
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. PERMIT; REQUIREMENT SAMPLE t
MEASUREMENT ' 4 . PERMIT. REQUIREMENT r NAME/ TITLE PMAL EXECUTRIE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT t HAVE PEstSOseALLv EXAMWeED AND AM FAMiUAR WITH THE WIFORMATtOes SUgemTTED HEREW: AND SAMED 08e TELEPHONE DATE A MY moviRv Ce THOSE meDeveDuALs insteEoiATay REsPOmE FOR y t j OSTAinuMG WE mFOWAMW, I WEVE NE SUOMIMED WFOWATION IS b {p fj - David Orndorf Aes AWARE THAT THERE ARE r s a TRUE. ACCURATE AmeD COMPLETE. StGNmCANT PENALTIES FOR SugemTTNeG FALSE ssFORMATIOst. WeCLUDuse -7 ~A *~,'- Chemist ry bnager THE POSSIGIUTY OF FWeE AfsD 20PRISONe#ENT. SEE 18 U.S.C. 51001 AmeD 33 x - n U.S.C. i 1319. 0%namese washr shase asseuses sensF Assesde Apese op em 8fe,000 M M'O' F MAL {.MOUTWE ,
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TYPED OR PRWTED ana er musnese : er esewe== s menene med s years.s OFFICER OR AUTHON2ED AGEffT @ NUMBER YEAR MO DAY f COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# ertschmenft here/
; SPORT *d' 9%!LT ** T X f d 7 M F9R 'I'7 '" 'I 44Ii "I5CiI4 IN3 I2 I
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I IfL A3 A 3'.ILY AAT.I jf/A Ab ("fm g,o + ; e ra , T EPA Form 3320-1 (08-96) Previous editions may be used. IREPLACES EPA FORM T.40 WteCH MAY NOT BE USED.) PAGE OF S3950/07010620917 1. _ _ _ _ _ _ _ - _ _ - _ _ _ _ _ _ _ - - _ _ _ _ _ - _ _ - - - . - . - . .- .~
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u Reduction Act Notice , pM4 l@2f' b u Mi'D in Okit ct' $%b fi Of ibfGrnWlk30 kS t'AlkMtb%! b VMy ffUm A r#hjj(* Of h b(MIr5 a.S 80
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WM pi g gnm fu (nw nucer Mintic : 10.1U) hters an awrm per rewrse for some cuiar faaUbe% l l
. M.)" @d N 2" f ^r mmr d miwr fdth s of N ham per repms includmr time for reviewing ut kw v< djn; W b dim < - , uhding pnd rimini2%ng the'datiwxded, and Wnrpleting and l
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ese m thi . Am of afwnanon md smente rquding the burden, estimate or any other aspect of j t
; t!k p yk th eMr..N:- iU!Mwg. aftki for 'rlducing thh NirknT to Chief ' frifornution !Ndicy { }
v !N&h, FM 121 U.S. Envimamn d Pection Agmey, am >-M Strert SW Wa.shington, DC 20160; and to the ; y ciWM IWonm on n et1%Aanry Mbirs, of%c of M:mnemem and Budget. Washinctbn, DC 20503, j y- , r m a .u yn ~ g , _, - m. ._ - .+ . . . - . , . . - . . _ ~. --i..,.--n. .-...-.._-...1..~_.) ,
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~ , c: l-General Instructions l
y 3 la 7f mn has i.een partiWI) compkted by preprinting,'dbreprd im,tructions directed at entrylof that information !
- aNeddy preprimed.
+
- 2, Enier *Pernvitee :NameA failing A&!ren - (ard ! tcility namellocation. if, diffcrcut)," " Permit Number,* and "bhcchary Num!vr" where ind;cated. ( A re t >rm is required for each discharge.) , ;
s ; 3; Entar dates t'egirmma ad endmg "Al<m/torm.c ;i ri# covered by form uhere indicated. l s' ; i d i Ep:r ed "I rumrter" as spectE:d i, momtoring requirements of permit. i ! s 4 Engr %ph%w ew" d N for exh p'rnneter und:r "Guantity" and "puothy" in units specified in pennit. - _l
' he " nonm@ rmnde mre (gometric avem: for bacterial parameters) of all sample mesurements' fe ead p.ua:vete W red dr. 7 %umrmg l'crio.li "Haumum" and "A /m! mum' are norm tily extreme high ,
<id b tyau ee ch:M duri , %n/aring Perim/." (Note to namicipals with secondary treatment l d eqWourrt:J ErNr R day avcr j: of wnpl
- ruurbrr.cnb under " !verage." anil cmcr maximum 7 day a\crr.gc )
of i rt + rirnwtr c : oWmd do ms r moninr% penod under "Afavimum *) )
~
p: jy y pe rz,,,rl s. - < fv - d p.m wercr m*r Vmently" and "Quahty" as specified in pendit. U V% "M Ex" m der d m - i , 4n 9 e %tr e""ws myr+)pnmit requironent. for each parameter. If none, emet "0" et umems durine monitonng period that exceed maximum / faba'or e s
.j p p. y *y g g n .,h. y syrrncr " o(actual frequency of sampling and analysts 'used' y' ,; ;.g, g im y , .)
, M4 n , n % . p e xt: nd a " et ! eye.'"cr:r speciDed io permit. (
- g . Enter " Cent,? for continuous ' :
nvFr c+'l^ fro:& pme6 * !9F b ene day per month *15fr far one day per qtuncr, etc ) 1 Up % fig Tnu" r P a ; M ..-" iG aremr/* (:daal ump!: type used during monitoring period) and as l 4
"j p o jp w.7 %.n r 17. p Epm ; rah" f. ' IndildJ;)! Sampi?r "I!!!C" f0f 2 4-hour CompOSdC, "N'1"' for i t rr A 197$ P?F^ ?rir ?, Cf )
n.W 'd@ ns d p v2 - + in rpard .wv.h a t'rief expba-umn to desenbe cause and corrective te m nW and r0me cact iid & by de:
- i- . .+ l J. I; i" #m d sr;W " ew n drm r* Moriw perid ever ".V) Ducharge" across form m place of data emry. ]
l 1 }? h*; *,ym >'?)J. gf l w:,ai favgry Qf:p" gnb *Qutbre qf pymcipal Execytme Oficer qf Ay;harged l A pu " +17! whmy y,+%
- nt *f,ar? .M twom c(form l e
!$ ,WI simo Fran ia 0%c(s) b OcN spermed itt p-rmit Hetain copy for your records.
i iI % d:t&& iv.stn@ m fn mc c! thk D:darge Monitoring Repor:(DMR) fann may t>c obtair,cd from Omce(s) s?ecified ive mit. r ,
,. c Legal Notice '
- s. j l TM rept is rehed by M (33 USC 131N O C.F.R.125.27) Failure to report or failure to report truthfully can ,
rmuh in civil pythy net ta e te-ed !!O MO per d2y of violdion; or in criminal penalties not to exceed $25,000 per day '
.i cf s ni5tio% or by imprismmt far nrt nv>re than one year, or by'both. i e i
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. EP.A. , form 33201 (Rev. C#45) -
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FERfmTTEE NAME/ ADORE!3 W F=e Fwimereen n r e DU%mid MAME NATIONAL FOttUTANT Ot9CMARGE EuheWADOst SYSTEM (MPDES/ Form Approved. ADDRES3 3e le 3e;yya y :, L g, y y pm 31 1 74er)4 N%.% MNN8 N,l,D% 7 9 gggL ;ey n 7y POW No22G40-0004
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(*U3$ S5) ^ [ ** 4*T%; O i i ; *) OE1D0"c PERMIT NUMBER DescMaRoE NUMeER r - r;y1L FACILITY . [ M ? uygLLgy 3 i' F " ngj;7 ;yp*f 1 i 1V7' ,$c. MONITORING PERIOD ' qr4yy, b( LOCATION YEAR MO DAY YEAR MO DAY FROM <e L<> .N t. TO r n% 3d N *" i- vu. navry 3ts n,, taougt; 122 23; g:4.gs; i 12s-27; 12e-2s1 130-3rp 7?7 NJ PISC1AP3T NOTE: Reed . '._L I__i betere completing 1No form. e PAMER (3 Card On/yr QUANTITY OR LOADING (4 Card Onlyf QUANTITY OR CONCENTRATION (32-371 146 531 (54-619 139-46s 146-53) NO. FREOUENCY SAMPLE 164-61) cF AVERAGE MAXIMUM EX Analysts TYPE UNIT 3 MINIMUM AVERAGE MAXIMUM UNITS ms, ,6 ,_ ,,, fe ,yo, PLD, Tx " -) : 0 9 I = 37 SAMPLE ( ' j) eawnex ner>+c e t. w n n t
//7 E9-
+4 3 23; 4 yy ng;y MEASUREMENT O,0'o A oroo A O
- j,3 ' i ? 5 n PERMIT ecopic 1 Egngqt g e h te e s e o e. c> c e ^/ p c o rny tut ;pggty gggy
;; .3 yr ~:3 , ya,e REQUIREMENT
, gy ay; 'pyy[y g g .- m am SAMPLE MEASUREMENT
. PERMIT l-REQUIREMENT SAMPLE MEASUREMENT PERMIT REQL*1REMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT FERMIT l
REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERDFV UNDER PthALTY OF LAW THAT I HAVE PERSONAkV EXAMMED ANO AM FAMtuAR WITH THE HsFORMATION 50 EMITTED MEREN: AND EASED ON ,'- 4- : TELEPHONE DATE David Orndur1. MY fMOUHtY OF THOSE motVIDUALS IMMEDeATELY RESPON98LE FOR OnTApaNo THE *FOaMAT!ON e erutvE THE sueMiTTEo NFORanATiON rs C / Chent s t.ry 11ange r TRUE. ACCURATE AND COMPLETE. I Aas AWAftE THAT THERE ARE .
. /
t ) [< FAN'h',' 1'
.e stoNmCANT PENALTIES FOR SueMITTWG FALSE INFORMATION. WCLUDING '
THE POSSteluTY U.s.c. s is OF FHet AND IMPRISONMENT. SEE 15 U.S.C. 51001 AND 33 # n33
"* 14 i
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TYPED OR PRINTED warme=6 ie. s%aoMM iisa r_ asiser wNee enNusse c ar eerwee, s mensw w mer SIGNATURE OF PResCIPAL EMCUTNE missume mies ao se sto. coo s rooms l AREA t COMMENTS AND EXPLANATION OF ANY VIOLAllONS (Reference a# street,.mts />sref OFFICER OR AUTHORIZEO AGENT w NUMBER YEAR MO DAY EPA Form 3320-1 106-36) Provtous editions may be used. (REPLACES EPA FORM T-40 WieCH MAY NOT BE USED.) 3y,,qyfy77,3g_ngy7 PAGE ,CF t .
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y mm.,,,,m..,_ m .. _.PaperworkReduction Act Notice . .,
' 1%!ie repmiing burdco f ar thb miicenon of inh >rmeeun is sticut.d b ury f: : a rey uf th Wn av un . ,
nigge pr t gora for wme mimt feciEtics to 110 houn e n ;werrye pr rer for mme h kr fxilitP j
,w&a wadicJ ngne for crayy ad mipor Lcthiie of 18 inw p rs me ip%hy M tm rv ews .;
instruetwn'4,rwarebig etuthg data sourtes, piering and maintin%: !! e ata riLd. an-! ;m.ph tag , q1
! rhirAing the cuRuiac ofintbaration.. Send commmis reprding the }ynEn atee y eny4 er hect cf .
this iolled;ori cf infarmanen, including suggestions for rrdacing this burden. to &r, kfmdinn Pficy
- litwh, PM 223, U1 Envinmm-ntal P40tution Agency,401 M Street, SWyWigton, Dt? S'it60; md b the j .
t Office of Infintration ard Regubdexy Affairs, OfSce of Manarenwnt and Dudgd. Chingroi DCc 205D3 i q
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1 Gederal Instructions :
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-1. If. fonn las been partully wmpleted by preprinting, disregard instructions diredal at entry of that'information "c already prrprinted.' :. . .
- 2. Enter
- Permittee , Wamedfathrg A<Dren (and facility narnellocadon, if difkrcno,"
- Permit NumAcr.* and
" Discharge Number' where ind:cated. ,(A separaic form is cquired for each discharge )
3_ Enter d des beginning and eMing "Af<mitoring Period" coscred by form u here indized A l 4fEnter each *Paramder" as specified in nvmitoring requnements of permit. [
-; 5. Inter *&unple Alcaarement" data for cach parameter under "Q:mnnty" and Vm'ay* m mun specifid in permit
%rmge" is cornu!!y arithate'ic antage (geometric merage for bactena! [nrameter:) of all empe nrnmmmentt "
for each perament obtain~J dudng "Afarunriny Period', "A faumm( .nd 9 Nw! , re norndly o ncme byl-
~
5; and law measuremenu obtained during "Alamtarmy Pcrind." (Note ta nuntipa!s vith ~condar; tumen
. . requiramcm Enter 304v averge of samp!c memuremeuls under ".-hrr,9 ' m A o ' ~ masimum 7-6y mrar r
of sampic masurenwmts (htained danng monitaring period undy "3famen3
- 6. Entet
- Permit Krp.rement* (ci cach paramcics und:r "QuantJf and "Qwm!y* us spmihd in g:cnniL
- t. i 7, Under "Ne E2" enter nurrber of sampic measurments daring monitoriny period &v exced muiann wnd'.e J sninirnum or.7-day averge as appropriate) permit requirement fbr.each pmmeter. If cert enter V .
F. En:ct "Frepemyof Arralps* tab as *&mple 3/easurent" (auual frequency c' mphrg md ernhsir uvd
'dmhtg momtonng penod) and as "Pcnmt Requiremnt' specifwd in pertw (ca . !#r "G-r! * (J cnmimw monitoring "la* for one day per week "/30" for one day per m mth. 'l "V ' far one d.y per tg rict,W .)
- 9. Enter "Lm;ic Arc" tub .u "hple Mcamremn?" (a:tual sample type wd durg muniMtirc p~irv9 and :
, ." Permit !&qmrementf (e g, Enter *Grch' for n midual sample OU/C for 2 N u r mlrH t. N P f:r centinuous monitormg etc.)
- 10. Where siolations of permit requiremcats are reponed, anach a brief explanmiw ta d crk w :1 < -a i n actioris taken, and refercrce cach violation by date.
!!, If"no disciurg? occurs during immitoring period, enter "No Dncharge' aw ; far m in pixe r! dm retrv.
^
I2; Enter *Namemtie of Prncipal Decutive of];cer' sub *Sgnature qf rnr.-iral &c nw o. th i r a .Mwm ? Agent * ' Telephone Number,* nad 'Date* at bottom cf farm.
- 13. Mail signed Report to Omcds) by date(s) Specified in permit Petain copy for your recct.h 1C More detsted instnr.: bans fqr uw of this Discharge Alo.eitoring Report (DA /R / form mw ta o%ir.ed fiam ofTicers; speciEcd in permit. q 1 Legal Notice ThiIreport is rmired ivy law (33 U.S.C.1318; 40 C.F.R.125.27). Ft. lure to report or fadure to mmrt truthf a!!y an result in civil penahies act to exceed $10,000 per day of violation; or in crhrdnal penalties not to exc pi $25,00r! per day of violation, or by imprisomnect for not more than one year or by both.
-IN d-
- EPA Form 33104 (Rev. 08-95)
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FERANTTEE NAME/ ADDRESS (Mebeehetee nee #d=w) NATIONAL POuUTmt OlsCHARet EUMmATiON sYstas (hPDES/ Form Approved. l DISCHARGE MONNG REPORT (M) NAME~ (f 7-f8/ OMB "No. 2040-0004 2 .'. V 5 ViLLFT P 7 pi i* u ~ T % ?Ii* (2-f 81 ;tJyppgv - -
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gae t "o ApprOv3 exotees 05-31-03 [ ADDRES3 ,3, lJg y n* ' " * " ~ " * *' {g3gq ^g y}}gj l PE'.MIT NUMBER
. DescHARGE ruMam , ,,,
& T r 't ; 9sv[P ;Rs70g9
~ l I P D [ f 3 P O ': ? v4 ] y ^ "? ' , MONITORING PERIOD 4 g '\JDJ FA M W -
,i;gycq y 7, g 7 7 pgg ..AT IJD' DAY YEAR MO ' OAY *8 3 *- '
YEAR ~ LOCAT M FROM e A. ,s TO na _ , q- -- yq
,, f. -. e3 % e q p ., , n .- e 9 ,, c. n l (1&27) t21-23 (24-25/ (26-271 (28-26/ i3G3il' NOTE: Road instructions before _ _ . ,g ~ ., this form. ' .__
*se. n*yr7 9 n. - auv r3 cerd orgyf QUANTITY OR LOADING I4 Cerd ontyi OUANTITY OR CONCENTRAM NO. FREOWNQ $ AMPLE PARAMETER 146-539 154-61) (30-45) 146-539 (54-6f1 OF EX m yss TYPE (32-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,s2-s* (64-681 (69-7af l
SAMPLE g y n c. f q3934 7,339,. g3 MEASUREMENT 7gy 7 gy
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}73a' s , PERWT g3c39 3 3 gew .gg3 ,, g g . g'j w y/ [3U{~
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REQUfREMENT e ~ w e. 6, g.
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SAMPLE ,,; ,,, p y g
' f.10 , IJ )/71{? 15 s 3)
,, y g 3 3 7 g ., 3 y ;,
/g 13ao *qa p $ r q. i(gg MEASUREMENT ggj g gy g v , - -
wm - ', 2 9 C 7 1 y p PERMT ggp33 gropop 3ppc93 g % gg g 3 .gy33f,' gg - rqf m" ,, - 4 5 r. y; <- - ,st ,s,, REQUIREMENT y .'3 gj; 3.yrv ., 7 , ,. 3 m , , , , , SAMPLE i MEASUREMENT _ PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE , r MEASUREMENT PERMIT - REQUIREMENT SAMFLE l MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQU:REMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER CERTIFY UNDER PEN ALTY OF LAW THAT I MAVE PERSONAMY EXAMINED AND TELEPHONE DATE AM FAMtuAR WITH THE INFORMATION SUOMITTED HERON: AND SASED ON ^ MY INQUERY OF THOSE BNOMDUALS tMMEDIATELY RESPON98LE FOR f
) OeTAMING THE INFORMATsON, 9 SEUEVE THE SueMITTED INFORMATION IS ,}< ,
/
TRUE. ACCURATE ANO COMPLETE. I AM AWARE M4AT THERE ARE slGNIFICANT PENALTIES FOR SUtMITTING FALSE INFORMATION, INCLUOtNG i , [" ~ # A - j D 61V 10 U rTitIO r f THE POSstBluTY OF FtNE AND IMPRISONMENT. SEE 10 U.S.C. I 1001 AND 33
/ SIONATURE OF PIWNCIPAL EXECUliVE 4
1 3 41-5 ? I I -- 47
- Os 7' !4 TYPED OR PRINTED v.s.c. e 1 ene arm sie.a==: naam --- rero
.mer a v.iae sonne a Ase mi
==an.nor.as=s e sw se sro, coo OFFICER OR AUTHOnt2ED AGEWT Qg NUMBER YEAR MO DAY OGMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# ettschments herof ,
EPA Form 3320-1 (08-96) Previous editions may be used. (REPLACES EPA FORM T 40 WHICH MAY NOT BE USED.) PAGE OF 9.7F55/370176-q^17 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ _. . .___________.__m___. _ _ _ . _ _ _ _ _ _ _ . . . _ _ _ e - ~ . . - - , .
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T . Paperwork Reduction Act Notice . . i; , Nide o;;rrtinn hw&u frr e ce% tion of idumatiu is eulmind to wry from a range of 10 hourp b an, ! I- rQ br rk Ma fb em mier feib, to 110 houre, as an avenyM per renpon e for sons major facilitis, i , vidt u v NLt M aver c for mst etd nent beh of 13 houm per respom; including time for reviewing l L inpit:om te.rduni +szih Eti sr , p% rid Ed maintabing the datinm1 Wand completing and ! rMesn3 h tch th oe mirMm. WJ wmm nts repoling the bur &n u.timate or any otlar aspect of ! l thighthp M ie-rmrom- init5ig 'ugyd.mdr reducing tW burderii fo ChieClnfinstion Pobcy I l l Bririb, PM 7h IM Enmonmentd Prewt ou Agency. 401 -M Stn-et, SW Washington,- DC 2040l and to the j l Ol6cb of Indseon and Pepdatory Afbir;rOfDee of Manarenwnt and Hudget. Wa.shington, DC 20503.' ' +
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General Instructions t :
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; 1[IUfir'm bu been partiAly compktod by preprinting,'disrtprd instructions directed at entry.of that information l i already preprinul. ._ _
- 2. Etiter *Pmiittee Kame 3!ul ling Address (and faciIlity namcIlocation 'if different)' *Pennit Number" and , , .
' fDirr.harpeNumber" Mee indjrxed ( A separe fano is required for cach discharge.) '
3 Entgr dues b gmnins ed er. dim; %nimrmy Pcru.J" cmcred by form where indicated. ) y *
)
4 ff at r cach '?aramet# as speci&d in monitming requirements of permit ? .
- 5. Eph." %r!r.E vrmem" ha fx e ch parnet t imder "(hantity" and 'guality" in units specified in pennd i tW. " is unrmah rAmen; asem (ceemetric avemee far brterial parameters) of all sample measurements -. !
l 1 ..far cad pramer oN rd drir ' "M m!!vrig Perd. *Mniwn" and M finimmn" are normally extreme high
- and b . trmWn t nn e&J & nim "U mitmeg iYriod " (Note to municipals mth serendary treatment ;
n;M4pwnf- Em t V 4 m erm N mmc rewr.mcM; under
- Itwage," and enter mnimum 7-day average -)
of untplc rrwne : c'. timid-nog emn%rmg period under 9/arimum ") , ,
~
i
. f . &5 W am /4 mr # P,r t 8 y imitr Unkr *ps W;tr* and "Gw1hty* as Specified in permit. . j
, h G N TVo /Y ene e W er cf mM_ me semenM drio.c moniering period that exceed mninmtn'(and'or j
; w ww N My m- w rprepW pema rmhen;ent for each parameter, if none, enter "r. --
~l
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. l E p-4 9., pe. y ,r . y .y H t. . y - qc m,wm.:P (m:tu;d frequency 'of san'pling and analysis used. I p.q,y,.m.e.g,e q 73y pmg fy,.,gg,., 'speciM in permit (e g , Enter " Cont," for continuous' !
r*W c+.' M ! 7 i cmm p wck * / FP !a em day per mmh. *l@D* for one day per quarter. etc.) )
. I pm. wupp p w m % y. m.sm.v# Mmal srvple tspe uscd during menitonng penod) and as 1
' j em , , ~mm , - (e , r et % d,a ,rer indhidnl samph *24!!C" for 2 4-hour componte. "NU* for l u n >.,cm egym n ce y R WMre y% H v p- q > rre m~m en: rTorted smch a 1,>ief explanation to desenbe cause and . Trective ;
. etbu M r . ard .9. re+:e ex ' s binim t v d e i
. 1 11> Jf
- a d dar " tn m J Mn3 rwimine penai cmer *No Dircharge* across form in place of data entry j i
)L Y5& "h r~ 7l&c of T mna' { scy!Te C&r" wn).$ "Sigr:ature qf Prmcipal Fxmdtve 0,fficer of Atahorned )
w"%! .jhs hh." AM "!W at Muam cf farm ' 1 13.' ? ! A sh ed Papmt to P fc(si by dMs) sintfied in p<;rmit. Detain copy for your records. j id; M.n d:t3.H 3 istme*in fn ese of this D* Anye A /mNr.ing Report (DA(R) form may be obtained from Office (s) ; speiGed in permit , j L
, y Legal Notice Tbn npmt i= reauired by im (33 U.S.C.13th 40 C.F.R.125.27). Failure to report or failure to pport truthfully can .
rmi! t,n civil r-riltm not ta ricmi $ 10 000 per day of viab60n; or in criminal penalties not to exceed $25,000 per day l
?I . M vieiidm. er by imensommt far rwt more than one year, or by both. j l
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i EP s vi orm JMtb{ lfev. M 30 i
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PERMITTEE NAw/ADOffss ta-bdr FareiwyNa wiseensa 4fD@rs=0 NATIONAL Pot.LUTANT DescHAAGE EUumATeo4 SYSTas (M' DES / Form Approved. NAW o { g y' g a 7g},(y7 p yg o ? .;74 y3s l g, 3 7 ; y' p L L Dy3 OMB No. 20406 ADORESS ?.3. 3 'i K 1 **7rs - '?T 2 (3US? J5) ^'P'*"'?"'I'*8"
- A T FI; 7;V[] O r 4 0 P. " P PERMIT NUMBER DescHanor wuuset y . yyy3L .
rn;pp[ygyya"'
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FAC!UTY M MONITORMG PERIOD
- e ,. y..,e 4 y g {. ,o-3 .( .n v a g r. -. "3 -aepat YEAR MO DAY YEAR MO DAY -
8 LOCATION -i OSN *M FROM >; TO +iMN 3/ N NOTE; T3 DISCM A M" l_l CM '
*
- n : ')L i T 1 3 % 4 ?> 3 u ? 120 211 122-23) 124-251 120-27) t26-291 13sst) R*** I*****I'** u ****FI***9 % f*mi-PARA'/sETER / (3 w w QUANUTY OR LOADWG 146-531 154-619 to M W QUANTITY OR CONCENTRADON 130-451 (46-53I 154-01)
NO. mtouency or $' AMPLE
'J2-37J EX anaty,s TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXWIUM UNITS ses_sm gg,.,,, gg,.m rw SAMPLE c?c$*r Mottt NcS7 -
7, 5 )-., ( 12} 0 f/y (g MEASUREMENT [sa tlg 03anS [ 3 " PERMIT . c rec s h e y*MMo etc r, , ty c oo top . 9 ;, Q7 (gKLf RA9 ) r , , j p a. ? ;aSe1 T3 t, 3 REQUIREMENT
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. PERMIT REQUIREMENT NAME/ TITLE PMNWAL EXECUTIVE OFFICER e cEntiry unoen rewALTv or law THAT e MAve raisonAtty ExAusuto Ano '
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CCMhENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af etrschments herof
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General Instructions ,. l 1[lf form has 'been partially completed by preprinting, disregard instructions ditwted et entry lof t i pnfomudion l
;;already preprinted. ,
l h-l 2JEnter *Permittec Name2/aihng Address (and ' facility name/ location, if dMerent)," "rcredt Nuhber," and ]
" Discharge Number
- where indicated (A separate form is required for exh discharge ) ]
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j 3 Enter dates beginning and ending "Afonnormg Period" covered by farm where indicated G ] l - [ ]
- 4. Enter each " Parameter" a spe'cified ist monitoring mdairememy of pct mit jL ,j )
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. 5. Enter "Lmple 3/eawrcment" data for each parameter under *gmate" and Nin!tt/ m tme sputhf in Mrmit ~ '
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- 1rerage" is normally' arithmetic average (geometric average f ar bacteri:d pnmu nen) of all s:impte nam ,cmem-l for each parameter obtained during "Af mmMng Periva**. 3/arin t # and."At e n># are r:omrdly Weme high a
, q and .lpw measurements obtained during "3/onnoring Permd." (Time m rweidpk mth mMg ticamen: a , requiremcat' Enter 304ay avnage of sample measurements under " twn W .af ener nuwimi:m 7+a) mf3F ' ofspmple meumenwnt> obtained durhig monitoring period under "Mgic s " 7 ..
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l 7; - (d enter hermit Regwrement" for each parameter under "(?vmdity" and Tua%" as spded m } daiit -
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- 7. Umkr fMe l& enter number of sample measurman:s durmg monitoring period LL:n ewec3 rnumi et -*
Ind4r i < minimum or%I]y average as appmpriale) permit requirement for end I gr;tmetcr. Jf nr . empr "fr. i - -
& Emcr " Frequency of Armbwis" both as " Sample M:awre:ent" {octual tregemy c' mpinq , ~d c'Wm ud ;
during demtoring period) and T; "Permi! Re<jwemi" speciGcd in permi' . (e g , Enter 'm1,' f.7 calhnots
" monitoring, lJ" for one day pa week. "P.W for en d.:y per inemLc"/dfr' for one dw per yt trur, e* L) 9'. $ntet "Lm;ile [.pe" twh as "$ ample Mcamrement* tauud sampic type med diruu: *
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" Permit Requirement " (c g , Entet *Ges" far individtnl snmp'c. "Bil' '" for Wlmt emm " ' 9 " fa continuous momforing, cic.)
- 10. 'Where richdions of pennit requirements are reported. anrh a hnef cutanation to d~tritr cau<c n d rormn actions taken, and reference cac h s iolation by date.
I1. If"no discharge" occurs dunng rnonitoring period, enter *L Discirge" acnss form m pla= cf dn cv IL Enter 'Name/ Title of Princi;'ai Erecunve Of!cer" uith "Signaturc qf P?mapal Cun:tn c Oph! c d raimrt&
.tgent," " Telephone Mmber." and "Date' at bottom of form.
' 13. Man @cd Piport to Office (s) by date(s) specified in permit. Petmn copy for your recordx le More detaiIed instructions for use of this DurhargeMcmuormg Report flM fiU form mpy le n4ained f.bm Oiiiccf s) ,
' specified in permit.
# Legal Notice i
his report is reqEired by law (33 U.S.C.1318; 40 C.F.Ri 125.27). Failure to report or failure ta rmnt tothfany can result in civil penalties not to exceed $10,000 per day of violation; or in criminst penahies tw to exca:e $25,009 rer day of violation, or b imprisonment for not more than one year, or by both.
, EPI Form 3320-1 (Rev. 08-95) )
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- s. 3 i7- ,,. , r t y y, 4.- ei SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER i CERTIFY UNDER PENALTY OF LAW THAT e HAVE PERSONALLY EXAMtMED AND AM FAMILIAR wtTH THE INFORMATION ftBMtTTED HEREIN; AND 8ASED ON TELEPHOdE DATE I MY INQI.ARY OF THOSE INOMDUALS eMMEDIATELY RESPONSFSLE FOR e r
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UaVid Orndor[ 08TAlpetNG YHE INFORMATION. I BEUEVE THE SusM1TTED INFORMATION t$ / \ /, n ,
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TRUE. ACCURATE AND COMPLETE. 1 AM AWARE THAT THME ARE SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMAft0N. INCLU0tNG [ [* ~ [,' ' /- #v P C,11C in 18 L TV 3 a O A }i G !" THE POSSIBILITY OF FINE ANO IMPRISONMEN SEE 15 U / f man T.,ner *wnwe.S.C. t 1001 mies up so AND 33 s top SIONATURE OF PMfMCIPAL N ,__t 4 c -- , j TYPED OR PRINTED .u.S.C. s l i.n
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t- , - A - Ph rc s mjm: bmde fm N ; oM.rtien of trienatwn is e.dtrsteJ to vary from a exnge of lo hours e an r mr:i : gr#ponx 1 fm e m+or L.2ia t..t 110 habe, as an averge per se>pom.c for eme nWor fecilities, '
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@A9:> HMpm f- rmh nd mn fulmes of M houn, per mense, including time for reviewing irert6 r Min ; e.,hh = ina wh e gdobg sKt issimiiniog thi data nwMland compkting and e:wvA H tids rd inform.6na Sechce.-r4 regnEng t!w burden estimate or any other as;wi of u <- - - . - % .
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.j < , Upakt PM 2D U.S. Emb"nmetM pmhtmn Aj my. 40! M Street SW Washington, DC 2GM0; and to the' l ooc of Infd/nphon and RepMoq Af fairw OMc.c of Maragement and Budget, Wuhiogton, DC 20503i
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Lc , 1-1 li !! form has tven putLdly wnpi-ted ty preprintingc disregard u;tructions directed at entry of that information 11resdy p:errintrd.-
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, c L Enter 'Peronittec Nar4 failing Add es (and frihty namellocanon, if different),"
- Permit _ Number," and
; "Oycharge Numhcr" where induted. ( A separate forrn u required for cach discharge.)
s 3 ; if nter d.ts beginning ad endin" "Abnitorind Peri <>d* coscred by form where indicated 4 ; fuer euh "Paramrer" n gerifkd in mordwring requirements of permit
- 5. Tie e hp!c Alcar rwr" da f ar cri paramc&r undet " Quantity" and "Guality" in units specified in permit. '
- 1! vvd i< norm.A en dc averve (prioric aserge for bacerial parameters) of all sampic measurements'
% exh pw ;.ty & c d tWn3 '1!srua ingr Peritaf3 "Sfaxuwn" and 'Atinimum" are normally extreme high e mcwm v tMM r! dung *Afenorinz P.crmd." (Note to municipais hith scamd uy treatment
. gr eert; i *cr r d.re :recm M srrph emurements under "c!wrage " and enter maximum Mn average o r syg g - ~ my , c.g, .d durim rw coring pennd under "Afarimum ") '
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e t{de/"ytb" c& - > er e r Wr+ re um:* during monitoring period that exceed maximam (anNor. ; 4 , %m . e 7..q pno , y rperme gnno nyinemcut for each.paramemr - .lf none, enter "0" , y- -
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WM A f emer"rm" (adual frequency of sampRug nrwl an:dvsis used 3 cm. y, rg.~.g. >Wt7. t e r:s@My pc + ad a "l',W! la nnrad gcmed h permit (e g . Enter *(bntf for cdntinuont
, m.' md "/ " b c e g per md. PFr f n one d w pr r month;"/'90" for one day per quarter, etc.)
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mh* fa indivibt smup!; "21!!P" far 24-hour composite; "N'A" for ce w3m.myggetj w Wi ~ d M r$ efpm& - m an rep,rted. athc! a brb:f esp!wation to describe cause and corrective y-4 95 t 7 - pj py( + m7,7 c3,_ *. vi du_g by d 3 t
- L i1. If $9 d da"" om n 69 P ' mt- mz [v;1iM. emer *% Dirharye" across farm in place of data entry c 12. I ? :< 4: w p + g ri v m arIam > (Q/ sitt; %cnmure of Principld Executive ilgher of Authon:ed 1
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- f 14 f.pe drum irstrucM fx ed of his lhbrge t A fawring Report (llVR) fonn may be obtained from Office (s)
- 1. seri9ed in permit Legal Notice R3 rt;wt is smu"ed by im (33 U.S.C.1318; 40 C,F.P.125.27), Failure to report or failure to report truthfully can rd b. ciJii p-egh s not t9 oced I10,000 per day of vmhtion; or in criminal penalties not to exceed $25,000 per day l of s clatim, er tq{iemrienr~mt hr not moe than one year, or by both. _
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- tm2ts (22-231 (24251 (26-271 (28-28/ (30L3,j NOTE: Reed Instructione before completing this fcerg.
PARAMETER r3 cent Onfri QUANTITY OR LOADING I4 Coat onrys OUANTITY OR CONCENTRAN 146-53I tw6tl NO. mEcutNCY. SAMPLE (32-37; 136-451 (46-531 154-619 OF EX ANatYsts TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS m3, tw6el l 16S70t 2 SAMPLE ' =>'*' " * '- $ ; 1 0 '.
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(;4 2; u.s.C. e isie. tFunwee anew st 300 NATURE OF PMWeCIPAL EkECUTIVE TYPED OR PPWTED ew er m=emen : - - :erseewe sea,me mer kicausse a e menene ana s mssee se se sto,oco AREA OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# ettechments here/ s EPA 4 1 108-95) Previous edluons may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 9 ,,-rr,f,7+- t - 2-gv PAGE OF
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- 3. Emcr dates begin:ung auJ ending ".1/cmlar: , !Yrm i" em cred by fvm u N r ' m N 9 ,
- 4. Enter cm, h "P. , ac/cr" as ?pecifed m momtaring r3:acmens of ern:a f
$ Edt f $ [41' ' *E' A. f t $f v. TC8llt/d" ddit [OT C3 b pd f 3 M '.. ICr D G $ 'T ' !.f; " 5! '
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- 12. Entct ".Vuu Tsile <nf Pr:v i;'al I b :. t,z , 0;h c i ?' b ,7iuw ' > n !r
.tgr at,' 'ic!cphone Mmher," und 'IMit ur bmow d f.:rm ' .t [
- 13. Mau ogned Report to OHke(s) by dacts) specified m pennit. I:emm m f c r w .a i .s
- 14. More detailed insuuchens for m;c of this Deschc rp.'/mnonnn 16;ot # f% fenn in.. le H H ' ; nc+
EpCCi[lCd 50 p0fm!! 4 i Legal Notice a Tlus uport is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Fadure o reym or f ada m , et Wh W-nwult in civd penalties no' to enced $!0,000 per day of violati.m; or m c rirmtr! p-r: dries rv H en r f iM 04: p r J > of violation, or by imprimnment for not more th:2n one yur, or by Neh. 4 1:PA Form 3320-1 (Ret. 0%95) . j y 5 m _ --
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PERaffTTEE NAGAf/AODRESS(AmedrFesegr#m wlssementfD$www) InADOIGAL POLLUTAssT oescoeAAef sm* DON SYWT98 / Form Approved. OISCHAflGE MONITO0 Wee MPORT I / gAgg 0 E i i l' 1 7ALL8Y P3WE9 ~. ? A 7 I 3 , r2- r 6i tr 7-rsr g .~spg ,, m - q
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3ifP?INOP37? PA 7iS?T g gy m e e g ym . a r C i V # 't V)LLTY D D U f. : 5TE!!D' YEAR MO DAY YEAR MO DAY LOCA M pgog qs ,. 31 TO n, n1 : e++ MW
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' .?"c* n?UT1- 9nvr%n; 426219 422-231 124-25b 126-271 (26-2.91 13& 311 &- -4 % f**F-PARAMETER (3 N W OMTITY OR LOAM (4 h on&A QWTITY OR CONCENMAMN NO. mEQUENCY $ AMPLE 146-539 (54-6f1 (30-459 146-539 f6&619 OF 132-37; EX mysis TYPE AVERAGE MAXtMUM - UNITS MIMMUM AVERAGE MAXIMUM UNITS nm, ,,46,; f,,7a p,~ SAMPLE 3,e3y~ se3e3 g 3 s g, y y^ , ; MEASUREMENT 7g 7 74 g . c*[p ,g PERMIT .
<-- u, s S3.P" 1 1 0 ,g g g a.. 3 p g , e, 7333 g . gg.. ..
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gj3yyepqp MEASUREMENT 7g ( I ,# ,' /M
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^ 3,wir MEASUREMENT gg7 g), gy // O M/$,, ;m Fe r k . PERMIT
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SAMPLE MEASUREMENT PERMIT REQUfREMENT ; SAMPLE MEASUREMENT PERMIT - I4EQUIREMENT t SAMPLE MEASUREMENT
. PERMIT REQUIREMENT SAMPLE I MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PfWGCFAL EXECUTIVE OFFICER 4 CERTIFY UNDER PENALTY OF LAW THAT1 MAVE PER90ttALLY EXAAAINED AssD TELEPHONE DATE AM FAMiuAR WITH THE IDeFORMATION SugedeTTED HEREM: AffD SASED 086 MY INQUERY OF THOSE ENDiVIDUALS eMMEDIATELY RESPosetBGLE FOR OSTAfNetsG THE tNFOmeAATION. I BEUEVE THE SuseAtTTED letFORRAADO88 IS p\ . #
David Orndorf TRUE. ACCURATE ANO COMPLETE. 8 ASA AWARE THAT THERE ARE '* ')(A /! [g ,
@I , j m SIGNtFtCANT PENALTIES FOR SusMITTlesG FALSE INFORRAATION, INCLUDING -
Chemistry Manager THE PossieruTV oF FIssE AND IMPR: T -~ 4
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- 18 U.S.C. 51001 u.s.C. s 131s. m maise an S.ONMENe. SEE AseO 33 880 NATURE OF PRuotsPAL EXECUTfWE 870.000 TYPED OR PRNdTED =ad er me=* man ' .-
- : er6erw =a e menen rais'ycease ru mies se so 0FFICER OR AUTHOR 42EO AGENT CODE NUtd8ER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af errechments here/
EPA Form 3320-1 (08-95) Prev 6ous editions may be used. tREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
'N70/973105 9917 1
- ~ - _ . - - ~ w
i Rmerwork Reduction Act Notice - t Whii: rwuis bwh n Ic r " - com; 6.m of infetion i< eginnthi to vary fmm a range of 10 hours es an v4 iye p. r ,: p m/t fe "m m * - fxiht h s . ta 110 Ints as an averge per f tspodse for some rcjor.facthfiem { iG s w. ; M W w ra f r rn Q and mmr ffl!Na c f 13 hours per respec. including time for reyiewing
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- n d:n surm Ohni:e nd nuinbinine s th: dats need:d. 'ed completing and M S k P4 ce dernfmfenhm. %.1 comrn nts regardmg (be burden e,Unute et.any other aspect of 4 d,jr c@.n4 $f mfornen mit ellh sugNum hit woucing this burden.'to Chief. Information Phlicy Prtni PM ?n U S. lineimmem! PmNetion Agency,401 M Street. SW Washington, DC 2040; and ta the OJSce of infdr%;mn and R gulMor) Athirt, O!Ee of M.mgement and Budget Washington, D7 20503.
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General Instructions ,
- 1. U- f he has tan partia!( compfcted by pryrmting, disreprd instructiom directed at. entry of that information i litudy preprinted. I 2I Enter 'Pamatre Naredfadhrg Addrevs (and facihty namellocation, if different)," " Permit Number," and "Disham Number" nere ind<cated i A separate form is required for each discharge ) .i 3 ' LpMr dates tegbmm :md endmg "Afomtoring Permd" covered by form uhere indicated d
4: Enter earb *!'aromevr" as pc 0cd in tncnitming requirements of permit, 5 E ow ' i gle W , o = ' v" dai far exb parameter untr "puantay" and "punary" in units sprified in pennit. a / M mr" g * : mrrv': eMmeth w y (pn4;t ie avenne far bacterial paruncters) of all sampic rneasurements - br i d paj N rU# * "* H d:.Miy "!fwiforn * /Ydrd " fgrim:ptt" and "j fmimum" are normally ~c%tteme high f, " l ni U m:r'":r& W1id duriv *",femormg /Yried" (Wie to municipals with secondary frcatment ) t; t'; Fem?'" E W. Y h MT)p: Of $3 ? pie UmMure NHts UndCr *,f Veraffe[ Ond Cr.fCf maximum 74h) 3VCragO .j i ords . rn ' < ' ' r's M ' M d'nv nminnng p:rrd tmder "Afartmmn ") ,
^
e n w,6,eF m + fr + pwreer une Wray" and "gualav" as pci6ed in permit. < _ { 7' g ,A] eff j g ter ,4. r pf q, p ,4 , me, dwing monitoring period that exceed maximum ('and/or H: M F y r m e arpmph:+ mmo remsemera for each puameter. If none. cnter "0". e y c ,, s y r.s n 1 4 wr-,e uma trenucncy or wmpsg ana anaiyss used br4 e s o e, mp @ 3d m WrHr Fm
- ve# specified io penmt (e g , Ene:r "Corrt " for continuous 7.p m mf~yy g o, p, g 7. ;f gr p.,e @ per momk "I VT far one day per quarter, etc.)
p , *4 q, D 'j j " ge} p M + nf. ,f f, grepp,f. (y g3) 5,;puph gype used during gnomtprjpg penoj) and as
*f ,* M w vm' " 0; p . N;r %ne far p. Nhd amph, *N!!C" far 2 4-bour composite. "A".4" for m,opo,m rb ' orri e:1
; E b P 3. i f Yi Ff d p. ?- r 7; n;ye e p repgrted ;p'3ch a b;jef Cxpbh3tlOn 10 dCACTibc cauSC and COffCCtiVC N ftS 1M . 3"d r'.'kU "W CKL D'I;f @9.Dy dM e 11 ; If "re dWr" o~ " i d w r ' c:H perm!. emer "Jo Dncf arge" across form in pixe of data entry.
;y ye ww ;y, ..r j rm n I&re we Q]:W r *.4 "SQnature qf Principaf Decuvve Gf]Icer qf Authomed A mi" *;W ,; t mv. w& ory pi "pa e"r at ty,twm of (3rm
- 13. I i nl $r d P N't 10 CRCN by d.ilte9) rpCCifed iu [crDOI Retilin Copy fDr yOur IcCords 14 Mc e d nded istnwo.s fx em of this (htN:arge Afonitormg Report (D3 /R) form may be obtained from Officc(s) roe @>d m pmMt.
. Legal Notice
- Tb4 revt is raauited by hw (33 U.Sr 131F; 40 C.F.P.125.27). Failure to report or failure to report truthfully can ms3 iWvil en16s em t s ciend $ 10S00 prr day of 3 iabtion; or in criminal penalties not to exceed $25,000 per day '
i of eiob!j~t er by ieritecet far rot more than one year, er by both. l l EPA Torm 3320-1 (Rev. C' e') l 3
n i' memTTEE NAGAE.%OORESS WNewWomvim's n(Dp=w) CLWW EpoauramT orecnanee = =eom Form Approved NARAE ygpp gf g L g,y p9 gg3 z 37 y , f 7_ ,, ygIy-2 ggoy;cp y 4MB No(N tr ADORESS P ,3. 9)i 4 M^5 h5; 11' * (30*R 33)- ' ^8"''ll'"2** * "
- A ! * *t ; DA1ID 0RDDDRf PERMIT NUMBER oisenance wusseet ' r - t- [ g p, L ~.
aS I p p r* 4 3 p 7 p *' Da- 1So??
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MITMM N ri i J O P'
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8 FACIUTY ,ygycg y4 y y p343g g7gygg LOCATION 3M FROM 4/ < ca TO 4 i :3 ia 6W M D I S C M f. N F ((_ ' 1 s?Y4: O5VT9 3 n 4 *1 *12 ** 120-219122-23e 124-251 - 126-271 120-291 f.w319 NOTE- Reest ineeucelone W . ,' a eNo % l' PARAWTER 43 cent on&s QUANTITY OR LOADING to Corit on&f QUANTITY OR CONCENTRATMf NO. meouency 146-62 154-691 130-46o 146-62 tse-sti or - SAhrLE r32-371 EX assam TYPE AVERAGE MAXIMUM UNITS MINfMUM AVERAGE MAXIMUM UNITS sense fe,_,,, ,,g 7a,
" LOK, .IN 73190T7 Op SAMPLE
( 33) p y n c a. nun nuece f 6 '4 0 !?MtP5 MET O L A *s : MEASUREMENT h() Mg 5005) 1 1 '* PERMfT . q g p ej r> 7 p r pp yj A c c cret - e s ') n tr - : c v c Ht y-- rett Jgyny ' ggyrg! P n rf n - ;p3gg y 1 (q REQUIREMENT 1 9 ',geJ' w . 7,p n y on . e c o t-SAMPLE MEASUREMENT n PERMIT ' REQUIREMENT < - SAMPLE t MEASUREMENT j' PERMIT y ftEQUIREMENT ;M ' "
) SAMPLE MEASUREMENT PERMIT - '
REQUIREMENT , S AMPLE . MEASUREMENT PERMIT .
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REQUIREMENT , SAMPLE MEASUREMENT PERMIT
- REQUIREMENT -4 _
SAMPLE MEASUREMENT PERMIT REQUIREMENT a. .2 IsARE/ TITLE MAR. EXECUTIVE OFFICER e etariry unsoen resaLTv or Lasw Twat e Mave Pen =aane v *===eo ano , TELEPHONE DATE ans causuan vuivu Twe smeonmaTion suouirreo neien: asso easeo ons < uv neouiny oe Twose motviouns massonaTay nespossmale con
.Dayid Orndor, : ;- ,
s oeransaso Tm immmenTion. i seusve Tw sumamTreo meronisanon is Tnue. ACCUnaTe AssD CoasPleTE. 8 AAs ARWane THAT Thete ane y ' p Chemistry Manager j t. ' e siaamcicanT resanes con suunmTTusa rust esposmaanose. noctuo"'* THE PosmeeUTV oF PNse Asso _ . T _i set 19 U.S.C. S 1901 Asso 33 4 l ') 39J' -5113 W' (' & t NM W POWICFAL EM TYP W OR PfM T W u.s.c. s tsie. spwinanse anaisr miser. snese
. erass m es.ensus messheseer andasseum a yearmJseine ay se sto.se, OSTICEft OR Atm00RIEED AGEIIT M NuteER YEAR MO DAY COMENTS AND EXPLANATION OF ANY VIOLATIONS (Ref-.ee as steochmerpts here/
lY ' C Y Of C EPA Form 3320-1108-96) Preveoue editiotte may be used. (IEPLACES EPA FOfW T 40 W99CH MAY ffCT M Usm.) PAGE. n3,73/9R M6-% 17 ,cF
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,- . . - . ~ . - - . - . - . . . pap'erwork Reduction Act Notice J . i m, .
4 ea*2, I Nblic rep >rtidg bur &n for tids colketion of informmion is earimmd ta ayth" arm **llO ' e r6 fre.; l l ayeinge per raponse for some minor facWies to 110 hours e.3 an mrp per rm x k dth.m wyighed average for uwjor and minor ixilim ; of flh%c pr rtyre @%t tr ! r w si.J i irpirtetious,'surching existmg d.da sourcu, gmhning and emntamine tb d.m c W 'dJ an! , s upb, o g h 3 tcviking dupliection of infornution... Sded comnxcis. regarding.the hwdm 'mun M < m Mh a r pxf of t6ir coLfection pi information, including wgynons far red.dng tb tmrde s to Gid. Wmpton Pohey , j Ikrah, PM 22), 7 U.S. Envimamenul Protection Agency,401 M Swet, SW M.mt:m D C D W ! H h the
. Office ofInformation and Regulatory Affairs, Office of Management and Budget, MsHnem. DC 20503 l ' i, 1
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General Instructions 1 It' form has been partially completed by 'preprinting, disregard instrwetiorn directed at entrytof tid information {
.already preprinted . . ,
2_ LEnter " Permittee : Named /ading Addrm (and facility rume/ location, if d& rent)," "Perimt ; Ne der." and
. " Discharge Number" where indicated. (A separate form is required for each discharge.)
l 3[ Enter dates beginning and ending "Alonitoring Permd" covered by form where indated ,
.' .T .
!' 41 Enter cach " Parameter" as speafied m m.onitonng reqmrements of pcmut
- 5. Enter "Samp/c 3/cawrement" data for ca;h parameter under "(%ntaf nnd 'N!ir? in umn rpeiriM in ;rrmit ?
' " trernge" is normally arnhmetic averane (geometne aserac far bacu -ial parm etem of ali m% rmstremen's
^ me mm!!y et:eme high
, for each parameter obtained darmg #31 muormg Perid 'Mmmw" rmd 7!O and low measurernents obtained dming "3 foNoring iYrml" Wmc i s m v6 v ith ecod m tiemment l
[ - )
- n:quirem:;nt Enter Dday average of sampic measurernents under Elm ." crJ cr v nu mem 74ai maag - ,
L of sample meamrements obramed dunng monilormg period under "Ala vmm S
- 6. Enter "?ctmit Requirement" for each parameter under "Owstr and "tj,4/f as sp: aned m p'n:rt [
!~ , t i * ! 7, Utnier "No I.P enter number of sample measurmems during monitoring pmod tLM med naaim tm undin ' minimmn or 7-dayaverage as appropnate) permit requirement tar czh pararrte !! rm. cer '0" -
-l
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- 4. Eater " Frequency of AnalpW tmth as %mple Mewurmnr (=tud h;um c' wpq L rA t~ah us used '
- {
\ durmg momtormg penod) and as " Permit Requnemenf pifd ir p~nm u:g E>c J W" fa cnniine j { ~ i- mmidoring. "1M for one day per week,"hju" for coc day per momh, * / t ' for one dr. pq ow ;) [ t i
- 9. Cuter " Sample Dpe" both as %mpir 3/canecmcr !" (actual samp'e O pc reJ dan ; mor: ' mrn irio
- r, ml ; '
Permit Requirementf (c r.. Enter "Grah" for indhHuf samp!:, "Bri!<
- for 3MW' 4
+, P fv f l
' 'contmucus monitoring, etc.) ,
l l 10fWhere viqtations of permit requirements are reported, anach a bnef opketimi ta dxribe w eri cmeeth; l 4 actions taken, and reference cach nobtion by date. l L l 1L Af"no disctnige" occurs during monitoring p~riod, enter 50 Disclage" acrcu form in plwe nf d a cr try
- 12. Enter "Name. Title of Principal Executn e Oficer" with "5gnature of Prirmipal Ere : ce (p e- w A &n:n! .
Agent? ' Telephone Number " und *Date" at bottom of farm.
- 13. Mai! signed Report to Office (s) by date(s) specified in permir. Retain copy for 3ont reemds e 14; More detailed instructions for use of this Discharge 3/omtoring Report (D)//D form me be oWiced rhm Omccm specified in permit. [
Legal Notice ; This report is required by law (33 U.S.C.1318; 40 C.I' R.125.27). Failure to report or failure to report irmhfay car [ i result inl civil penalties not to exceed $10,000 per day of viohtion; or in criminal r nalties not to en.wd M5 000 rer day I l of violation, or by imprisonment for not more than one year, or by both. i n 1% i , i I.~
, . .? ..
i-EPA Form 3320l1 (Rev. 08-95)'
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PERMITTEE NAME/ ADDRESS thshe FordepName'Imeen.= lfDitch,.id NAnossAL POuUTANT DISCHARGE se memMON SYSTEM MPDES1 Form Approved. NAME DISCHARGE MONITORWG REPORT /OMRf OW No. 204,0..0004 p; ,e yprr uu. avs .n n ; ;-
~ ; r no . t s. .,- 12-1 61 417-191
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v _ b L - Appmval egiees C5-31-C8 ADOREW r, 1, y)g q 33>s 35g y7343 WM UWR onscHARGE m y
?:n: 14513 3 ? !! J 3 3 ,. ,
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= i, g;yv MRORIPfG PERIOD M ' J C; .- #
~ 7 t R n V*LLff PO%{ 171TI3% YEAR MO DAY YEAR MO DAY ~
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LOCA M FROM ,- n- s-. TO n, a 1 e- en~ n 3 r c -
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e;e. .s1T3 n: r's 12 & 211 122-23) (24-25) (26 27) (26-291 (30'399 NOM R***I S*N 'I*9 'N* I**f'- (3 com on&l QUANTITY OR LOADING I4 com OWs OUANTITY OR CONCENTRATION NO. mEoufMCY SA4LE PARAMETER v46-531 twsts (30-45) 146-521 (54-691 OF (32-371 EX ANALYsS TYPE ! AVERAGE MAXIMUM UNITS MINIMUM AVERAGE. MAXIMUM UNITS ,stes, 164 681 tsS7a
, SAMPLE 43g~~> 3 v. y p ; e3.)3). 7 7y*- j MEASUREMENT 'f gj z y jj g ,/7 ,
f g m,, ,
;3til 1 a; m PERMIT %ppe y m et : e .: 3 g,9 - 93g .gg pQ gj. '
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REQUIREMENT . ., ,7 , , , , , , , , , , , , ,. ,, r i, SAMPLE 9393~ 3 p.3 3 3 . $ 3 3 3.y y )9 ;
,3 [ $ e.
;3-g ;[ , k , rl. L MEASUREMENT gq gg g . ,f f
'tM
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O *1 % J 3 1 1 3 PERMIT c e g p a. e 3 3 pg r 3 .: 333 g 33
. g g- 4g g ,,
p.,, , REQUIREMENT ., ,,j,, ,,, ! nor ,, ,, - . ., q - ., , . , , , , , 3tt tsg ;1215: SAMPLE 3pg334 e.~eggy 39; en7)t t*q,rq4y a c ~- MEASUREMENT < 4" g 4~' 4[ O Lr PERMIT nm 3 p g e: qAf333 &g 79 lp 4 ,' ",, ["g' 131s$ ; ) - 733 ]'
- n. ozyP -,; y 1. , , . REQUIREMENT , , , , ,, , , 4 ,, ,
SAMPLE n g) . ,. g g , e
;i,?W, IP C3103[7 1? 3 3 g ;. . g ,,, , .
* :t y , y c. " t i 1 " 1 ~' p L t. T.
MEASUREMENT g gf, j g j g ;r ,,,.. ; g y*",
~ 1 ".6 7 1 ) - PERMIT ppm po p 7 g9g gq q g : ggp w3 , f' ~ p w~ -
--+ g,,,, -,,,- vr REQUIREMENT -
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, SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT ,
REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNOm PENALTY OF LAW THAT t HAVE PERSONALLY EKAMINED AND f TELEPHONE DATE AM FAMtuAR WITH THE INFOf%4ATION SUBMITTED NEREIN; ANO SASED ON f MY INQUIRY OF THOSE INOlvtDUALS IMMEDIATELY RESPONSISLE FOR 1 r , 08TAINtNG THE INFORMATION,1 SEUEVE THE SUBMITTED INFORMATION IS .- / (' s David Orndorf TRuf. Accu =4TE ANo cOMPtETE. i AM AWARE TNAT THmE ARE - :
- w ._ s SGNIFICANT PENALTIES FOR SUBMITTING FALSE 4NFORMATION, INCLUDING ClieL11.11 t t v M a rt zi c+ e t- / \ 91001 stO'NATU'R"E OF P'RN'GCI' PAL' EXECUTIVE i
707 e1 17 o7 - (.'" 9 _q THE POSSIBluTY u.S.c. e 131s. e%wn. OF FINE.ANO e., e IMPRIS.ONMENT.
.esew mer icA,ss sh . SEE 18 u.S.C M spo,opo AND 33 TYPED OR PRINTED e,.d ar marem.= w - : .r a.rw ,e s momess eid s resrs s OFFICER OR AUTHORIZED AGEIET CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# strechments heref EPA Form 3320-1 (06-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF 517 7 6 / 17 ,10 6 < O '117 1
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a Paperwork Reduction Act Notice Js ..I , j Fihlm nyude burh fu :Lik ct&ctkn of infore.mtbn K estinnts! to vary from a rr.ge of 10 houn as m f j f my6p per reppu:e for ys mar fmNiet to no hourgs e asprage per rdpee fd sane major fkihties, " .l Si h mHed nura * , f r %ir s.ad im ' c trihties of 13 lumriphr remonse, includmg time for revising ! mrit ewn; 6 mhirq e dra Jh w n ge hiyg mai@tdidmi jhs ata bm!cd? nnd~cqmpktieg and 4
,z. j rd keg th1 r a!!n Uon v mbr:r " rt Mt mutf repudmg the bmden eder@ or any other erect of '
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. thhgDMen p inMmr a inihdire; sur An[for rescing "this burdcu,' t6 Chkffinfdrustien Polky Urwh FM 223 U $ EWren MM Pmtion Arrey. 4m M Street., SW Wehmgnia, DC 20460; and to the ;
O@ch ef h@rnsbon :cul 15 guhtory Af f6rt Oftbebf Mumgement and Budget Wadtington, DC 20503.' e j r , l
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2.- Entm *Pcrmit/cr Nat e' Mailing Addrevt (:md facihty name/ location, if different)," "Pernut: Number," and ,
- D/s bar;m Number
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l 35 Erue: a.. , tb ing imd endir %mn>rmk Period' covered by form whcre indicated i'I ' f
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' C EnMr och *ParameW as speciNd in emmoring requirements'of permit. i 7
l s resm;&u-y'uma er ce pmer m der wunw and ouantv in units sexitied in pcrmit.
%vraf a normt s men av my (geomeMr average for bacterial parameters) of all sampic measurements -
t fat h h.pam mety on mf dur% M t >rmrn:: Per*nd: "Murmum" and 'Mininwm' are aotmaly extrcme high l
- oyd Lm.c s uo o ehmd dM7 %et.em.g PerioJ" 1 Note to mumcipali Wih secondwy treatment '+
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- 1. Ytem:.t i , e - f- ce p m r ner Santm" ad " pun /w" as cpecified in permit. y j r 7. i Mei no W c'e m +er et san D r wnnents during monitoring period that exceed nmirmnh (and/or-' ' .l !
n , 'n e+ 1+de rw x emrwd rwn! regnuement fx cach parameter tf tone, enter "0". eenws%-m m.y . u-regmcw syne, or sampny and aresis used krv rw29ig p + ed a W > u PeyreirerP neAd in permd (e g , Enter "dont,* for contimets j 'e
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, .U, , M ! #7/f[h / j) $ f*'h kh'mM!Tf**T y_) VW l US'?d dmiDg monit0fing period) and 35 i
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#1j jf * - dM a7:# e cm Oneg > nimm permd enta "yo Dmharge" across form in place of data entry. {
! 12l VM: ' ><i% > f l'y rs! [:: nxtw OVce" wif t: *.%gnature of'Prmcipal Executive Ofj?rer of Andhori:rd
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A* " % tybm We'A ," aM Sr)ofg* at bolicm tf form - !L f.iei @ N 0y "t t9 Chce{s) by daWs) spercified in permit. Ectam copy fu'ryour recordt f j If ! be d nNd ibidstmw fer cm of this D:n Mrge A feitormg Report gn8 fif) form may be obtaitied from Office (s) - ecerned iipermit' i Legal Notice j .%. ;m l
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- l, Th$ rem it recuired by in (31 USC.13' 40 C.F.P.125.27). Failure to report or failure to report truthfully can redit f ciril pmits et i, neew! $10RG p-r d4y of malaian: or m crimind pertanies not to exceed $25,000 per 6y cf viet;um rir by.tmptivmm-nt far rx t rnnte thar year, or by both. 1
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ETA form 232M (Rev. cW) r: ' l
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PEIMTTEE DIAWADOFECS @mu FerebreN== '!.reeres IfDWows GTioseAL POLLUTANT asscoeARet EuasmAftose sysTae /WOfS/ Form Approved. . i!!) Y 7 1 Y S. bi, E T $ N I . P. SIkII)2 rp .3 NIT 2 $EilIOT "' M k-P
. A00 RECS t , 3. .t ) t G N*90';6iR 113 e . (DU M S 8i) W '"5***[ M 88 4?IE; O A Y I:' O3DD0yy PERPUT NUMBER Df9CD4ARgE ggimesq y 7 { g g {, ,
39IPP(N;P3Rr- U 15 i ggg U J01 , 4 FON1Y q z g jy p q y;LLgy ppyop 37gT[]s E DAY YEAR MO DAY - LOCAT'O'8 FROM ,_Y_E_AJ <$ l~. 30 i TO 44 -e . >t f" d0 DISSERM I_l EM *
\?Yy: n6Y[n %%nW7 12S219122-239 t24-251 t20-271 (20-291 (30'311 ; NOTI; R**A 5 **
- W-PARA N TER 13 carat on&p C Y OR LOADNee t4 w oriM QUANUTY OR CONCENTRATNIN NO. w oupscY SAW'LE (32-371 146-531 454-891 130-459 146-539- 994-011 EX or As.ALyys TYPE
/ AVERAGE 'AAXIMUM UNIT" MINIMUM AVERAGE . MAXIMUM UNITS asses fu, . Iso-7cp
- SAMPLE a'e"* *"4c? ! -
M 00 7e ( 12) /, & MEASUREMENT $M' hr b P - ~6 6/Yr.5 33q03 [ ] O ' PERMIT .Stee w . e re n c a 3 an" 6.0,
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tw I C t" / ;Wes-s e r r, t e u e ;p14e :p g t ,3 REQUIREMENT . 5 3 t:3 j pi y .n p g g y y .j gy g eg eggyg p- ' r, 7 v, I n ; p y y;( SAMPLE N.SA^* h e u te t a ^ 4 W 7 7- ( *an t pL "'~ 6 3 j y,p h d h en MEASUREMENT /3/ /5 / M (mg
-} ) ; 1 ' 1 *) *) PERMIT - teat 0* ce Sp e s $^v 90**w M S "4LCr/ ;0M-e r c e,3 7 r e ; a q q r; yg; .
REQUGEMENT _ segg f g y. @My @g g r, f t . gp7[ SAMPLE 033000 30610^ *
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( 19) j e ecy 3gg MEASUREMENT M31f CJ6/ /d (prq[p
;)O53 ( ? 3 PERMIT . 034 W *0Mt*- 43' n s@ pe S .'~ i' 018 7, HEPORT 's10t/ ; n ,*, n erLgeye ;933- yam REQUIREMENT com vp g y ;; yNyg ;wg; *g/L *q) 3; p .
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( 1q) y7 i& L MEASUREMENT /87 3d hg[ 7gisi 7 333t"' '"*M** 0"? 06**** 1 [ PERMfT 22 % .. 79 0@ '/ 741CL/ a tt A S -
= c "t :i f N T 777"I': V it L t REQUIREMENT cett . w r) m in g , j np yj nggpr i n'S, 257173.TCEDU SAMPLE 00P?n" ^P?" W O m'
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42'G/ 1 ) ' PERMIT -r u e r? $ * - ^~ * * " t 'r *?O . C M e r> *: ?b 1R , _ '.=I C n t' 2 P- . ryr;rgy ; a l :; 1 I s, L a REQUIREMENT 3^2r t. g a g ?. 70s.ILY in n.3/ L *%0373 f SAMPLE i MEASUREMENT i PERMIT : l REQUIREMENT . psanastTITLE PIWWCFAL EXECUTRtf OFFICER etntwv ussoEn PEasALTv er taw TMAT I 94 AVE PEftto80 ALLY EXAAAIIBED AffD - TELEPHONE DATE Ana #Anmunn wim THE meonasAriose zusamTTEo MEREm:Asso sasto one A /,/ nov tefOul8tY of THOSE 190oiVIOUALs IRAt#EDIATELY REN FoR -
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I otTAresesse THE MFofusAftoes. I SEUEVE THE sughmTTED sesFofusAftces to DilV lG Crndorf TMUE. ACCURA AfuO ComePLETE. I AAA AWARE THAT THERE ARE Q y- .< v . snwncAmT RETE Alms som swamTTwo eALsE isseosmeAT,oes. mectuom s '/ \ ' ^ i 4L2393-5113 C,terlistry t Mananer TM! Posasesutv oe riset Asso inspiesosensesT. sEs te u.s.c. s 97 04 28 u.s.c. e isie. m asisw meme seawne mer assamme mise a, toot se Amo ss , M M OF M ENE h TYPW OR POWITED saw er . _. - --- er eseweso s amaste mis s ymmms sto.aso 0FFICER OR AUTHORIIED AGEgf7 W __ 98UtWER YEAR MO DAY COMIENTS AND EXPLANATION OF ANY VIOLATIONS tref..a s# effechmerrts here/ , -4 g g, .- pg g.
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EPA Fort ,s20-1 908-95) Prowsous odetsorts may be used. IfWPLACES EPA FOIN T 40 VWGCN MAY 900T BE USED.) PAGE 3 ;3 7 3 7 7 p y 3 p p 3 ,
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I' l [v . Paperwork Reduction Act Notide .. J e ; f f PuNic reputirp burden fist tid udlestian 0{ infernutua is evirutM i:j n ry 6 m a um N IfJ } s:< ac n l g mrigiper tt<penz bir some sd:x fkht:e, to 410 heur as an r;mga p r n - f.- E :b < f; b
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- , Of fice ofinforduuon und Regulatory Aff airs, Office of Mami;mment and Badr. Wu bcy , K 2T01 l
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1 g I Grenerni Instructions I , 1 if form has been partially completed by prcprintmp, dn.reprd in'.tructione diwcted 8 entry of dat inf.amanon aircaJy preprinted. l ! 2. Enter "Permince Namedfmhng Address (and facihty namcMacation, if differem)." " Permit # W r! ce," anJ l *Dluharge Number" w here indicated (A separate form is required far cach discharge ) 4 ! 3. Enter dates begirming and endmg %mtoring Period"cowred by form u here mdi::ted
- 4. Enter cad "1bramercr" as specified in monitoring requiremems of permit
- 5. Enter %:ple Memurement" data for c:u.h parametcr unir pua y,' anj % ev in un ' spared in p'rmit.
" Average" n wmnlly anthmche astrage (geometric awr.c'e for E -:1: d p m m ) M a!! s , .g* n mm menu for beh p:nameict obtaimd dunng "A! maan"e l'emo.i" %mra " a nd '4 ' ' > '
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and low me:n.urenrcnts ohuined dunne "Afvermg /Yrmd
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1 1 con of sampic mcxmrements retained during amniprmg p;:riad tu&r M fa " r j k Entcr 'Pernatt !kjuircmen!" fc*r cdCh par;UMCG-f undc;r "(hrbh " and ' Qi! % Y" A N 'i: 150 77'.f 7,. Under "No 1:1" emer number of ramrh n ;utments datier rc: xuman pu d d. n ' . ! n- , ,tc mndu mmimum or 7 day awage as appropn:ue) penmt reqWrement for ts!! pnre e ta If: r- t * : t "r' S. Enter Trect:cna- of Anfais" both as % mple \!camrm n m' ni b y a c' ' nM r A e h2 ~ m* during mcnitenng period) and as "PernJ1 Re. par mert" rpadkd in p':n. ' (c p ,
- "I i ' " ft ' m:ne momtoring. */7 for one day per veck, "/.W for ca day pa raun a "I fa v d n p"r ca :rt i, c 4 1
- 9. Enter %ple Tye' twh as N "r!c 3/ramremed tamual s:ap!c tm nr.t cor onn n p 4 ad. ~
"Pcrnut Rcqmrr ment." (eg, Erict 'T?ra!? for tade rt:n! wnpb " N!!' '" br 21 * ~r - r v:
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. continuous monitoring etc.)
- 10. Where viol $tions of pennir regmrcmems are reponed. at!xh a brief cm m: ion la c' W c.w Mie rtn eacDons taken. and reference cach violation by dale l l
- 11. If"no diidiarge" occurs dunng monitoring penod. cdcr "W D!WP 7m form D pl: M 6 a cory l
- 12. Enter *Name Title of Prinapa! &ca.nve Qll:ccr unh " agna:ure c.f Pne tw! Tu we ; & r , et V 4;!
Agent," " Telephone Number," and "Date" ur bottmn of form
}3, Mail signed Report to Office (s) by date(s) specified in pumit Petam copy for 3 our reemd-14; More detailed instructions for use of this Disch.7rgc Afomtories' Rcro*/ @UM form m.0 be d un' i hom OfLerm specified in permit, Legal Notice i 1M report is required by law (33 U.S.C.131P; 40 C.F.R.125.27). Diture .to report or fedum u mpor' teadduMy rw result in civil penalties not to exceed $10,000 per day of violation; or in cronmal p+nalties nat u rrmed W Orn per du of violation, or by imprisonment for not more than one y car, or by both.
1 EPA Form 33204 (Rav 4 95)
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peteNTTEE NAME/ADDRESSGewswesPowf.arensa(D@="f NAT'ONAL POLLUTANT OrSCHARGE EUMueATION system lRFDf3J Form Approved. DISCHARGE MONITORNee REPORT OMB No. 2040-0004 . NAME z y 1 y :, . , n. +., s . e r. v >yr2 ;-ra - y. 12-t ar I 7-1 99 ~qyv -nn- we- - - --
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g ADORESS e, h R1L 3 ('; 1 Ts ~1 *S) 123a$ PERMIT NUMBEJ orecHARot MuMeeR , A T * ?l ; 9A71) 3E7?OPF t' + - Fign! , r 3 -; E p o i n r o g n ; 5 1567T MTNG PERIOD v A y ry a
! " I if N 7ALL T POJ7 5? API" YEAR MO DAY YEAR MO DAY LOCATION FROM -e7 - na TO n~ i 2- e. y . , 7 m e. . , 3 - gQs ee3 ,
nr, oswT , 3, ,n, ,e 120 211 122-231 12+259 126-211 I20-291 630'311 NOTE' **** * -
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(3 ced ontys QUANTITY OR LOADMG I4 Cod on&s QUANTITY OR CONCENTRATION - NO. mEoutNCy gg,jPLE PARAMETER 146-53) (54-619 130-45I 946-5M (54-699 OF EX mys,, TYPE (32-371 , AVERAGE MAXIMUM UNITS MINIMUM AVERAGE - MAXIMUM UNITS ,st-sss rg#sgs fas.7o, SAMPLE g. p e . 3 333 3 eyg3pg g 7s MEASUREMENT PERMIT mpg gg [g g g - 1 ^, a q 7 t 3 a g.333,y 3,y gg 3 ;%e 4,3 gg33 1, l r, : rec -3,,1 ,z,,, REQUIREMENT 99
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- PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT
- REQUtREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT MAME/ TITLE PRNecrAL EXECUTIVE OFFICER CErTiry tmotR PENALTv or law THAT t MAvE PERSONALLY EXAMINED ANO TELEPHONE DATE AM FAM UAA WITH THE INFORMATION SUOMITTED l.EREIN; ANO BASED ON i MY INQUHtY OF THOSE INDIVIDUALS fMMED6ATELv RESPONSIBLE FOR /g- # 1 C OSTAfMtNG THE ENFORMATTON, t BEUEVE THE SUSMeTTED 19eFORMATION IS
'b;-,,'j D3Vid Urndorf TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE l ' [9 '%_-
SIGNIFICANT PENALTtEs FOR SUBMITTING FALSE 19fFOf3AATTON. INCLUDING ChOPli R t P7 Mana9er THE POSSletuTV OF FINE ANO IMPRISONMENT. SEE 10 U.S.C. 91001 AND 33 " \ -~' -* , - , U.S.C. I 1318. fPinsfase erest stese smeans awr henase mes se se #70.000 SMNAT'U'RE'OF"Nd'EXECUWWE AI4EA TYPED OR PRWTED mas er ===*=na 61 . reter-ese e naeante sea s ie=r s OFFICER OR AUTHOMsEED AGEWI CODE MJMBER- - - YEAR MO- OAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference es ettechmerrts heref []O hir - i r n ,? EPA Form 3320-1 (08-96) Pmmous editions may be used. EftEPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
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, Panerwork Reduction Act Notice V .
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l' 704 urenhg ieen fa de cAto .ef inGnmon is esmc.ted to wry from a range of ,10 houp as an
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+ni- Qrm o mlura me dt vw: , gernog and muntahdng the data nmk:d, and sampleting pd 7 .
r- g M des r o e ' m " " y m J t..m ,g: prd;ng tb bu:dqn estimate or any other apt of '
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l Ag ' od M # m , inder une N r ' br mJring 1% burden. to Chief, Infonration Policy ; f:hM. PM 221 f U. Ent imwrmi Pmtecthm .Agerg 40! M Stwt. SW Wadington, DC M460; and to the l i Ofib o! !nfonreva mJ P uintory Af %rs 0%c of Mannenrot and fedg Wahington, DC 20503. r i *
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i General Instructions ' - 1 J If farm has been putb!!y comph tnd by preprietingc darerard instructions directa! at entry Ef that infonnation ! i
.Jna,dy preprinted.
1, 2! w:ESr "?crimure Nar w M mlin;: ,f.idmx (and facility namellocation. if di1Terent)," "Permst: NAber," and I
*Dat ha ty Amh# v h re inacated ( A sepante fonn is required for each discharge.) ,
i 3 Enf.ir dmes tqianm y ad enior '%mrormy Pcnod" covered by fann where indicated
'i 4: End er$ Panevtcr" as spec:f7d m monitorma requirements of permit s
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S.Imm" en:4 M no w" d va hr erb parmoeter un&r "pwmtf and "Qualite" in units, specified in pennit. f a is omn 31:; hai m - (r men: avens fur bacteri:0 panmeters) ..f att sample measurements 1 (waLm.re1r & mdde W n:- rq Paiad', 0.tanmum' ard 'A rminn.m' are nonnaUy cxttcmc high < 1 nj % cua m:< m r?. na 1 Nri " i f. mrin? /*mmi" ' t&te to n unicipals Wth second tri treattncnt of mp!. m o tremem ; incer "buagf ard cuer maximum 7 day average l m tuen fe*' dev> ;
, cr ; c. .-9 pr;,, & ciwvdAm om m ' mo f undu *Mn uwe'i ") ,
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- werr'i" 9u:W " and "daf .y" as specified in penmt ,
[ We ~ w ; r i aa r +ct / * ' d'c mr et ; dri"". rronsring p: nod that exceed tasximum (amUor ( w. : g Mr e - m a~rm t r pmmt. trmmmm for each parameter If none, cnter 0"
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, + % o s getual f requerg of emphng and mdyg uwd i L ' ' [,4, g ,,y m) .e, , pe, m -d . *"e m / l' <:enw!" sp:ckd in permit (e g , 0;mer *Omt " for continuous J l ,
f f. ~ , ,, nj (, c i ,v y H , ' P ' / fx or* d n per month "199" for one day per qturter. et; ) , c n,m my,I n a v ,, w r.u -l, i %rmerr" h ::tf sa'npe %pe eut daring monitoring periot0 and as
.m fyd, ,,n, ,.. r f p; y tw :# fm indMdut sampt Mic" for 21-Leur' compoute, "NT for g,, mems n a sc.m m 3 ,
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l l 14. 7 prc dW d iWrue.s fx ev # this piui nye Mwwmk Report (lufR) form may be obtaired from OInce(s)
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, Leoal b Notice TINr$m is emuirnt by im (33 U S.C. Ulta 40 C.f.P.125.27). Failure to rep rt or fslure to report truthfully can i' red't i" cwil r tities rmt t- ocmd $10R10 per day of viohtion; or in criminal penshies not to exceed $25,000 per day of viaM, on, or lly ieriammet f.it riot more than one year, or by both.
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MRurTTEE NAME/ADOMESS(7=rhe Forsh9 None'Lorersee gTe&owf NATIONAL POLLUTANT DtSCHAMGE ElmMNAT*04 SYSTEM (NPDf8/ Form $pproved. NA ME , ~z , g g((q {T
- 74*{. OtSCH,A G,E MONITORING REPORT (Og q , ,. ,
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- s. s,- = , , ApprOvet expires 05-31-C8
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/ AVERAGE MA't! MUM UNITS MINtMUM AVERAGE MAXtMUM UNITS ,ess, (64-68; Ar:ALYss TYPE f6s-7ap i s SAMPLE a"F7** a'$P '~"~' ' ' '
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REQUIREMENT r7' 97 *Y; . 1AItr M- .; / L ! M *' SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME!TTTLE PRINCIPAL EXECUTNE OFFICER i OERwv LNotM PENALTv OF Law Tv AT e HavE PtRsONatLv EXAMINED AND AM FAMILIAR WITH THE INFORMATION St.'8MfTTED HEREIN; AND SASED ON TELEPHONE DATE g g ^! ' ~- 4 ( )
,~' . . ('y-' MY TNQUtRY OF THOSE INDIVfDUALS NMEDIATELY RESPONSBLE FOR OSTA7NING THE INFORMATION. I SEUEVE THE SUBMtTTED INFORMATION IS f._. 8 [J 4
j Cl1C m 4' ' ' l' t I " LIE 3 7 C F TnUE. ACCURATE AND COMPtETE. I AM AWARE THAT THERE ARE 9GNmCANT PENALTIES FOR SUBMITTING FALSE INFORMATION. 9NCLUDfNG
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t THE PCS98tuTY OF FmtE AND IMPRfSEENT. SEE TW U.S.C. I 1001 ANO 33 5
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d u.S.c.9 1318. sPoasium emw ewee semann wwr wude shes op w #70400 SiONATURE OF PRINCIPAL EXECUTWE TYPED OR PRINTED sad er me=*meC - '- J er ewween a niemne ew a yearms g OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO OAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a#ettM.T-,ts heref EPA Form 3320-1108-95) Prewtous editions may be used. IREPLACES EPA FORM T-40 WHICH FAAY NOT BE USED.) -- - 37 T, , s .a- 7 PAGE OF
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Paper *ork Reduction Act Notide
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i PuhUc repotNny burden for this collectioa[f infomation is utitruted la urT frw a rd;- of 161 m n An , i . adr4J per rep <mw for some minor L;ihtim. tal10 h6un g anwrm pr rcyar f.a mm; ;rs t fx dith ,
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with a weighted average for trugor an.f minor Lcifiti f ., of 13 lers pt, rrpo istructions.,warchin); emiing d2:a xe n gathering-:md. m 'ntaimny the dm nrkd. al mektt ; . ru req *ing du owkction of information, Mmd enmenu rprding the hnic d!mc.i er i :lty m a cf 7 ' this collectido Li infanmtion, induding supptio:n Dr reduune tLk brin, la CUA kfe wth PA' Drinch, PM 223, U.S. Environmental Protation Aginey,401 M Stnn:t, SW Wairgton, ir 27tGu; ed to the i j Offi6e of Infoniwtion and Regulatory Affairs, Otfi e of Msnagement and IMpt, WWangmncDC 20$03.
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, , General Instructions
? 4 ;
- 1. If fonn has been ' partially completed by preprinting, disregud instructions directed r3 retry of flat infarmation already preprinted. - ~
- 2. Entr.r *Permince Name/Afa Img Addecsx (and faciht) n;me/ location, if ddLient)," *Pcrmit Nmder," and '
"Di.wharge Number" w here indicated (A separate forni is required for each discharge.) (
- w. .$ >
g 3 ' Enter dates beginning and ending "A fonitoring PermJ" covered by form where indealt d, j
- 4. Enter each "Parametcr" as specificd in monitonng requirements of permit. ,
- 5. Euter %mple A!easurement' data for cach purameter und:: "Quarwie" ,md *Q.unty" in un .< grtind in prmn. '
" Iveragc" is nonnally arithmeuc ascog:(geomdric average for brteiat para urd of di smpe neu rme@
for each paraneterobtamed during "A/omformg Feriodi "Enum " and 9 ' - m .,re mrmdly e trw UC and low naurements obtained during. "A famtormy Permd
- Cime to ruudp0 with seconk twannen requitanent: Enter 30-day avemge of sampic measurem';ds tmda % re
- nd crrr mavixm Mn' s crag i of samp!c rucasurements obtained during nmnuoring period unbr *3 fary ") .
- 6. Enter "PermliRapdrernent" for each paranteter coder " pus * // md W M>r at sp cirh:d m p :W. (
' 7. Uader "No &" emer number of Mmpic measurmena durmy monitoung penad tM cd ret t ire trmdSr I imnimum or.7-day averrigc as appropnate) permit requireme;it far teh p^rmMcr 1rr.m erder "n"
+ E. Entcr .*Frepcmy qf Analysts' inth as " mple 3/carurmnt' (acm.d fregucen cJ mplid .wd , dp osM
'ddrmg mmutonng perned) and as *Pcemit Requirement" specHiM n, partn" f : g. i~r r "ri et." fu mdHom monitornyV//7" for one day per weck "/ST for one day per month, "1 W fm one d n p r er rtr,
- 9 Enter
- Sample 7)pe" both as %mp!c Mramremem* <rtua! mnph typ:: med darine moenag p" n!; and .
s *Pcemn Requirement," (e.g., Enter " Grab" for indindual sample "J.r!! N for ?mur cmrp.de '" m r, l continuous monitoring, etc.) 10,,Where uclations of permit requirements are reported, ot ach a bncf expimfion to dmriv rw ' ar d enemiu rctions taken, and reference cach violation by date d
- 11. 'If"no fscharge" occurs during rnonitoring period. enter Wo Dmharre" cerns farm ir pbcc <.f dn c f fy 12, Enter " memtle of Prmcipal &ccutsee Officer' uith %7a.'ure q!'i nepn! &c etwe ti;&er o as thw' Agent.* " Telephone Number " and 'Date" at bottom of form 13, Mail signed Report to Oflice(s) by date(s) specined in grr Retnin ccpy far your reccrde
.\
14, More detailed instructions for use of this Duchwge Mucuemy Report (DA/H) form me tic o%it ed f am OfGecN 1 specified in permit. j Legal Notice This;rdport is required by law (33 U.S.C.131S; 40 C.F.R.125.27). Failare m report or f.nh:re to report truthMiy on
. result in civil penalties not to exceed $10,000 per day of violatum; or in crimarmi penalties not to ec+d $23 WJ per de of violation, or by hnprisonmer for as more than one year, or by both.
3 1 t l' EPA Form 33204 (Rey,08-95) I 1
w ~ w --- PERMITTEE NAME/ADDRESSthW Fore,Neselecen (D.S w NATIONAL POttuTANY cascMaPof EuMmanON sv5 TEM (NPDES / Form Approved. NAME DISC j 7 4 , , 3 ,. , E MONITORING REPORT,(0 ,7 f ,,, 7 . ,, ,, CMB No. 2040-0004
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9%y3 3 3s33g gm93 .)9g [" ' g , ' ' " 3 ff, , - w2 ,y es .,..s S AMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT ( PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER i CERnFv UNCER PENALTY OF LAW THAT t HAVE ofRSONAuY EMAWNED AND TELEPHONE AM FAMIUAR wtTH THE INFORMATION SUBMfTTfD HEREIN. AND SASED ON f DATE MY INOUIRY OF THOSE INDtVIDUALS eMMEDeATELY RESPON9BLE FOR .m j d, R 1 O U T11dO F Af 06TArNsNG THE eNFORMATION, t BELIEVE THE SUBMITTED tNFORMATtON IS / i TRUf. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE /, [' h < , %.y ' 9GNIFICANT PfMALTTES FOR SUBMtTTIN0s FALSE INFORMATION, INCLUDING b I:C l' 16 '. E i !1 Gila R O E THE POSSf9tUTY OF FfME AND IMPRISONMENT. SEE le U.S.C. 91001 AND 33 _ U.S.C. f 1319. semanees armer shese seen,#es mer mrue thes se so i70,000 SiONATURE OF PftlNCIPAL EXE ' TYPED OR PRtNTED aw ar me=* men -_ -- : eF eerwesa m menes w s eesen; OmCER OR AUTHORIZED AGENT NUMEER ^ YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# strachments treref EPA Form 3320-1 108-95) Previous editions may be used. (REPLACES EPA FORM T 40 WHICH MAY NOT BE USED.) PAGE
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FEftMITTEE NAWADOFEOS(JaredeFacewyMuse'Leeen grr,fMo# . NATIONAL POLLUTAst? DeSCMARGE JLmIMATION SYS*EM (NPDESJ NAME
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- Form Approved.
ADOREOS " 3. ;)I 'l **"7"E' MN NG NT(D% ,7 yVIT 2 O O.7 L 7 x F M No.204(NX)04
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- PERMIT j REQUIREMENT SAMPLE MEASUREMENT PERMIT REQtJ!REMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAMEiTITLE PRMCFAL EXECUTIVE OFFICER s CtRwY UNDER PENALTY OF LAW THATI MAVE PERSONALLY ERAfAINED ANO f T' TELEPHONE AM FAMILIAR WITN TME #tFORMATION SUBMITTED HEREW: ANO BASED Oss & Mk DATE Dayid O tT.d c r f 8AY WOUIRY OF TNOSE WDfVfDUALS eMMEDIATELY RESPON99LE FOR its[-
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Ch a LsLry !!aH3g~er ORTAINWG THE INFORhBATION. I SELIEVE TNE SUtutTTED INFQRMAPON tS TRUE. ACCURATE AND COMPLETE. : And AWARE THAT THERE ARE 9GNmC ANT PENALTIES FOR SUBMff7WG FALSE INFORMATION. IItCLUDesO
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--/,u /(/ g v if THE PCS988UTY OF RNE ANO IMPRISONMENT. eSEE 18 U,.S C. 9,1001 AND 33 f
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9e7 gA; ep u TYPED OR PRMTED U.s.C. s 131s, sPwamse sender swee s,eausee m,y siensi seese sr0,000 84GNATURE OF PRWIFAL EXECU' TRFE mas w mensaien : - a er a.ewee e memne ans s remras OFFICER OR AUTHOREED AGENT M, NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# ettxAmts heref A J b d 6 ( b : / + -C_ { EPA Form 3320-1 106-95) Previous editions may be used. (REPtACES EPA FORM T-40 WHICH MAY NOT BE USED.) --;}fa79;n, PAGE S 77 7 ,OF
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! Paperwork Reduction Act Noti 4 ~
{ pubih!, repwiing hafden lot this COUeMa d{ infmmtion ii ntdmd 1) bu y * # r " d II I ?! { D I saente per recponwe far noruc minor frihtie, to 110 hoers av an au- pr - fv< n 4 D : lit- ; WL a scighted neny for major and mi or fucihti - of IP hour:. p e re ro ,m V t- 1 . m:
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' i :m / c m u l l l oewny e couaon a wrmam. w ce e yd, , t n ,t me .
y+ ve I thii dlation of infatnution, induJing wppetion.: for red..dv P < b ' i: C i * ,
.t.. Pob Brarwh, PM-223, US Ecvarenental Prots non Ageuy, ea! !.! Sucet, m E > , ; - DCMw, I fn t! e i
Ottice of infbtnation t;nd RegulAory Affairs, mfee of Man.: enwr:t and Du@t, W W s D^ MN e .. __ _ _ _ _ . _ . _ - _ - . a j
. General Instructions 4
I If form has been partially' completed by preprinting disugard instrwtions dimtd u imry of pt infarmation
,atuady prrprintal.
2.Ihter *Premittee Name/Mailmg ,f:Mress (and facility name/locatian, if d:ffernt) * "Famu Wnberf ami
- "hi3 charge Number" where indicated i A separate form is required for exh dodnrre.)
- 3. Enter dates beginning and cndmg 'Momintmy Period" covered by form where mkmed .
- 4. Enter each " Parameter" as specified m monitoring regmrernents of pomit.
- 5. Etter " Nam;+/c Afeamremera" dm for cach p:uam::cr unJer "(hunntr M T Vaf a uni <;dd ir p?rmit.
'Aurage" is normaH) arithmetic averar.c (gccmetric avenyp far En:: ten d pm :urrs) d au < qY se momero for each parameter obl tined daring "Monitarmy Pcrinf', S / arm " " , d S ' n # ; rm Diy (4me 1 int and km racasurements obtained dunng "ifworry Ivre s/" P p n y v @ 5 m4 in urm ICqrtirctnent: Enter Fi-day average of s.unple m.:aturen: Mc i:ni r ' :6erY d c; er m ' im at: 749 , er of sample measurements obtained dunng umnnoring peumt uder "\/c ' s S
- 6. Ijnter "Perr ur Rcquiremen/" for eac h parauctr untt */wm" J" r,"acy , M m te m 7 Uitder "/o 1lr* enta number of samph incasurra ms du mn m:. maric.3 ;rried d e s dnv : d wd'ar nimimum at WI.y crage a nipupiate);L di equanwm f oi O L j smein 0 un . s s 'r
- 8. Enter "Fruytency of Analym" tah as " wie Meam:rmc-t' n m al 1: c o c: *
,m d . ' rk a n daring monitoring rcriod) and r "Pcrm t Rc9 tan mmt" gmfw ! in p tm a ue I- r " O e f.. m m % u momtaring, 'la" for one day rcr week, "100" !ar un : d n per mom' '/' ir nn . p. ,,m, j
- 9. Enter "Mmt;2!e Tvre" luth as "Nunp!c Mcamrece r (e d camp? 17 erd d:un r" w p~ in h . H ,
I "Pcrmit Begrarem,ent" (c g Emet Wh* far irmMdtaf s mplc. " 1!!: f or .M s r n ;,r
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continuous inonitoring. etc ) i l I 10. Where violatiom of perrnit respurcments are ejmrted, enach c bncf e :nion t i dmW ca ode n r no
. acDons taken, and reference exh violation by dare.
I1. .lf"no discthrge" occurs during monitoring perim!, enter "G Dm / as w . form m ' ~ f c' ' 4 e t r1
- 12. Enter "Nameil'ttle ff Prmelpa! lhecunve Qcer" with "Smrunt.me afi'r!? u;w! Lx ' % *3- htwd Agent * ' Tele;> hone Number ' nnd *Date" at bnuam of foret l 13. Mail signed Report to Office (s) b) datds) specifr;d in permit Petain ecpy rm your reew
\ l l 14, More detmled instructions for use of this Discharge Ahmauring Refwt (D)!U) fem ma b rh rin:J f r ru Mrimm ; y specified in permit. 1 , r Legal Nou.ce 1 Tnis report is requirnt by law (33 U.S.C.1318; 40 C.F.R.125.27). Fmluw to report or t.uhire h nyat truthf uny c 4 result in civil permities not to exceed $10bM per day of viobunm; or ir trirut.a! r<ralnes na t i wa 15 071 rr do ( of viohtion, or by imprisormwnt for no' more than one year, or by bod 1 5o l l . EPA Form 3320-1 (Rev. 009F) l l
PERedtTTEE NAME/ADDRESSWFeraryName/Imeessee(Dep eved NATIONAL POLLUTAff? OISCMARGE EUMINAT10K WYSTEM (NPDESJ Form Approved. - CME DISCHARGE MONITOR 5ee REPORT /OMRi
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- 1* ~ s - msyT 3 e, n a e. n p o (20u2 tl (22-2 T1 12^-25) (26-27) (28-299 (30u311 NON W W*** 9 9 N N $0'l*- *
'3 C*'s ony; QUANW OR LOAMG I4 Cerd 0i47 OUANM OR CONCENMATION NO. m VENCY SAME PARAMETER 146-531 (54-691 (30-45) 146-531 154-691 OF (32-371 EX ANAtyss TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ' m, fg,.gg; fgg.7o, t3(;< 73p5L SAMPLE ety3,s A.y yn- rx a a e c ~ { 7 j, MEASUREMENT
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REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRedCW'AL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 4 MAVE PERSONALLY EXAMINED AND TELEPHONE DATE AM FAMIUAA WITH THE INFORMATION SUBMITTED MEREM: AND SASED ON MY INOUH4Y OF THOSE INotVfDUAL S IMMEDSATELY RESPONSIBLE FOR ; s CST AINitsG THE INFORMATION, I SEUEVE THE SUDMtTTED INFOstMAT10N IS / ' TRUE. ACCURATE AND COMPLETE. I AM AWARE TM4T THERE ARE /~ i /[;# 1 e
.' 'vQ' #.
r Devid Urnderf SIGNmCANT PENALTIES FOR SUBMITMNG FALSE INFORMATION. !NCLUDtNG T**E POSSIBlUTY OF FINE AND IMPRISONMENT. SEE 18 U S.C. 91001 AND 33 / i ^6
- 6 90
( 1, 909 q11- r) 7 pd* S'iO'NATU' R EOF PRIIOCWA"L EXECUTM'E - - U.S.C. e 131o. s%nesee seaw snese sessuswe mer eiussie zwise ne se sto. coo
~ TYPED OR Pref 7ED sas er mens == : . - - - . _ : er aerwomi s - wwns ener s pearmJ OFFICER OR AUTHORIZED AGENTI CODE NUMilER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS tReference s# artschments here/
b.lC1 h / M $'n ras ? EPA Form 3320-1 108-96) Previous editions may be used. tREPLACES EPA FOIN T-40 WHICH MAY NOT BE USED.) PAGE OF 9 ? 7 'i / ) 7 D i n 6. A 017 1
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< l, s Papenvork Reduction Act Notice
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1 P& 2cp& tms i fe f.* chth 3 of inforneido is estinuied to vary'from a range of 10 hours as an t egy : pr Wpp.c tm wms mib fxKn . v. (10 tmun r, nn averap per sexponse for some cuior facditics. v.hli a v ethW ser f 'r : 4g and rn wr frihtim df iS Imts per rupmv , induding time for reviewing
' in ter ans w hirc n eOnr a i sure pthHsg kJendnin,y ths data rekvifinJ cornpletippand {
I i . q u n7 h thep M iermwoa. ' dd cwnx rm rcrard r;g Om burden estimate or any bther topelt of . 0 6 deHrecim a Af icF m u e n, im um q;f &ns for cJulh[tbii hurdaita Chief lInfornatEn?Pobey
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ined PM -223 UM Enemrrrd:d Pmh.ctmn Arm." ,40! M Street, SW Washmgton, DC 20460; and to the Ophof Infornanon and Fq Atory Af fe, Of0ce of Management and Budget, Wm:hington, DC 20503; l -: f i _
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.i General Instructions-
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p. 1; pfinn hw ben putbuy coinpleted by prrprinting.Wegard instructiom directhi at entry M t' hat information
- already preprlnted.'
2: Ennr "Pe> miner Nav:n A'athnt M!"en (and facility namellocation, if ditTerent)," " Permit Number," and
?Deriniree Nmn!vr" u here ind1cated (A $cparate form is required for each discharge )
3 Entdr dres bc@ ming and endme "?.fmetoring Period" emcred by fotm where mdicated +'
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-4) EM'!! c3f'h Ydrtr"/Pffr" dS SpeCib'd ID PiOldtONf1@ (CguiP2filent$ O[pCituit 5 ' Emr "Gnj:!c Wo.r e *" 6 far erb panen-ter under "Guant/ty" and "Quanty* in units specified in permit ' I
- Wrf n "* aPu r66 avery (pometHe average for lecterial paramettre of all'sampic measurements nia zul panredr* 0b &d 6nd M f */,4rw /Wm F. " Afarimum" and "Afirsimum" are nonnalT extreme hip,h >
< i hu mrmren e%W d nme %nNrms Period." (Nate to municipals with seconbry treatment m i n er0 Eun;" k My men 7 rf mpe in usurernenu v ider " Average " and enter maumom hby average of $Yr~.h? r?,NMJ ' 7 Mt? -: tilaf't N.l dJi W ITDMirit'f' pCIMM UQd2f %Ilm#m ")
n ' ; %r p m :p s ? for end; p: < . p < < e,ht "Q;ianMy" ':nd "Quahty* as specdicd in pctmit , u . i n 7;;gr m
,ee",'%
m rf Mr A ms
- m*
croe* arwh Tvpe d ou+ rev wiimment p.ernut urn w deriv formonitoring each parameter. pcmd Ifthat ncone, exceed cmer mnimum "0" (and/or ' )
- 1. .
\ !.'U/Nt* A[$ fer"lPf7f h)CNfd ff0QM]CJ Ot $d{DplhrQ $fld $na Sk$ 11$ed
- h. ( ,,* b ( g 'IMH**!'1' f[ , i l'^/ f I (. I f.Qb di
#w rmbag r e n1 a 7e r t l'm;" ire-w" peciDed in permit. (e g , Enter "C<mt? for continuous ry, o "!P W c'?J? Fr ni " / M' I?r our d ty per month *l.T0" for one day per quaner, etc ) '
c g e *v ..7 g! 7p" t-tt 3 " .:m/c mem "e" (aaxd sampic iTpc used during momforing period) and as 7em Mwmemf O g , Fa er %ah" for indpihal sampit "N!!C" for 2hbout compos:tt "NOf" for
< Cc4,ww.S rypyy g }.
- j h \G Ar - (i d hjy9 of p. p , rm4 wi % ;pe reported. DDCh a briff cYplan3!iOH 10 dCSCribe cauW and COrrCClive ces ( Ac~ and rd:tra c ext si+Mn by dati 11; }[% dI;C) Pfg OCY (W "' loonbrig prie,v[ efuer
- Vu Dfn irge* DCIOSN forfu in pli1CC Of data Calry.
k p m]r Ym,ffn , f jbeim! l n;,,ty Ogn r* uM "% nature h['rincipal b:recutwe Officer of Autharl:ed e.~ rem #.,.w eza.wum erenn I R W deMeph n Otr(O by Jams) specifwi in prmit Retain copy for your records.
" 14. Wre d:hN ieWm's far iue of thh l#x horgJ AInnitormy leport (IETR) form may be obtained from OfTicc(s) l "
7 sreined inymA h L - Legal Notice i TW rp. n rugured by im D3 USC.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can
. reuil j3 tivil pgatties not tyrtceed $10 000 per day of violation; or in criminal penalties not to exceed $25,000 per day
( , of vidafie, or by imprisonment Or not emre than one year, or by both. 7 1 [ EPA Term J32tN (Rev. Om) W t *
- - . ..A.____ _______;__.-_.____-_m.___ -
( PERufTTEE NAME/ ADDRESS (leesdeTardfyNeuwieresen gfD@resi kADONAL POWTTANT DISCHARGE ELNW ADON SYSTEM (NPDES / Form Approved. NAME - g7 ygtL 7 , ,j 7 77i*; , DISCyP E MONITORtNG REPORT (Dg/ , q ,7 , 7 . ,. . OMA No 20440004 Appr eng res 05-31-18 ADDRETO 3.1 e %*i ^" ' ' ' '~1 (3' 'I#) 77.. 3 ., ,e3 -) r n .y PERMIT NUMBER csSCHARGE NUMBER P Pi r g(
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3-?O; ; ~^ : ' i s MONITORING PERIOD F.*_CILITY e,; '3 l , ,1 ? ? '^
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- YEAR DAY YEAR DAY -"-
LOCATION FROM . TO 1
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$ ,, r ;. n.yv . mu, 1m.- (20 211 122-231 (24-251 126-27) (28-29) 130-311 NOTE: Reed instructione before completing this fortri.
PARAMETER '# C"'d onM EatANTITY OR LOADING If4 Cerd OnM QUANTITY OR CONCENTRATION NO. FREQUENCY SA$tPLE I 126-531 (%$11 (36-451 (46-63o (54-691 on (32-37; EX ANAtysrS TYPE AVERAGE MAXIMUM UNITS M!NfMUM AVERAGE MAXIMUM UNITS m.sm ggs,; g,37, SAMPLE ,' *'t' ' ^ 5 S- ' f
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SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT Nt.ME/TTTLE PRINCIPAL EXECUTnfE OFFICER i CERTiFv UNCER PENMTV OF LAW THAT 4 MAVE PERSOW4.LY EKAMMED AND f TELEPHONE DATE AM FAMM.l AR WITH THE INFORMATION SUBMITTED HER9N; AND BASED ON (' .g % ^
,. j MY IMOUIRY OF THOSE thDtVIDUALS NMEDIATELY RESPON98LE FOR t
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,.y ' ,,' 4 08TAANtNG THE INFORMATION. I BEUEVE THE SUBMITTED INFORMATION IS #
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L h t *" "i01tV-1 ': O n 1 ;' f . TRUE. ACCURATE AND COMPLETE. 4 AM AWARE THAT THERE ARE 'f; [ ~ [ Aj
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*3 9G.E POS9BiUTY OF FINE AND NPR:N#FtCANT PENALTIES AND 33 FOR SUBMITTING FALSE INFORMATION. INCLUDING T* SOMMENT. SEE 18 U.S.C. 91001 U.S C. e lais. ewws erwar eme son,me may sween mwe e, e, s70,000 SN3 NATURE OF PRNGCIPAL EXE TYPED OR PRINTED .aw er mer*=na : - _ - - : oner rees e mome== s,w a rewas OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLAN ATlON OF ANY VIOLATIONS (Reference a# atractements treref EPA Form 3320-1 108-95) Prev 6ous editsons may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) -n PAGE 3y 773r,?e <
,OF
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Paperwork Recluction Act Notice - 4 i ; l' Ps.Mie repu,t.t y burd.n f or this cMi- : tion c.t mi :nt>f u h t 't:r.m W : ) t o , i: . r s in 1 s,, ; a W fa[e p u r n ps r.:# iv m ' Jninur tu tiniu , 0 4 I10 irm ai an Ei rJ ? 1 [< ' Wt '
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f b' Et a %ct;;hicj aWr:ge fcr Ingt nf rw cr Lc%it.a cd IE %(:; pr n y , el' l- 1r W;
;enu tim M.ing cutmy daa unc . U n , c a-J m umi 6- a re H ' H 3: frr 4 'i f t VidAId g (!1G CONCijid. U[ IM[JMn,450r;. [h Dd gD PTCib itfafdmf IN IL" t(
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j dir, co&ctiod of inf ann: don, mduding : un riiom for reJaur7 th k M . ta (' b t e rc !i - P.O + f Bruih, PM r223. U1 Envinemental Pmtccoon Apercey, Cl M Stn " N V < t (ce M EU, < d t , @ l Offier of Inh,rnution and Rqulatory Affairs, O!E;c of Mamgement sod DM ~t, % J.:m: . IK' W i l , l _. . ._ ._ . - General Instructions 1.,1f fum h.a been putially completed by preprlcting, disregard irutnsti:midir eted a cntry 'of LM mfornution alret.dy preprinted. * , 2, Enter 'Perminee Name'Atalhng :Idriress (and facihty nameih>catian. nf di[T:stm)," "P rndt Newd ed atd ,
" Discharge Number" where indicated (A separate form is required far erb de.ch 1)
~
3, Enter dates beginning, and emhng "#mitarm; Periad"cowred bv form where mi::. "d l
.t. Emer cach "Paromc!cr" as specified in rnomtoring requircrnenP; of p;rnot, j
- 5. Enter "Nample Alcawrement" d.ua for each parame:ct unir "(Aunof :m1 "o in" a un ' 57 * ! n; p rmit
".-hrragc" rs 'mnn:db alahmein; as crane Os: m>;tne m c . ce ft r in 'crial p
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' : c f 3D < q# u m wnte i for r.6 parn:ne:ct obtain:d danng "i/ordare c Per mi" 7 /m;" ':0- ,
' '- r it . h a MM l
.wd in irun.smmenh et t.uned during ".6mitoru z lb!' C e o, ' . 9 1 -
, neu 4"g :m arn j aquirement En:cr 10-day average of mupm meraments i der " . -
'!<mi'
. . T 7~ n cem i of nmple measuicmets ub!murd durin!; nkrotarmg p-nod untr "Um 5 l
- 6. Unter "Primu Requ rrment" fer each pan .f r u n er ' pu m uy' ; f "S o y" v 4 in p , -
7 U mter "/,.-ifr" emer oinuNr er mrP mmm m dm -- ou > "m mdd -
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uf - mininutm:0! 7-day aurage :!s apprornab) pmut regm rem m! pr e % p:--ner. U ' "er "t er " > F. Enter "Frrywnn of ,lnahWs" both as "i mpic 4! w ment" h md t cu na t ' m hr3 r 4 1.h ' 1 uw during, morutcum; ;rnod) and , s '/'cra:it Reggement" sp :kJ m p;rn Ug ! .r"'i"*fe tw " momtaring, "l?" far one day pen week ~130" for cm dy per n " */- ~ i e onr c , p r o srtt, a r
- 9. Emer Mip!c 7)p? hmh as y imp!c Menwremen" indd ur@ sp i ed de rr! - p-W N <
"Pe rmit Rcquirement," -(c g , Enf ~r "Gm6" for indr ' dud sampM ' at!!- for 2 : &P >"e m ' " f l cor.linacus rnomtormg. etc ) 1 L
- 10. Where oiolations of p;rn:if requirements arc icportd, an d 4
!aief c+ r.!:untia : to < v i"
- a< vw ,
actions takt., and reference erb siolation by date 11, if % discharge" meurs duririg mo:Jtcring penod em cr "Jo D. ciece" '::re ; farm m 4 " c f u e 93
- 12. Enict *NameTule of Prinapal Erentiu Offwer' wnY %gnatur of Pr, 7x' lb > c:t i e < < in m afgent,' ' Telephone Number," and 'Date" at tntom of form
- 13. htui signed Report to Of! ice (s) by date(s) specified in pennit Pc:an com fm yom rr.ra l
- 14. Mort detailed instructions for use of this Dischar;;c Mmnorm : Report (!A //D ferm aq be r ! min 2 f c.m! mf.ccm )
specified in pennit. 1 Legal Notice ! l This report is required by law (33 U.S.C.131B; 40 C.F.R 125.27). Fudure to rcport or fai' w to nyr* nwhis!!y , result in civil permitie3 not to exceed $10,000 per day of virdatmn: or n crimins! p nalties not to erW C5 07: per 6 of violation, or by impriummerit for not more than one year, or by both. 1
.I EPA Forra 3320-1 (Rev 08-95) l
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PERMITTEE NAGE/ADOfESS peeMerdwy#s 'tacenes arthfbronqr NATIONAL POLLUT ANT tafSCMAROF EUMeNAff000 SYSTEM (fWPDES/ Form Approved - NAME .,y jg, <avy- ,y .sj
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- I T ' YEAR MO DAY YEAR MO OAY LOCATION FROM a e ,, TO a- m- : , .., y ,.q,;, n ,'"" 3 3 ,. .
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/ TELEPHONE DATE MY INOUIRY OF THOSE INOlVIOUALS eMMEDIATELY 'RESPON91 ELE FOR /S D;1Vid Otudor[
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i , 3 F s T General Instructions 1' ! I , - ' 1: le fxm to bd partb!!y compb4 by peprmtmp, disreptd instructions direchd a entry of that information !
- $eady p epdntd _
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' fibch2rp Number" vd em indicated ( A separate form is reqmred for each discharge.) _
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~ R ? b i dmM imm etw br cv ef Ris Didaye uvnwrmy Rqwrt (DM/0 form may be obtainee from OfGce(s)
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m eifed m p m i - ( , , Legal Notice TNs. 1 is remured by im 03 U.S.C.1318; 40 C.F.P. 125.27). Failure to repmt or failure to report trmhfully can rmf!ikeivd rMitic rM i y rgrmt !!0,000 per day of si&tirm; or in erindnal penalties not to exceed $25,000 per day ' of nAr' ion, or by eprimrm9t ur tut ruere than one year, or by both, s:- , w s .e m
't
' frA Form 3320-1 (Rev. MU.?)
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PERMITTEE NAME/ADDREG30=we Ferder Newl-m (Defwr> CATioMAL POLLUTAmt psCHARGE EUWNATION SYSTEM (NPDES / Form Approved. OISC ,OMB No 2040-0004 ; NAME - y ;L + ,,
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YEAR MO DAY YEAR MO DAY -. LOCATION
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NOTE: Reeniinstructions before completing this forAi.
- IN * ' 2
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f'e , SAMPLE MEASUREMENT PERMIT a REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT g REQUIREMENT - l NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER i CERTwy uncER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND , TELEPHONE DATE y.{ AM FAMlUAR WITH THE fNFORMATION SUBMITTED HERE**I: ANG SA3ED ON MY INQUIRY OF THOSE INDIVtOUALS IMMEDIATELY RESPON98tE FOR OSTAINING THE INFORMATION. 8 SEUEVE THE SUBMITTED fMFORMATTON t$ f
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THE POS988UTY OF RNE AND IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 *d' - ' ' ' 3 I i 890 NATURE OF PPJNCIPAL EXECU' TWE TYPED OR PfUNTED U.S.C. mad er Eame=e= tale. na.R=e N _ sesser smes, amer =s mer.hiende *biee age se srom W MBER
- er ese-e.a s sioneas w a y.orms OrrlCER OR AUTHORIZED AGENT CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refererece s# ettschtre tts heref N; %*I r-EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) -
PAGE CF
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- 2. linter * / 'e rmitta Wme Mallo c sid/ress (and fxifity c.uC/lcration, if d' cren!U " / 'c -: 9 *
%>* ol "Dischgc Vwnber" u hcre indicaecd ( A separme f ann is required for c:n h 6 c Mrp )
I. Enter dates bqinning and cnding h:t 'rm : Pcre d'un cied by enn a tcre n d 1 Enter ca h "Airar , ter" as peufied in m,mt.ning rc7nra enh; cf p u:nt s b 'Of " $ gut \ [c # s 14rC h 5 '? !" d'i'.3 f0f C.l lt p tr3Gi Pf ::a hr *ll a MI*t ~
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- 13. Mad str.ned Report to 0"icen; by date(s) spedfied in ;ctnat P r ',u n a , f u u u r n = r:!
14 Mare d.; tailed instructions inr uw of this De w 4 /s> r m3 j 'c;v : !.9 ' ' ', fn m te . < geafied in permir Legal Notice 1 This report is requred by low (33 U.S.C.1318; 40 CJ.R.125.27). I a , m to r mc:rt o- 6 ' - 3 s , '
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rewlt in ciWI peaa!ti;s not to etceed $10,0W per day of wan,m; or ir! c n r r :J r e a% r <
'.7 ,OA, -6 of dolaison, or by imprimnment for rM rnore than on : ynr, or by both F.PA Form 3320-1 (Rev. 03-95)
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1 PERMITTEE NAME/ADORETO (W Forsfify hue /L carsee @@smus) NATIONAL POLLUTANT OtSCHARGE EUMINATION SYSTEM (NPOESJ Form Approved. DISCHARGE MONITORING REPORT IDMRf hAME Ir 7- ts/ OMB No. 2040. -0004
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/ PAGE - 'OF /__ _-/
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PERMITTEE NAME/ADDRE23(Fee &FadnNwleresee(DAmm) NATIONAL P0Lt.UTANT DISCMARGE EUM14AMON SYSTEM (MDESJ F0fm Appf0Ved. DtSC NAME . g p e r; ggLLjy n g w g p; - p(?{ps MONITORING REPORT (Og 7.y y 9.q g 3 g - g g. . NM No. MMOOO4 s a l gags p , 3, t- ; ; n= m;.1 s 3 11 * (qt 9 9 95) Approval;empiree,05-31-98 l ser?; ni7T1 3Ee M3e PERMIT NUMBER DISCHARGE NUMBER e *
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AM FAMfuAR WITH THE IfeFORMATION SUgutTTED MERE!*e: AND BASED ON / 6 MY IMOVtRY OF THOSE ENDIVfDUALS eMMEDIATELY RESPONSELLE FOR - I j' DdVid Crnder[ OSTAINING THE INFORMATION. I SELIEVE THE SUBMtTTED INFORMATION IS TRUE, ACCURATE AND COMPLETE. -,' ,vb [' ,. ' # 3-nttal F ! g []andge r I AM AWARE THAT THERE ARE SIGNfRCANT PENALTIES FOR SUBMITTING FALSE INFORMATION, WeCLUDesee - e u A [' ' 4 y ,"' 3 g p e y y 3 p# g*-
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T1%3) ! l- S PERMIT scte~^ Sn&t* ?- ce *- , c ' e e~ c t cv.t ;; ; * ; a3q; yrtg REQUIREMENT in- 1,01 acnty g a r, l 93; y cLla, Yi - 3;ng!e -) q SAMPLE 39 . z y;- p yty my ~ ;f g f r( *y i 3';a
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. PERMIT .? ? P S o r D"3'ee r3t- 7e3 m *t*>>t 37 - ;c ,, ' ; y e ; ;; REQUIREMENT +g a s+ t 79 M ec. &*? spr gLs rgi f,3yTw qr .
SAMPLE , eun MEASUREMENT - PERMIT REQUIREMENT l SAMPLE MEASUREMENT PERMIT REQUtREMENT SAMPLE MEASUREMENT PERMIT , REQUIREMENT #* ~ SAMPLE MEASUREMENT PERMIT . REQUIREMENT SAMPLE MEAStIREMENT PERMIT REQUIREMENT . g M*"1 TITLE PRINCIPAL EXECUTNE OFFICER ctRTirY uNcER PENALTY Os (Aw THAT HAvt PERSONAttY EXAMINED AND AAA FAMIUAR WITH TME WsFORMATtON SUOMITTED HEHEM: AND SASED ON #/ [sg TELEPHONE DATE ( MY INOUIRY OF THOSE 8NDtVtOUALS IMMEDtATELY RESPON98tt FOR gy i.e - VIMCrg OSTAINING THE INFCRMATION, 8 SELIEVE THE SUEMtTTED INFORMATION IS '
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TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE / c-in e--r.' M3n ,,v sicNmeANT PENAtnEs EOR sueMiTTwo rAtsE wrORuAnON. =ctuDma g iMf['y, .i 3 THE PossSIUTY OF FfME AN ' u.s.c. t tais. arenomme w,D IMPRISONMENT. SEE 19 U.S.C. t 1001 A#so 33
- P*- I N 3 - 511 ' 97 TYPED OR PRINTED ser mese asseusse per *=4an, shes e, se s gAco 810 NATURE OF PRINCIPAL EXEO'UTRIE
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ane ar mesennew b . _ .: ev eseween s - -^_ ane s yseras ggg4 OFFICER Oft AUTHORt2ED AGENT g. NUMBER YEAR MO COMMENTS AND EXPLANATION OF ANY VIOLATIONS / Reference atartin Aments trere/ DAj N' $(h d y %> L EPA Form 33201 (08-96) Previous edinons may be used. tREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) . 33y7737;37 F,n';7 PAGE ,OF _#_ , m _ . - . _ (-- - - - - - ' ~
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-i P i General Instructions
- f. If form has been partully compkted by -pr: printing, dhrqard instrtdione dh td 8 catry of dat inferaution aheaJy preprinted. .
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- 2. Enter "Permmec Emc Afad.ny .f ddress Omd facihty sumc/hx:adon, if d tirent) " " Pep:3 %ced er," and
' _"Diuharge Number" where indicated ( A sepirate fonn is required for exh d:daged 4
c Ll Enter dmes tqinning and ending "Emtarme Pertad" cm cred by form aLete uAcaud 4f E5uct each "Ibrmncter" as specificd io monitanng regmn;mcats of p;rmit l S. Elder "X mple A/cimerment" data for each par m "er m:d r "(hmnnrv* nd %W m amo y Sque permit < j
" h erare" is nm rnath arithmenc accryc @ mne!ric ;n my f ar tz mriM p n v: of !ls apea w anem y for each m, mmicler obnincJ d:nnm "Erhorm / crim!" "3 /ar - * , d "3 ' i mamh, e pra ac tig!
;md im musureru m obtamed dunn? "3 fcmf ormy P, riod " D ne to r: .is vA 00 % te mm rega.rament: Emer Ad.n averap of sampic measurements und::i "fu r n u i~ n 7.ra of samp!c m' easaremens Wamed donng me" nring p riod undar S f 2 i
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-I n-l- : m umd W mini til n c>r 7-day anrwe as npproprire) pernut rgire' mn! tar ca9 p" rver. If Pw, r"MT
.._ s F. Gater 7erriswng> q/ A'i/m" bwh as %"rtW 3 /n m ef Q : -'lIw P a p r i e: d c r ab; a m r
.daritu monitoring p rityf) and as "P, m n Anjuirr":en' sp :iG:1 i; p T e im 'l'**Ere ""+
man;taunp// C" far one da p;r u cei, "!. M" frr om dm pr nmth "/,, < ' ! 3r : u p : yi:n "r; e; ; -
- 9. Enter hiple 'l? ta
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"Pcret Recpiremer!!" tc y , Ymcr "Gra'" tar indm&:1 mm7 "M ' tar H- r
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- 10. Where siolations of permit rcquiremcnis are rep 3rted .S. ah < brh.f c.splamx to , m 'c+-
- 9c 4 actons taken, and referena: cach nolatmn by d:ac i1, W"nq dischxce" occurs dunng moni:onng pma<i, enu u Ih/ec; e
crm, fonn m p4 : .rfc tc:tn. i 12 Ewcr %ne 7itie of Prmcipal bentive r)";ccr" wnh "Surm!we W Pr;m:;'c! Le se W. - f . h m Ager:1,' ' Telephone Number," nnd "Date' ut tqww of M:m. 13; Mail dgned Report to Ofnccts) by date(s) specified m penn;t. Detam egy !at : car rt:ror&
- 14. More detnikd instructmns for use of this / Marge Emicing Report (DMj fann me teciw! b rn Tice ,
speafied ire pennit.
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Legal Notice Thig report is required by law (33 USC.1318; 40 CF.R.12i27L FMure in rent or fe' to np c trathf-dy cm re:aalt in civil penahies no' to exceed $10,000 pa day of s udanon; or in meum! pnatne r ! > en cd 12f % per 6 of violation, or by imprisonment for no' more than one > car, or by both
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i \ EPA form 33204 (Rev. OP-95)
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