Text

NPDES Discharge Monitoring Rept for Nov 1996 for BVPS, Units 1 & 2
	ML20147B305
Person / Time
Site:	Beaver Valley
Issue date:	11/30/1996
From:	Noonan T; DUQUESNE LIGHT CO.
To:	; NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
References
	NPD3VPO:-0568, NPD3VPO:-568, NUDOCS 9701300218
	Download: ML20147B305 (63)
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e aver Valley Power Station Shippingport, PA 15077 0004 THOMAS P. NOONAN (412) 393 7622 DMalon Vice President Fax (412) 393-4905 Nuclear Operations December 20, 1996 NPD3VPO: 0568 Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555 NPDES Monthly ReDort. EPA Permit No. PA0025615

SUBJECT:

Beaver Valley Power Station, Unit No. 1 and No. 2 BV-1 Docket No. 50-334, License No. DPR-66 BV-2 Docket No. 50-412, License No. NPF-73 I

Dear Sir:

Enclosed is a copy of the NPDES Monthly Report as submitted to the Pennsylvania Department of Environmental Protection.

Sincerely, T. P. Noonan Division Vice President Nuclear Op3 rations DNH/trs cc: D. A. Orndorf J. A. Cool R. K. Brosi 7 Central File g$

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g \ DEllVElllNG QUAlliV 9701300218 961220 ENER6Y PDR ADOCK 0S000334 R PDR 4.

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NPD3VPO:0570 Page 2 December 27,1996 samples were obtained and the results ranged from 32.5 to 40.0 mg per liter. Adjustments to the flow path have been made to tids facility and improvement in the operation has been noted. No exceedances have occurred in the first half of December.

If you have questions concerning this report, please do not hesitate to contact David A. Orndorf.

Sincerely,

) := J T. P. Noonan I

Division Vice President, Nuclear Operations bjm Attachments cc: D. A. Orndorf J. A. Cool R. K. Brosi Central File - K.eywords: NPDES Reportable Occurrence

J8 a Beav Valley Power Station B' SNppingport, PA 15077 0004 THOMAS P. NOONAN (412) 393 7622 DMaion Vice Prookient Fax (412) 393 4905 i

Nuclear Operations l December 27,1996 NPD3VPO: 0570 l

United States Environmental Protection Agency l Region III, Pennsylvania (3WM53)

Water Permits Branch Water Management Division l 851 Chestnut Street Philadelphia, PA 19107 '

EPA Permit No. PA0025625 Reportable Occurrences

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.

NPDES discharge monitoring point 008, the Unit I cooling tower pumphouse, exceeded the monthly average, daily maximum and instantaneous maximum specifications for oil and grease and the monthly average and daily maximum specifications for total suspended solids. A sample obtained on November 20, contained 89.1 mg per liter total suspended solids and 34.0 mg per liter oil and grease. Previous samples on November 8 and 15 were within specification (for daily limits). Investigation into the exact cause of the upset condition did not lead to a definitive conclusion although there were several maintenance and construction activities ongoing in the area. The area was cleaned and subsequent samples were all within specification. More frequent surveillances of the area during future maintenance activities will be performed to prevent recurrence.

NPDES discharge monitoring point 203, the Unit I sewage treatment plant, exceeded the pH and total suspended solids (monthly average) specifications. On November 4, the pH of the plant effluent was measured at 5.63. A chemical addition was made and the plant effluent returned to specification. Four total suspended solids OEllVERING QU ALITY EKE)GV

g' 8 have VaBey Power Station SNpptrert, PA 15077 6 -

THOMAS P. NOONAN (412) 393 7622 l DMaion Vice Prook$ert Fax (412) 393-4905 '

Nuclear Operations j

i December 20, 1996 NPD3VPO: 0569 l

United States Environmental Protection Agency Region III, Pennsylvania (3WM53) l Water Permits Branch l 2

Water Management Division l 841 Chestnut Street i Philadelphia, PA 19107 ,

J 4

I NPDES Monthly Report. EPA Permit No, PA0025615 l

l 1

l

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 S incerely, l l

l T. P. oonan l Division Vice President j Nuclear Operations DNH/trs Attachment cc: D. A. Orndorf J. A. Cool g((ly[glgg R. K. Brosi Central File 0U ALITY EREBGY

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AA @py hav Valley Power Station 4 ShWngport. PA 15077 6 THOMAS P. NOONAN (412) 393-7622 DMsk>n Vice PresMont F u (412) 393-4905 Nuclearnperatlons

),

', December 20, 1996

, NPD3VPO: 0567 i

Attention: "DMR Clerk" l Department of Environmental Protection j Bureau of Water Quality Management 400 Waterfront Drive Pittsburgh, PA 15222 NPDES Monthly Recort. EPA Permit Number PA0025615 i Gentlemen:

NPDES Monthly Report for Duquesne Light Company, Beaver Valley Power Station for November 1996 is submitted for your i consideration.

Sincerely, T. P. Noonan Division Vice President Nuclear Operations DNH/trs Enclosure cc: D. A. Orndorf J. A. Cool R. K. Brosi Central File l l

l OEllVEllNG l 1

QU ALITY j ENEIGY j l

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PEftMITTEE NAREJADOREM(AnshJsFerdheyNese/IsressesifDqdbreer) NATIONAL POLLUTAffT DISCHARGE EUMefATION SYSTEM (AFCfS/ Form Approved.

g DISCHARGE MONITORING REPORT (DAWif 4

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REOutREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT .

REQUIREMENT NAME/ TITLE PRINCFAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT e HAVE PERSONALLY EXAMWED AND TELEPHONE DATE AM FAMfuAR wtTH THE INFORMATION SUtMsTTED HEREIN: AND SASED ON s MY INQUIRY OF THOSE INDIVIDUALS IMMEDtATELY RESPON9IBLE FOR * . ' }

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sto,opo81001 SaONATURE AND 33 OF PRNGCIPAL EXECUTfWE TYPED OR PRINTED ens er menennen : , _ # aerween a maame end s yearms OFFICER OR AUTHOnt2EO AGENT CODE NUMBER YEAR MO DAY' COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s#strechments here/

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() / M O f"'4 C EPh Form 3320-1 (08-95) Previous odetions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF 33199/96[331-943'i 1

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Paperwork Reduction Act Notice !

Pohhc ,ponmg bmden fu this udlxoo of inforouaon is estimated to vary from a runge of 10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months as an j

nerge pa e pm for m : cur li.iM _ . ta 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months as an aseiage per se>.pme for some major facihties, och a waghted avers :ar m..jor ad u.ner fxditiu of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per response, mduding time for reviewing w,tn tm, wanhing ex.tting da w c.e phe ring and r:uintaimng the data needed, and completing and amew mg the to!!anoa of uforwuoa. Sad conanents reptding the burden cotimate or any other asp:ct of

, th:s co!btied at infomuion, indudmg suggutions for reducing this burden, to Chief, luformation Policy

) thanch, PM 223, U.S. EmironmenLd Protettion Agency,401 M Street, SW Washington, DC 2G160; and to the J

Office of Inferuution and Rt gubtory Af f airs, Offke of Management and Budget, Washington, DC 2050L

l. . _ .

General Instructions

1. If form has been partially completed by preprinting, disregard instructions directed at entry of that'information already preprinted.

2. Enter Permitter Name Madmg Addren (and facihty namc/ location, if different)," " Permit Number," and "D:uharge Number" w here indicated. ( A separate form is required for each discharge.)

3. Enter dates beginmng < nd endmg "Momtormg PerioJ"coscred by form where indicated

4. Enter cach "Paramricr" as speufied in munitoring requirements of permit.

5. Emer "Namr/c Af unw mnt" d.aa f ar cath panuncter under "Guantity" and "Guahtf in units specified in permit. l

".f m v" n conmai) mhmeac aens (geometric averge for bacterial parameters) of all sample measurements -

fur er o pam > du duurd a ong 3/onuwing Peru /"; "Marimum" and " Minimum" are normaHy extreme high I and low naasuremeus Wamed during "Witermy Period." (Note to municipals with secondary treatment re p i u m nt Emcr nda amp; ef ung ic urzsurem:nts under " Average " and enter maximum 7-day average l c.f mmpic measuremeus obtamed durmg uomicring pawd under "Marmmm.") 1 1

f, En:cr "/9tuid Rojwre unt" f<r exh p mun 1er under *Guantity" and "(Juality* as specified in permit.

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7. Under "Na !Y rier arber cf s.unpic aca ann nts during monitoring period that exceed maxirnum (anNor miMunan or 7-day averm o ap;iropnate) pennit tequirement for each parameter. If none. enter "0".

t Eucr "Frc; <

, of s . ?p s " Lah :n '" lam;le Meamrment* (actual frequency of sampling and analysis used J n:ng; monitoriu s pe r s J) anJ a " Perma Requinment" sp;cified in permit. (e.g , Enter "Crmt," for continuous menircring. "/

f.>r .a e d.9 , ur week, "/ W for one day per month. "l/90" for one day per quarter, etc ) l 1 Emer "Nm /n' T! re" (2 th as %n;W Mcawrement" (actual sample type used during monitoring period) and as l "iW:!/ Inpirowa," (e g , Inter " Grab" far indi'udual sample, ".N/IC" for 24 hour2.777778e-4 days 0.00667 hours 3.968254e-5 weeks 9.132e-6 months composite, "N/A" for conunuous moiutorin1. etc )

I

't0. Mere siolaions of pcraat repacmeus are reponed, attach a brief explanation to describe cause and correctise acuons taken. and ref Ance cach siebtion by date. l

11. If "no discharge" occurs durhm momtering peric4 catcr "No Discharge" across form in place of data entry.

12. Emcr "Name'litle <] Prwclpd Decutne Ollicer" mth " Signature of Prmcipal Decutive Oficer of Authorized l

.1gera " " Telephone %nber." and "Date" at bottom of forat 1

13. Ma:1 signed Report to Omcc(s) by date(s) speafied in permit. Retain copy for your records.

14. Marc detailed instruvais for u:: cf this Diwharge Mumtoring Re;wrt (DMR) form may be obtained from Omcc(s) I specified in permit Legal Notice 1

This seput n required by Ira 03 U.S.C.131M; 40 C.F.R.125.27). Failure to report or failure to report inahfully can l icait la avil penshirs m t o auxJ $10,000 per day of s mlation; or in criminal penalties not to exceed $25,000 per day l of viabtion, or by brposor ment for nnt raue than one year, or by both. I 1

1 EPA Form 3320-1 (Rey, OMS)

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PERANTTEE NA8E/ADOIESSWF rderNa==eEscers dfW NADONAL POLLUTANT Of9 CHARGE EUMINAMON SYSTEM (MDDES) Form Approved.

NAME DCHARGE MmfTORWG REPORT N1

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sv,o. :~,,- 120211 122-231 424-251 I26-271 128-29) 130 39) NOTE: M ineencaioRe W <enapiehme % form.

ns?T3 2-PARAMETER 13 ceed on41 QUANTITY OR LOADWG I4 NdOrWs QUANTITY OR CONCENTRATION NO. W OUENCY SAMPLE (46-531 (S4-619 (30-459 (46-539 154 699 OF 132-37; EX m yss TYPE i AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS , sus; f,4.gg; fg,.yg I

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mc ra nor faktis . to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months n an average per response for sorae trujor f acilities, , eith a weighted awwe fur may and minur tasihua of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per response, including time for reviewing l nans twns, warthin; exi Lny dea wwes , ,pth-mng and maintaining the data needed, and completing and icviev ug the w!Ian.;u of mfemuiun. Scud conana.ts reprding the burden est mate os any odwr aspect of thn- udio t:oa of mformathn, in.iuding suptim s for reducing this burden, to Chief, information Policy l ih ant h. PM.223, LLS. Environorntal Protsxtina Agncy,401 M Street, SW Washington, DC 2(M60; and ta the c Ottice of lofornution and Rgulatory Attair'., Ofthe of Management and Budget, Wehington, DC 20503. . . - - . - _ . _ - _ _ _ . - . - . ~ ~ ~ , . , - , . ~ . - . ...,.~e,,.-------.- General Instructions

1. If form hu taxn partially completed by preprinting, disregard instructions directed at entry of that information already preprinted.

,2. Enter Ternutter Vame Mathng .tddre.u (and facility namc/ location, if different)," " Permit Number," and "Ducharge Number" u hac indicated ( A separate form is required for each discharge )

3. Enter dates beginmng and endmg "Monnoring Pcrml" coscred by form where indicated

4. Emer each Tarana tce" as speaficJ in monitoring requirements of permit.

5. Enkt "Y nr/c Mcawwc;<nt" iMa for each parameter undu "puantity" and "Guahty" in units speciRed in permit. ,

" A ct, , <

is nornully mhmtlic mer ge (geometne aseranc for bacterial parameters) of all sample measurements 1

nr erb pannneter otuntd during, 'A!,mmr!/ : Permd", "Manmum" and " Minimum" are normally extreme high !

1 :d. h m m memcNs obaa ed dming " Mom /arie l'aind " (Note to municipals with secondary treatment l reqbiretucat - Entr hday acq. ; of:mde tacamrements under " Average " and enter maximum 7-day average ; cf . ample measurena b obtanud danng menitoring paiod undcr "Manmum. ") ) 1

6. Emer Ta et f van m ni" lw tach p aa mer under "Guantuy" and "Guahty" as specified in p:rmit. l 1

.7.Unt: 'L /!r" cmer mmh r of wuple ucmt.nnents during monitoring period that exceed maximum (and/or minimum or 7-d iy mum . a, appmpnate) pamit iequirement for cach parameter. If none, enter "0". L l'aict *Frepemy ./ a 1,so" beah as 'Lnf e Memurment" l (actual frequency of sampling and analysis used i dmig roccitonmt gned) anj ns 7crmit Requirovent" specified in perunt. (c g., Enter " Cont," for continuous l nm o ning. "/ 7" fer me day gr u ed, "I 30~ for one day per mranth, "lNO" for one day per quarter, etc.) ' , 1 Engr "S,mple 'i)p " tub as ".' anric Memurement' (actual sample l>pe used during monitoring period) and as T a ma Rc.pacment" teg ~f'ider "Grah" fvr individual sample, "24/K' for 24-hour composite, "N/.1" for cormnuous momtonne, etcJ

10. WN rc uolations cf snait reqsements are reponed, atixh a brief explanation to describe cause and corrective actions t:icn, and reference cash siolation by date.

I1. If"nc :harge" occurs durmg monitonng pcried, enter "% Discharge" across form in place of data entry.

12. Enter "Name:iitle of Pnnci;A laccunve Ofiter" uith " Signature of Prmcipal Executive Of]icer of Authori:ed Agent." " Telephone Nwber, and "Date" at bottom of form.

13. Mail signed Report to O'L;c(s) by dat4s) speafied in pern.it. Retain copy for your records.

14. More detaii d instrumans for me of this Dinharge Manitoring Repw! fDMR) form may be obtained from Office (s) sinified in permit Legal Notice nia rept is required by !aw (13 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can redt in aul peraltin not o neerd $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprimrnxnt for not more than one year, or by both.

, e, EPA Form 3320-1 (Rey,0095) W .- _ . _ _ _ _ . . . . _ _ - m-m . . < -. .. ._m . . . . ._ _ . ._ _ . _ _ . . PERMITTEE NAREJADOM2StreeMaretyNewimrer==#D@wie 8:ATION AL POLLUTANT DSCHARGE EUMStADON SYSTEM (NPDESJ Form Approved. NAME gpgy7 y 3 g,( 7 y p9ynq.3;y773y NY% MNMG N (D t? ?3 D T ,i 3 TP 4 LD 9 3 Dg g P ,? AoO m n . , . m2 m-,a m . gm 33, A P<0%= ira os's ** (7f2; T) i i I O 3MVD31F PERMIT NUMBER OtSCHARat NuMeER y pgy3g ~ 3 ti I P ? I

0 ? 3 7 i PA 1. W 7 ? MONITORKvG PERIOD 9

FActuTY gqgy94 y 4 gg: y p 3 j p, p 3;g,73g LOCATRON FROM +n ii t TO 4a l: i *O7 M ^a D E ", C 3 i O O 8 l 3M * '*PV: 01VIJ 38%03?O (2&271 (22-23/ (24-25) (28-271 (28-291 (3G3rf NOTE: Reed instructions before completing tNo fcfm. (3 Cour onrys QUANTITY OR LOADING I4 Cant onty) QUANTITY OR CONCENTRAM NO. F E MJENCY SAMPLE PARAMETER 146-531 154-619 (3e-es) 146-53t (54-69I cF (32-379 EX Angysis TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,,m; (pse) 16 M ar SAMPLE i r 3 ; 1 g i p: ; MEASUREMENT 000Se e e e 3 r a. 0 5 . arc 0 ( 13) 't 131 1 1 3 7 PERMIT c y 's t e n '90b*e3 330 **:0507 ) a g it % L Y ;2A3 e r r. a r v r 19137 v a r. 't REQUIREMENT g 3033 n p y ,; gggy, my 3;g SAMPLE MEASUREMENT PERMIT REQUtREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTNE OFFICER I CERTtFY UNDER PENALTY OF LAW THAT t HAVE PERD. ALLY EXmmED AND AM FAM!UAR WITH THE INFORMATION SUBMITTED HERON: AND BASED ON MY INoutRY OF THOSE INDIVIOUALS IMMEDIATELY RESPON98LE FOR 1 p j r* . - G TELEPHONE DATE OSTAINING THE $NFORMATION, t BEUEVE THE SUBMtTTLD tNFORMATION 83 / lj yc i, *d C ? .tCo r i

TRUE. ACCURATE AND COMPLETE. t AM AWARE THAT THERE ARE StONIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDNeG - ('

. / " /'[y[h t 1 4 l a?- 't'Y-e ] _7-[{3 3 %3 - } ~7 ~g J THE POSSIStuTY u.S.C. n 13te. ewi.mOF FINE.AND.tMPRISONMENT. s r an son, Ins mer sicAnfo Ages se SEE 16 U.S.C. 91001 so 870,000 AND 33 OF PluffCIPAt.IXECUTIVE SMB08ATURE AREA TYPED OR PRINTED amr er mana== : _ : era.c= n a menne and a yearas OFFICE 3 OR AUTHORIZED AGEffT CODE NUMIBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# ertschments here) g () /jf % Acs C etN D ? t *, T 4' ? 143 14N3Vfi 131 [ T '? ? l . T 'i *?3t? 3" rig" 0"I397 0" i ? T' '2 f. Y 1 P . cD3Rf T1E 9AILI N41IiU3 POR 3v!Z D t s !?

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Ef$ Form 3320-1 (06-96) Previous editions may be used. (REPLACEG EPA FORM T-40 WHICH MAY NOT BE USED.) . 4 , PAGE OF >

,n.-tL /o, ,1 3 c: ,a-33 .,4 ,

t Paperwork Reduction Act Notice Pubtre reperting burden for this collection of mtornution is estinated to vary inen a rmg: of 10 % a an average per repnw for some rninor f ailitier,, to 110 boars as an avcuge ru temmw tor v : rnyt fxihGes, m h a weighted average for nujor and nunor facihties of 18 houn per response, in luJing time for remeu.ing

mstructions, searching existing data sources, pthering and nuintaining the data necjcd, s.d mu'pl.9mg and reviewmg the t.olicction of infunuation. Send couunente, regarding the burdta etiau: e er % dher o pet of f

j this colhxtion of infornution, including suggestions for rufucing this burden, to Chief, !nf amation Puhe) l Hrah PM-223, U.S. Environmental Protection Agency,401 M Strret, SW Wehmgton, DC 23460; a,1 to the ; j Office of Information and Regulatory Affairs, Office of Management and Budget, Washingun, DC 20503 ; ) . . . . . _ . . ~ - . . . - . . . . . _ _ _ . . . . . . . _ _ . . . _ _ . ~ . _ _ . . . _ , . - . . - - , ~ , _ -,L..__-- J General Instructions 1, if form has been partially completed by preprinting, disregard instructions directed at entry of that infornution already preprinted.

2. Enter

Permittee Name/A/ailmg Address (and facility name/ location, if ditTerent)." " Permit Number," and "Discha ge Number" where indicated. ( A s:psate form is required for each discharge.)

3, Enter dates beginning and ending "A/omtormg Period"cosered by form where indicated

4. En[ter cach " Parameter" as specified in momtoring requirements of permit.

S. Eiter "Sampic Alca:,urement" data for each parameter under "Guaniuy" and "Ouala3 " in units specified m pernat "At erage" is normally arithmetic aserage (geometric average for bacterial paran.c!crs) of all sunple maamrements foi cach parameter obtained during "A/onitormg Permd"; "Alarimum" and "Mennmn" me nonna!!y c streme high and-low measurements obtained during "Alomtoriny Period " (Note to municipah with secondv, treatnut requirement. Enter 30-day ascrage of sample measurements under "Awrngf and enter nuxin:ont 7-L) averig of sample measurements obtained during moni1 ming period under "Afaumum ") 6c Enter

Permit Requirement" for each parameter under "Guantay" and "(Nahty" as sycitied in permit 7, Un&r "No Ex" cnter number of sample measurments during me,nitoring period that excced nMmum (andem mininmm er 7-day avt age as appropriate) permit requirement for each parameter. If none, en:ct "o"

8. Enter *1+equency of Analysa" both as "Senp/c Afearurment" (acmal frequency of sunpling and on.n sts ued during monitoring period) and as "Pcennt Requirement" specif2ed in perm <t. (e g . Ems "('ont " fr cominum monitoring. "l/7" for one day per ueck, "100" for one day per month, "I U far one d.:y per q:cu1er, eu ,

9. Enter *2mple 7)pe" both as "Lmple Areasurement" (acttul s:unple type used during moning period) and a

" Permit Regwrement," (e.g., Enter "Grah" for individual samp!c, "RHf for 2 Mour composite '\ T for continuous monitoring, etc.)

10. Where sichtions of pennit requirements are reported, attach a brief cap!ar.atmn to danbe cause rd wrrectise actions taken, and reference cach violation by date.

I1. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data ettry

12. Enter "Name/ Title of Principal Executwe Ol]icer" with

Signature of Prwerpal Excaan e Ogkcr uf.luhormd Agent,* " Telephone Number,' and "Date" at bottom of form.

13. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your records

14. More detailed instructions for use of this D3chage Afonitoring Report (DAfR) fenn may be obunned 0 om 00i:ch) specified in permit.

Legal Notice 'lhis report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to rtport or failure to repcut tnathfully on result in civil penalties not to exceed $10,000 per day of v;olation; or in enminal penalues not to enced $75JXra per day of violation, or by imprisonment for not more than one year, or by both. ~. EPA Form 3320-1 (Rev. 08-95) - m_ . . _ . _ _ ._. - -._- _ m m m. _ - ~ _ _ ..._ _ _ _ - . _ . . . . . - _ _ . . _ . _ _ . . _ _ . _ . _ . _ . . ._ ., PERamTTEE NAGEJAODfES(DeshM=sh& Namw teresses tfD#rmed NATIONAL POLUrTANT OrSCHAfteE EUMW.ATION SYZTEM IM' DES 1 Form Appr ved. , N N NAndE g g g y qt gggLLgy p3ggq 3y4713g [ [, gyLg pggg 3 73 gg nOMB No 2 40-0004 ' ADOREss o. 3. 331 1 a*' 't i ; itI t (50B9 15) -Appe emins ,os-am eTTM; DMID 3P3DORF PERMIT NUMBER oeScMARGE W aahest f .,p{gg{~ RI?pDi,p3er ?i 15077 MTOsumo Peuoo *I33R ' FACILITY 3 g 3. / 3 3 g A r,( o y p sy y g g 371?{gs YEAR MO DAY YEAR MO DAY .- LOCATION FROM 4 3 li t TO 29 11 31 tt0 93 D E 'IC H A M ? ] ' t0F ; \TT%: 'Dk1i) 3 t" M 3 3 R V 12o 21) 122-23 t24-25) 12627) (20-2st 13w311 NOTE. Reed lReemoneRe k% comp 8enne % term. 13 cog on&J QUANTITY OR LOADING (4 Card W QUAN M OR N M NO. *f00ENCY SAMPLE PARAMETER 146-531 154 61) (30-46o 446-639 164-sti V 432-37) gg AfeALYSS TYPE , AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 882m tas-asi tes-7ap y ;{ SAMPLE MEASUREMENT oceter 0$tt03 SetSte ( 12) i l')200 1 ) O PERMIT f:0027F ' Swe$) r 350 h () c rrt t o @ 3,0 igggty mgg

5 ? !. '1 ? 4 ? 11157 'l i L g : REQUIREMENT 3399 w yg 7 g 5 ir g y p 44 39 i3LIS7, T3rqL SAMPLE 00&S0* ttNta ; $ 3 a e s t:

t ( 1g) i 333ppiDED MEASUREMENT i SS313 1 ') } . PERMIT . 3730*? O 3 u t tc L )>t **;300 30 10 ") rgggLt ;rt a 3 - E F 7 f 'l 3 p ? i4333 f ti L d ' REQUIREMENT cese aj fp; p g/ pg myt ^1L4 ikD 11Cy35 SAMPLE n ': e 0 0 ? hete>? Otact; , ( 19) , FRON / T ??

3M 7 C T- MEASUREMENT '

01S56 t. ) 3 . PERMIT - 40@y*? 700CM r Okt 94 0 tt ? $ {_5 2Q eggLt ;3Ag. F F ? LilS M ? ;4355 7 4 L tt : REQUIREMENT p2 -y yjg p gp . g gyg "Lly, I' 03133[? 02 SAMPLE ( 7.3 ) 3330ct C *r C F 4 7 *

7 9 c 's ,

P41U PSiCA?if$r PLAN MEASUREMENT h yW 37'50 1 3 3 PERMIT ' 7EPSPT n P D e ? C73*** O C O M c: 70393* ' O. ? ? . g gg t ;3 tit; l ?PNLOFNr 3qMS y ( Lg _ REQUIREMENT .;g gg3 ggyt7 37 q ;3 ^ ~ egg ; SAMPLE I MEASUREMENT t PERMIT - > ! r REQUIREMENT 5 ~

t. SAMPLE MEASUREMENT ;

PERMIT - REQUIREMENT ; SAMPLE MEASUREMENT 4t . l PERMIT . i ~ ' REQUIREMENT [ NAME/ TITLE PRWCFAL EXECUTIVE OFFICER I CERTIFY UNDEft PENALTY OF LAW THAT I MAVE PERSOesARY EKAMINED AfdD AM FAMeuAR wtTH THE SIFOsusATIO88 SUOMITTED MEREIN: AseD SASEO OAe /t % TELEPHONE DATE > MY INOUsRY OF THOSE WIDIVIDUALS lasteE04ATELY RESPOesSISLE FOft f David Ornde f 0* TAWING NE WPCeupATION. I SEUWE WE SUGhalTM INFOfMAAMN IS TRut. AcevRATE AseD consetETE. e Aas AantARE THAT TweRE ARE s y/' /. //f,/, W r_ i Cher*' s t t siossmcAssT PENALTtES FOR SucessTTwee FALSE meFOsWAAtiose, wectuomes / - h=- l/ i J - N ng'e r d t' THE PossesuTY OF FNs u.S.c. s iste smennas.E.AfdD IAAPetSO.ssesENT. is u SEE acean,.S.C. 3 ? % '; 4 I ! 1 46 12 !O stes. s .nas. mise se se91001 AND 33 seGesATURE OF FIIHElFAL EXEC 4MIWE ~ ' isier sto. coo TYPED OR PRWTED aaer er ===*i - _ era s s meaan. r asseural OFFICER OR AUTHCaeZEO AGENT AREA, can NUtdBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference er et*ochments heref

y a p 4

0 /$*[. %0k y4Ferm 3320-1 los-S6I Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) .,,,. , e, n m-- c- PAGE OF ..m, h. t . l c ___ - . _ . . _ _. _ ._. _ _ _ _ l j Papenvork Reduction Act Notice l ) i 6 pubbe repmting burden ic- this collect.on of informstien is estinuted to vny f ro;n a range of 10 Ma.~, u .m l aerage p;r repomt- for sone mmor facihtaes, to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months as un average per ret m. ' for som; nw r tiihtin, i vith a wdgbted average for najor and minor facihties of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per reym , , im luJmg im Nr ruic.viog l m trm tions, warthing esting data saanes, gathenng and nWntaining the data raeJcd, e id Wrplcnng and l j mviewmg the collectiori ef inforumon. Send conunent.s regarding the burden cain A m q vtht r apt of this co!!ntion of intermation, including suggestions for redacing this burden, to Chd, tatarcuton Pohey firanth, PM-223, U S. Environnwnt;d Protection Agency, 401 M Street, SW Washin; ton, DC 20460, ed to the l ! Of fice of laformation and Regulatory Af fairs, Office of Meagement and Budget. Washinpa, DC 20503. l l t i _ _r . _ ._._ _ _ _ _ _ . . _ _ _ . . . _ _ _ . _ __ ._. _ _._ _ J General Instructions 1..lf form has hxn partially completed by preprinting, disregard instmetions directed at entry of that mformation already preprinted.

7. Enter "Permitter Name/Afaihng Addre<s (and facility name/ location. if different)." " Permit Nu nher," and "thwharge Number" where indicated. (A separate form is required for each discharge )

3. Enter dates beginning and ending "A/omformg Period"cmcred by form u here in.bcated

4. Escr cach " Parameter" as specified in monitoring requirements of pennit.

5. Erser " Nam;de A/cawrement" data for each parameter under " Quantity" and "pu: day" in unitc specifia m pcnnit

".hrrage" is ncimally arithmetic aserage (geometric aserage for bactaia: p u.aneus) of all umpk measurements for em h parameter chtained during "A/onitormg Period". "A!amnum" and ",Ismmi.m" re monaUy extame hip.h and hm measurements citained during "Abmitoring Permd." (Note te munic:pa!s mth secondar., treatment reqmrement: Enter 1041ay average of sample measurements under "Arcrav ' :md er,ter rrm.ununr 7-10 avenge of sample measurements obtained during momtoring penoa under "A/2unam "j

6. Enter " Permit Requirement" for each parameter under "Quantrty" and *Guahty" as spetiGed in pennit.

7. Uruier "No is" enter number of sample measunn.nts during monitoring period that exccca msnmm (and/or rninimum or Aday average as appropriate) permit requirement for each parameter, if rme, enter *0"

3. Enter "F ry:<ency of Analym" toth ns. " Sam;de A/easurmen!" (actted frequency of suupling an.! c:nhsts m:d daring monitoring period) and as "Pernal Requuement" specified in pernct. (e.g.. h nter "('ont." fci continums monitoring "l/7" for one day per week, "b3a" for one day per month, "1W for one de per :;uaner c:1)

9. Enter " Sam;de 't)pe" both as " Sam;de 3/eanrement* (actual samp!c type used dariq nwnhoring peciadJ and af

" Permit Requirement " (c g., Enter " Grab" for individual sample, ".NIR

for 2 4 hour4.62963e-5 days 0.00111 hours 6.613757e-6 weeks 1.522e-6 months cor.pn.( TA ' fer continuous monitoring etc.)

10. Whcre victatians of pennit requirements are reported, attach a brief esplanation to de.crite er use ar d conettne actions taken. and reference cach violation by date.

I 1. If 'no dischuge" occurs during monitoring period, enter "No Discharge" across form in p; ace r4 data cetry.

12. Enter "Name!71tle of Principal hecutne 0])icer* wnth

Signature of Prmcipal Dec::ine Oficer J tethoraed Agent,* " Telephone Number,* and "Date" at bottom of forut

13. Mail signed Report to Office (s) by date(s) specified in pennit. Retain copy for your records.

14. More detailed instructions for use of this Discharge A/om/oring Report (DA/R) fonn may be obtained u mn OlHeef s) speciGed in permit.

Legal Notice l lbs report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or fai u:e to repmt ::uthfully taa result in civil peralties not to exceed $10,000 per day of violation; or in uiminal penalties nm to eued $25,0W per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95) .4,e PERMITTEE NAME/ ADDRESS (fadde Forehey Name%eense grDglyaw) NADONAL POLLUTAN f OtSCHARGE EUMusADON SYSTEM (MDDf8) Form Approved. NAME DISCHARGE MONITORING ftEPORT (DMR) . ' 5.1 i

F 4 LL :Y " 3 ,! .' , ;**"I3" (2-t s/ f r 7-rs/ 1 psoep -w'"q v OMSv No 2.04Q-OOO4 Jn;p (3ggg~qhy ADORE:s ; , 3, 3 )t 2 *= - =e*

PERM!T NUMBEA - -a - . otsCHARGE NUMBER 7% ) i?*e; .)g(Iq 3q1DDqc _ , 9 7 E P ? I J l' ' {" oA i5)77 MONITORING PERIOD 5i339 )Ci4- ! V$LLTT 9 7 4 r i t

I ^) VEAR MO DAY YEAR MO DAY LOCATION FROM ,s tt nt TO qn ,i 3m 3ey 53 3r7 gz7 p y Zt &c?

<~ru . aeu(3 m ?a3,c (20 211 (22-239 124-251 426-27) t28-29) 130 319 NO N R**8I"* WO'* W% N NM-PARAMETER (3 Ced On&# QUANTITY OR LOADING I4 cad %I QUANTITY M CONCENTRATION NO. FREQUENCY gg g 446-539 (54-69) 136-469 I46-63) (54-691 Or (32-37; EX ANatY9s TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS esm fgggj fgg.7c,

? L T E. , ? J ? 2 i, SAMPLE y9,,y 33933- , 3 7 m. .. 3 qg y_p, s p MEASUREMENT PERMIT ggg p g

)'3 13 [ 1 REQUIREMENT g 9 9,.;. 9 g w p .:., p 3 < 7 ,- . ^ ,yer . u, ,,,- ,,,,,t s, ., ,, , , , , , , , , , ,_,, e r, P 1 IT 7 3191) T ? 7 .y SAMPLE , ,3 pyyyp g9py, 399 ^$ O 7 r4 ::j r??A"+ .! pLit^ i ' PERMAT gygm 33^$1 1 ) , n r. p g 7 7 q ,q 3 7 333p 3 g p 9 g. 993 , y' 7' ~, g ,,-,r.3,,, ;,e- 7., ,_ REQUIREMENT , ,y,,, ,,,,, ,, ,,, SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PftlNCIPAL EXECUTIVE OFFICER i CEstTiFY uNotR PENALTY OF LAW THAT 4 HAVE PERSONALLY EXAMINEO ANO . TELEPHONE DATE AM FAMtUAA WIT *t THE INFORMATION SUBMITTED HERE!N; AND BASED ON r9 , MY tttOUIRY OF THOSE INOlviouALS IMMEDIATELY RESPON99LE FOR [f# I /J d OSTAINING THE INFORMATION. 6 BEUEVE THE SutMITTED INFORMATION IS i / , TRUE. ACCURATE AND COMPLETE. 8 AM AWARE THAT THERE ARE 'd'- h/ (M ..My [' - - Q ViG. C N 5 OUI SGNIFICANT PENALTIES FOR SUBulTTING FALSE INFORMATION INCLUDING' [ THE POS984UTV OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 ' '. I 9 343-%il7 9b } *) 2Il U.S.C. s isis. sP a.m animer me sananes mer biciuse m=s se se ssom S80 NATURE OF PftileCP' AL EXECUTIVE AREA - TYPED OR PRINTED .as or ====mnc :ermene s maarns sad a r.ers J OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS . AND EXPLANATION OF ANY VIOLATIONS (Reference a# attachments heral - CI N / SC kc< R1 L S Form 3320-1 (06-96) Previous editions 1may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE t5 31117/951031-0334 1 1 l e m. -.4 -.e,w..,. -.- e .... - -. -,..4. - . . - . I Paperwork Reduction Act Notice i l Pubbe reatirg burin Dr this cWI w n of m: An is minuted to vary from a range of 10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months as an I rw " p r te P. w for F ne m n hab i Enun as an awrage per gespoose for senn major f acilitiu, oth a w. gbtcel u riag: ,. r nu r and m - , of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per response, includmg tirne for reviewing i l 1 4mch:m, se archmg exhting ' :a urm Aine nd nuimaining the data needed, and completmg and } toim:rg the colletuan t.f nic4n.in ( l Sa.J mrranents aegardmg the burden estinute or any other aspett of j tiiis uhtmo af infornution, inchidug numsn a for reJoeing this burden, to Chief, Infarnution Policy j l Ilrah, PMCB, U S. Er sironwraal Protunon Apen y,401 M Street, SW Waahington, DC 2(M60; and to the ' Ottia of infernutian and Rqu!atocy Affairs, O!!he of Management and Budget, Washington, DC 20503. l General Instructions

1. If form has been r,atiMiy w pleted by preprinting, disregard instructions directed at entry'of that information already preprinted.

2/ Enter Terminre Name Alaihng Ad/ren (and facility name/ location, if different)" " Permit Number," and "Dncharge Numbre" v.here indicated ( A separate form is required for cach discharge ) .

3. Enter dates leginomg and ending "Atomformg Pertad"coscred by fonu where indicated

4. Enter cach "Paramcrer' as speciGed m moratonng requirements of pernut

5. Eeter "hpie \/: . w " i nt" J da for cat.h pn.uocter under "Guantity" and "Gaahty" in units specified in permit.

hc. / is nornully antha : tic asetag ; (r omcuic averar; for bacterial parameters) of all sample measurements fcr erh pam eter et Umed dmin "% mng Pewd". "Alaannum" and "Ahnimum* are nonnally extreme high md low mea anemer:s ata ..:d 'uring "th mtarrn j'cru d " (Note to municipais with secondary treatment .reqmte nau En cr 31 da, 4 ua ;: of sam; h: nusmement3 unJer " Average," and enter maximum 7-day average of supple m ewacms obtahd during mcnitormg penod under "Alaxim!.m ") Ea r.r "!b r:a Fc, ure f f> nt' hn ah paran cur uni _r "Gaantity" and "Guahty" as specified in permit. t U n Je r "No &

u d;;r imNr of ump!c m;asunnents during monitoring period that exceed maximum (anfor minimum or 7-dy mean as appnyi:ac) pennit requirement for each parameter. If none, enter "0".

1 Fea "Frcp 7:cy rf O a j ,J kah > ~ inf'!c Alcawment" (actual frequency of sampling and analysis used dmic n:ermamg paivd) ar.d as Temut Reqdremcvt" specified in permit. (e g., Enter "Omt " for continuous mennetiag, "I " for t t ; day per week, * / 30" fer une day per monih, "l/90" for one day per quarter, etc.) 9 Emcr "lang!, 'i)f " tah as %yfe Aleanecment" (actual sample type used during monitoring period) and as

!'crv,:t M ya.rrmer:/ " 1 g., Enter "Grd" for individtnl sample, "NHO' for 24-hour composite, "N41" for contmuous monitenn ; ct: )

10. Whcre welanora of pwnit regirements are ocported, attach a brief explanation to describe cause and corrective actions taken, and refcrence caih violation by date.

I1. if "no discharge" wens durma markring p;riod, enter "No Discharge" across form in place of data entry.

12. Entcr " Nam 7 ale ofi>mapal nccutn e Oflccr* uith " Signature of Principal Secutive OJ]icer of Authori:ed

.h;ent * "Te:ephone Nun +cv," and *Date* at twttom utform.

13. Mml sigucJ Report to O!Ticc(s) by date(s) specified in pennit. Retain copy for your records

14. More detaild instnntims for m,e of this D&har)lc Afomformy Report (DAIR) form may be obtained from Ofnce(s) specdied in pennit.

Legal Notice 'Th 'repsrt is required by % (33 U.S.C.1318; 40 C.F.R.125.27). Failure to reput or failure to report truthfully can rewh ia civil psr4! ties not o exJ $10,000 per day of violanon; or in criminal penalties not to exceed $25,000 per day of violation, c.r by imposn meet for not nyue than one year, or by both. + , EPA Form 3320-1 (Hes. Ov95) Yo , n- , m % A __ _ __ PERMITTEE NAME1 ADORE;S#7=w.F resyN L.c r erDuPwow) NATIONAL POLLUTANT DISCMARGE EUemNADON SY TEM (NPDESJ Form Approved. NAME yr;ggy4 yzgggy p9jgo 3 f A p 7 7,3 N gE NORWG MYe, (% 3;3 p97 pp 3g93 OMQNoy 2040-0004 ADOREIS ? . 3. 3 ') K 1 "91 D5E1S l 7' I * {5QG2 45) APP # **t amp05 x 3 -3MS 5,Trb; ~; O I D 3SFD03F PERMIT NUMBER j orsCHARGE NUuSEn y yyqgg idIPPCt~P3Er Pt 107' MONITORING PER!OD FACN.11Y g g(y; 3 y4L(gy p3gy3 3yg7[3y LOCAh* FROM tt si TO ;o ji 3; 700 40 OISCM&MP l 300 ETTN: Di7I) 3L eDSRP (2a2r1 (22-23/ (24-251 (25-271 (28-29/ (3G311 NOTE: Road Instructions befoes _ t-_; this -Clform. PARAMETER (3 Card OnM QUANTITY OR LOADING I4 Card OnM QUANTITY OR CONCENTRATION NO. mEQUENCY SAMPLE (46-531 (64-6 rI 130-451 (46-55 (54-611 OF (32-371 EX ANgy,3 TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS dm is+ssi tas-7ar '& #r 0 2 *- os SAMPLE 7035c? 7, # E 000"00 ( 12) / MEASUREMENT 7, 5 O 7 gy4 l 33ano 1 ) ) . PERMlv . **??%c .&$6@00 t OOT 5.0 O*240P 9.Q .' ?E 8C L Y ; RAS e r rt.U s 4 r 7!Si; 1 A L1! . REQUIREMENT c;3; n y (;m g p g p g{t g. 3g ~)L[pq v7pmL SAMPLE Otc*^t * *r ^ t *- c 0030$? ( 11) / ., I;. > ,J .-. P ,. g D n h MEASUREMENT 4 - 4 b, / hM 73337 L } ) P p MIT . 070000 OceP0 r - M? O t tt 2 0 0 JJ 190 E FA L I ; FAB eP/L1r er ~?)35 7AL3 REQUIREMENT 3932 m g pg' -93 pgy y gr f L 3[L \ 5 () O g 715 ' SAMPLE 000?*> ?*407) 00 MOO ( jl) / P'R74 ; f U

U 9 lif 5"? MEASUREMENT bf {$ b [ f ygh i

q?$5$ 1 ) ') PERMIT Jccate St??OS ' Oct 1 7 3 9 0 c et 15 20 : PRK LY ; GAB REQUIREMF,NT gyj

c P L J ' ': r IR)RS Yll; gg :3 .g ,) pggty g agfg

L J.' , [ *f 2 3 -: 911 r T?. SAMPLE { ": 3) C77003 6030C 7477C7 r4?U *9sAr1?;T ? L A 't ' MEASUREMENT g,[Jg $ $@h h 7[ [g 500C7 1 3 0 PERMIT :: E P o ?

DPMD r ' 507 Mt 300030 C C G C':q 000 M5LY 37[3:

"iLUO47 17353 fill: REQUIREMENT ga gy - ns y(y . y p 3;3 . o res SAMPLE MEASUREMENT PERMIT -

REQUIREMENT . SAMPLE . MEASUREMENT PERMIT REQUIREMi'NT r SAMPLE MEASUREMENT PERMIT REQUIREMENT g. t ! NAME/ TITLE PRWCFAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PfRSO: TALLY EXAMINED AND I AM FAMluAR WITh 'ME INFORMATION SUSMITTED HEREtN; AND SASED Oss TELEPHONE DATE l MY INQtARY OF THOSE INDIVIOUALS IMMEDIATELY RESPONSISLE FOR [ lq ,- # ! CSTAIN!NG THE INFORMATION, 8 SEUEVE THE SUCamTTED eNFORMATION IS i' ' [ DdV i fi U T nd 01-1. TRUE, ACCURATE Afs0 COMPLETE. 4 AM AWARE TMAT THERE ARE \ SaGNIPtCANT PENALTIES FOR SUSMITTING FALBE INFORMATION, INCLUDING f / //h [ ' '/ . bI 2 s 9,3 - S 113 Cht' O 5t1 V lla93;"e*

1 96 l 2 2%

THE POSSIStuTY u.S.C. s t atS. #w.m. saisier 08 FleeE.ANO sN , sasusesaMPRisomeMENT. may ensame noise seeSEE se sso, tScop U.S.C. 51001 AND 3*OF PRNCFAL EXECUTRFE Sa0 NATURE g i TYPED OR PRCNTED aw or meesnese - COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference as attachments here)

eranw e a nasaans eiur s resraf OFFICER OR AUTHORIZEO AGE 8ET M NUMBER YEAR MO DAY q e e

Gas

orm 3320-1 (08-f:5) Previous editions may be used. (REPLACES EPA FORM T-40 WteCH MAY seOT BE USED.I PAGE , OF 3 l .a. . y p ) % L , 01

d.u s ,s 1

L Paperwork Reduction Act Nptice : Pubhc pyorting burdtn for this tullectmn of mfornution is estinuted to vary from a r,tnge of 10 Leur s as an l ,t av nage per response for wnw minor f acihtics, to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months as an avmge gwr recee for wn e numr facilities, ! } with a weighted average for r:q;or and minor facilities of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per respons nehtJing tim: for raiewing ! nutrtwtion<, searching existing data sources, gathenng and numLdning the data rmeded, m.d ecmpletiag ed l reviewing the collectmn of information. Send comments regarding the burd< n estimate or my other met of , this collectmn of infonnation, induding suggestions for reducing this burden, to Chmi, Infmutmn Pohey l Hranch, PM-223, U.S. Environmental Protection Ageng,401 M Strect, SW Wuhington, DC 2040; ad to the Office of Infornution and Regulatory Affairs, Of fice of Management and Budget, Washington, DC 20503. i..___ _ ____.___ ______ _._ _ _.___..________ _ _ _ ___ . General Instructions L If' form has been partially completed by preprinting, disregard instructions directed at entry of that information alie4dy preprinted.

2. nter *Permsttee Name:A/ ailing Address (and facnity name/ location, if different),* " Permit Number," and Discharge Number" where indicated. (? separate form is required for each discharge.)

3. Erder dates beginmng and ending "Alonitoring Period" covered by form where indicated.

4. En er each " Parameter' .ts spectfied in monitoring rcquirenwnts of permit.

s. Enter "&vnp!c A/coauremen." data for each parameter under "(Juantay" anj "Guality" in units specified in permit.

"<!verage" is normally anthmetic average (geometric aTerage for bactenal par uneters) cf all samplc measurements fet each parameter ebtained during "Alomtoring Period", "Alemam" and "Almaum" are nonnaby c treme high

md low measurements obtained during "3/omtoring Period." (No:e t unmtipah with secondary treatment requa cment: Enter 30-day a,erage of sample measurements under "sheraC and enter muimum 7-day average of sample measurements obtamed during monitoring period under "Alaximom "j

6. Enier " Permit Requirement" for each parameter under "Guannty" and "Guality" as spccified in pernut

7. Under "No Ex" enter number of sample sneasunnents during rnonitoring period that excced nmumen (and'or minimum or 74!ay average as at.propriate) pennit requirement for each parameter. If none, enter "u*.

4. Enter " Frequency of Analysis" both as "Nample A/camrment" (a:tual frequency of smnpimg and enahsis used during momtoring period) and as " Permit Requiremer' specified in pernut. (c g . Enter " Cut? fm cominnous monitoring, "/ 7" for one day per weck, "/90" for one cay per month. */M for one da per quarter, ete ) i

9. Enter %mple 7)pe" both as "Sunp/c 3!easuremem" (actual sample type used duria; monitonog period) and as "Permir kcquirement," (e g., Enter "Grah* for individual sample, "NHC" for 2 4-hour com; mitt, "N/A" for continuous monitoring, etc.)

10. Where violations of permit requirements are reported, attach a brief explanation to describe case ad corrective actions taken, and reference cach violation by date.

1I, if"no discharge" occurs during monitoring period, enter "No Di3 charge" across form in place of data ertry.

12. Enter *NamcMitte of Principal Executwe Oj]icer" uith "Sgnature of Principal Erecstne Oj)ker o.r Authori:cd Agent," "Telepimne Number," and "Date" at bottom of funn.

13. Mail signed Report to 010ce(s) by date(s) speciDed in permit. Retain copy for your records

14. More detailed instructions for use of this Dacharge A/onitoring Report (DA/RJ form may be obtained from Office (s) I specified in pennit. J l Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can re.sult in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to excud $25,000 per day of 5iolation, or by imprisonment for m>t more than one year, or by both.

l EPA Form 33204 (Rev. 08-95) 5,l l l t N PERMITTEE NAME/ACJ AESS (F=remdeFarm#p Name% ersee tfDggryuud W.TtONAL POttUTANT OtSCH ARGE EUMMADON sv3 TEM (NPDES) Form Approved. NAME q y3,7 7 . j, , , . . DISCH RGE MONITORING REPORT,f,0% 7 ,, ,_ . CMB.No. 2040-OOO4 . - - 7. 1 -m - . Approval empires OS-3198

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ADORES 3 , 3 ,, '1 I (3jyc s5} ir- . ,3: - o y: cn,y PERMIT NUMBER DescHARGE NUMBER ,.,y g . . 73;n,,- m7' 1 MONITORING PERIOD ~?33 IAN . t? , y n 1. ', : y 0: ' ' ' 'Pi^! YEAR MO DAY YEAR MO DAY _ LOCATION FROM TO t 1 - ar + i- a r. - .t + nie,.v2 : g $e7 . . < - , gy- 3; , (2G271 (22-23/ (24-25J (26-27; (28-29t (3(>3f/ NOTE: Reed instructions befor6 completing this form. PARAMETER (3 Card on&A QUANTITY OR LOADING 14 Cerd On&J QUANTITY OR CONCENTRATION NO. mEOuENCv SAMPLE l 14&53r (54-61) (3e-451 14 & 5 3) 154-691 OF 5 (32-37; EX ANALYss TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS esum fg4_ ,3; fgg.7a, SAMPLE em s . 3 .v

u -

7, O b - . ~ ~ ~ , [, [ h. ( ..~ b / [ bMb "' ~ " ' MEASUREMENT 19qn' t ) - PERMIT 339e=% e& y e - ,,9 m 4. ; g. 7,3 ,.;ggy ,y3 ,ye7 ,3-7 , . REQUIREMENT SAMPLE -~s .u , < ~ ~ ,' ' ' . . , T c r w :' +, . "., 3 3 '.. '< a*-r=-* h, . g S O,7 3df (4*1 [ b 2d', , ] , ;,. MEASUREMENT 3 3 r, , a 7 3 , PERMIT a r w .- ~ .e g y < ,, 3 .+ 3 u 3 g- y 3 pqg ;9 gp , , . , , , , , , , ,, .,,. REQUIREMENT ,,, 3 , ,, ,, , _ . , , SAMPLE )yg 4, ygs. e3-~ m s9y- *e~-;y ( ) ag / j

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c. MEASUREMENT 4eA , h [ (y m [;-

3 3 ;- . , PERMIT 3~.9se . c. e g ~ p . 73~ ogg ( - tc p . *j g y e , .gr : ,e ,qq. . - , fg 4 REQUtREMENT y,.. ., ,y, 3 rry *- ' - /* r. -3 , MEASUREMENT (),O/G (),CQ ~ d 7 {g

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EUT 3II3i

. - , . - , , , . REQUIREMENT o. n . y n=re, 4y . - - - c...,,, SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERDFY UNDER PENALTY OF LAW THAT 4 MAVE PE8tSONALLY EXAMINED AND TELEPHONE DATE AM FAMtUAR WITH THE fNFORMATION SUBMITTED HERDN; AND BASED ON MY eNOUIRY OF THOSE INDIVIDUALS iMMEDIATELY RESPON9BLE FOR q/ o O (jD i OBTAINING THE INFORMATION. I BEUEVE THE SUBMITTED INFORMATION IS y? J j4/f,'[ p j/ ilR 2,d UtndOri TRUE. ACCURATE AND COMPLETE. 4 AM AWARE THAT THERE ARE ' - k /7/)/ g'-(p L .tc n .s t ! 3 mn ar,e : SIGNtFICANT PENALTIES FOR SusMITTfNG FALSE INFORMATION. INCLUDING '- "# {7

i

9

} ~qJ}O ^ q 'E A S ra THE POSssiuTv OF FINE AND IMPRISONMENT " slONATURE OF PRINCIPA L"EXECUTIVE TYPED OR PRINTED u.S.c. e 131e. sFwasaw easer e ana er menamim. : -_ : er a.rw s.enm. s mamme. smr SEE m., eiene ann 18 u.S.C. s y.oras so sro.9.,1001 coo AND 33 OmCER OR AUTHORIZED AGENT ARu g NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# stischments heref 0 6 e % a Eg Form 3320-1 (08-95) Previous editions may be used. IREPLACES EPA FORM T40 WHICH MAY NOT BE USED.) PAGE OF w r ew w n t _ _ _ _ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ - _ _ . , _ . - _ _ _ _ _ _ _ - _ _ _ - - _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - -_- __n - x- _. -_ _ _ _ _ _ _ _ _ - _ _ - _ _ _ __ ~ ~~ ~ ~ I Paperwork Reduction ct N_otice _ Pt.hhc r prting bunkn im this ohi.w ~l uL m.uka a exnruted to vary from a pnge.of to hours us an ! ad e(F i pt, r I +." [On so IU r L .rN t ' ' f, hh. , IJ l 10 huuri RS 8B C,elqe per IcS[VMe for home major fKkbl5Ch ,t ah a weightt.J werge Sr m.vr mj mirwr hiulitia of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months pr response, indudmg time fer reviewing j d rau s da n g c w. mp A , au , ga:benne :.ud wuntaming the d,aa nmied, and comp!cting and ; ro n:v. . J (br odanon of mforn :nm. S.wi comaats seguding tJa: burden estimate or any other impct of l ~ tha colhttun of *nfornetr,a, ududing u; ptuom for redo:u g tb .s burden, to Chief, Infornution Policy : ihuah. PMC, US Emoroom cl ProNtnen Agncy, 401 M Street, SW Washington, DC 20460; and to the Office of Efomation and Equ!.d.iry Atla A Office of Management and liodget, Washmgron. DC 20503. f _ General Instructions

1. If funn ha.s been partially completed fy preprinnng disregard instructiota directed at entry of that information alreaJy preprinted.

2, Emcr "Pcmuttec Naw d /aing Addre.u (and faality name/ location, if different)," " Permit Number," and "Dmhome YmnN r" where indicatcd (A separate form is required for cach discharge.)

3. Emer dates beginmng and endmg "Alonitoring Permd* coscred by form where indicated

4. Emcr each "Parana rce ' cs speafied in monitoring requimacnts of permit.

5, Enct "Lmj /c T /< .cev i ni" ha fm t ach pararacter under "Gmmtuy" and "Gua/ sty in units specified in permit. ". t u n c" n nar,;U3 rub:w . cry.' % unctuc ascrace for bacterial parameters) of all sample measuremems fc r erb mran mr 4ta > cd My N / +nomm Per~i". 9/<ummm" and "Alenimum" are normally extreme high m i in maamemeu ht:m.cd dem ' S /v ;termj' Per.od " th'o:c to manicipals with secondary treatment rqurc:en E m ci Ut a m: , of umi' m ;nremms under "Acerag " and enter maxinnun 7 day am.ge nf wm@ %.a umv m o!Lu ed during nionituing pcriod wider "Alaumum,") EnNr "!'mn.i !!c ;uri r ul" for u h prammr iMr "(hantity" and "paa'n,' as spectfied in pernut. 1 Und < "W A" c mer aci e t .a.q: nuasurmcms daring monitoring perxxl that exceed maximum (and/or nannuun a "-de e c s w opri.uc) Wonit icqubement for ca;h parameter. If none, enter "0" t U mcr "!~re m og , r/ - 9, ' mh a "tm;>!r Afcou< runt" (actual frequenev of sarnpling and analysis used dmq n.onimona a a21, nJ "!i rr:a wpecemen" <:pecified in pernut. (e g., Enter " cont " for continuous , cm h - " ! ~" f~ r c da n r v- A "! N" fur one day per month, "/J0" for one day pcr cgarter, etc ) 9 Mr " V er/ w i)j .

F A :c, " aj !c 3/c.mrrmen!" (md sample type used during monitoring period) and as "li i n.:t !.7 warm " s g Emcr *GrA" far in 1mdual sample, "N//C" for 24-haur composite, "XM" for 4 w:mnuaus m:>nitoring. ec )

10 % ic viclawns cf runt it parm;ats are reportei utxh a brief explanation to de:.cribe cause and corrective

anom td en, and referne c tx h nJ!auon by ide.

I1 If "na dchar cr" ou. .rs inr:g nmnoring permi enkt "No Divharge" across form in place of data entry. U. Emer "Nxnc la!c ol 1 nn::p'! ! rec unve t y!)ccr'* sith "&gr:ature <f Prmcipal becutwe Officer of Authori:cd te at * */'c!cphone N;nbcr " and "Date" at bottom of form

13. M:ol 3igned P.cpert to OfTi:em ty date(s) specified m pcrmit. Itetain copy for your records 14 Mme detaid instnn ns for u,e of this Dmha7c 3 fomtoring Report (DAfR) form may be obtained from Olfice(s) specified in rumit Legal Notice His apet is requbed by ! x i33 U AC 131M, 40 C.F.R.125.27). Failure to report or failure to aport truthfully can nwult ja s :1 pr.Mtics rmt , cnd $10.000 gr day at sinhuion; or in criminal penalties not to exceed $25,000 per day of dolation, or by ugrM*.r,t f or not more than one y ear, or by both.

EPA Form 33201 (Rev. 0 99f) Nol . . ~ . ._ . - PERMITTEE NAWADDRESS(7=w,Ferery A-=wleren==cf!NSE .ar) NATtONAL POLLUTANT OtSCHARGE Elmesh ADong gYSTEM (NFDES/ Form Approved. NAME ;qgyqg y4ggg7 p3g73 ; 7 g 7 p ,3 , y DesCH,AR,G,E

7. , MONITORING REPORT f,7_ (DM,R! 3f gy77 7 33y 93ygp70MB Nw 2040-0004 ADDREIS P. ?. 3'11 Q P: '<: ' '* '

(933P 35) Ap ggo sus E?7N; 3(V[D 3ffD9qr PERMIT NUMBER OtSCHARGE NUMBER y . 7yyg 3HTPPI10P3RT dA ?SO77 MONITORING PERIOD A3 0 FACILITY :gy7q g ggg y 3pgp 37g9y3y LOCATION FROM 1L ' TO iO 1i .5 6 #DD ND 0ISCitECE lfj DC7 4r?9: n!!!1 ya

a y e (2a2ri v22-23; t24-25; (2s-27; (2s-2s> (30'3rj NOTE: Reed instruceone before completing this forre.

PARAMETER (3 Cen%f WANTITY OR LOADMG (4 Carst On&A MANTM OR CONCENTRATMM N O. m M ENCY SAMPLE 146-531 154-679 (30-45) 946-531 154-sti or (32-37; EX ANALy$rs TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS m-ss, ts4-ses #6S7a 3 3 ' T 3 ', , T3?gt SAMPLE cone ^t *etar; tthc0: ( ig} 7,u7;pqg MEASUREMENT l '7s!? ; 3 ^ PERMIT Maece Spa t? r r $$$ etnes J3 17 i g gf ;gygg' gn.yp ,,qr e g gg. REQUIREMENT w e =t y) 3, gj p g 7;,7 wy p g f y, yyyyg

rL p; a 7'zm - SAMPLE ' 'e S M t * *' t a t etmt ( 11)

. 7) ?, y I i n - :; R 3. 7 ir? MEASUREMENT O1t si 1 ) 9 PERMIT c cet^ e t ch M.: r 009 c t3*M 13 2? gICr/ aga .orLat t- 3 il: y ; y,3 REQUIREMENT 33n 59 3p3 p3 g7 yy gf g gm L14, ii ? ) >? 31 ! 7 av SAMPLE ( $3} 03te*0 M eaty ance r ng 7pr=*< *y ygg MEASUREMENT Ny F/ 3 x; 313$? 1 } 7 PERMIT pp35* pyngqr M t M e. cet t :: 4 . ukoea es cggy ?5?ing -crLUT NT ' 2751 iaL7 REQUIREMENT 3q g er a pgygy -4y .;9 933 SAMPLE MEASUREMENT PERMIT - REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE ) MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT i NAME/ TITLE PRINCFAL EXECUTIVE OFFICER 9 CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSOesALLY EXAMINED AND AM FAMtUAR WITH THE INFORMATION SUOMfTTED HEMEM; AND BASED ON TELEPHONE DATE .j a f MY NOUIRY OF THOSE INCtVtDUALS iMMEDeATELY RESPON99tf FOR // * - gy, g ndor; OBTAINING THE INFORMATION, t BEUEVE THE SUBMITTED INFORMATIOes tS }' / )- " /a ' / )#7 !liWL p$ S t ? y 218 Ma 7 TRUE, ACCURATE AND COMPLETE. SiONIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDieeG-8 AM AWARE THAT THERE ARE i ,) ' /-/' [/[/ g - N@ /h/ 4[7 ]g} Q[} } yh ' [2 ' y' THE POSSISIUTY OF FINE AND fMPRISONMENT. SEEmise mer encamm 18 U.S.C. 9,1001 AND 33 e sesrocoo S80 NATURE OF N EXEN AREA TYPED OR PRWTED annarmanen u.S.C. e 131o.=:s%neme . - ensur er a.rw .snes.e s.essus s menene.na s y. mms . OFFICER OR AUTHORIZED AGENT CODE NUteER YEAR MO DAY COMMENTS

AND EXPLANATION OF ANY VIOLATIONS (Reference s# ettschments here/

4 4 O / C k /t P t' ENorm 3320-1108-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE OF 3 af OLQ- - , u-3. - + L Paperwork Reduction Act Notice l Public reporting hunten for this collection of inforation is estimAd to vary imm a rw of 10 t ces as an b eente per reapon .c for some minor facihtics, to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months as an average por n vine fer mn.e ner f.e 'ihbes with a wrighted average for myor and mirior facdities of 18 houn per repons , iduJing taa o, r u icwing , instrmtions. scarching existing data sounrs, gehening and maintaining the des na ded. <uid mpletq md revwwing the. collection of inforuution. Scud conunenta scgarding the burden utun.ne or ry & wxt of l l tha collection of infornation including suggestions for reduemg this burden, to Cb,cf, Inf onnation Poiey , Branth, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW W.ahington L>C 204t,0; and to the of fice of Infortration and Regulatory Affairs, Office of Management and EtuJ tet. Wm.hington, DC 20503. ; i _ . _ _ _ _ . . _ . . _ . _ _ . . . . . . - _ . . _ . . _ . _ ..,___ _ _ ._ . _ . . . . . . - _ . . _ . _ .. } i General Instructions

1. If. form has been partially completed by pwprinting, dirregard instructions directed at entry of ths: in formation already pr printed. .

l

2. Enter

Permittee Name:Afadmg Address (and facility namc! location, if dttfarentl." "Perrmt Number,* and "Dncharge Number" where indicated. ( A separate form is required for each discharge.)

3. Eruer dates beginning and ending "Alonitoring Permd" covered by form where indrated

4. Enter each " Parameter" as specified in monitoring requirements of permit.

S. Inrter *.%unple Afeamrement" data for each parameter under " Quantity" and "gualay" in units gxifi:J in penrat " ferrage" is normally anthmetic average (geometric ascrage for bacterM parameters) cf all Lunpl; meamrcmcnis fot each parameter obtained durmg "Afomtormy Permd"; "Alarimum" ana "ifinimod are non:muy esticme high and low measurements ebtained during "Alamtoring Permd * (Note to nemicirab. u tth scurmdx treatmc u retpurement. Enter 30-day average of samp!c rncamrements undct "Arcrare." and ater mau awa 7--Ln average , of sampic measurements obtained during monitoring period under "Afamm.>n "; l

o. Enter " Permit Regmrrmenf for cach [urameter under "Ovantity" and "Gaulay" as spcafied in jumit

7. Under "No Er" enter number of scunple measurments during monitoring penod ihat neerd mamum (and/or minimum or 7-day as evage as appmpriate) pennit requirement for each parameter, if nonc, en:er "D'

8. Emer " Frequency of Analysis" both as "&vnp!c Aleawrmens" (aanal Twqucn.:y of c auplum and ; n:.lpr us.:d during monitoring period) and as " Permit Regwrement* specified in penn.t. (e g Emcr 7 'm:t " f^ commwen monitoring "/F for one day per weck,'b.4r for one day per month. "/50" for one ua) per qmuter, ci; )

9.' Enter " Sample /)pe" both as " Sam;'le Alcawrrment" (actual sample type used dang moni.onng reiod) and . ; " Permit Requirement " (e.g., Enter "Grah" for individual sanipie. "2.#R'" for 2 4-heur com[nst "E t" f x cominuous monitoring, etc )

10. Where siolations of permit requirements are repmted, attach a brief exrdanation to duribe cm i d wnectne actions taken, and reference cach violation by date.

I1. If"no discharge" occurs during monitonng period, uncr "No Discharge" a:russ fonu in place of data a try

12. Enter "Namemtle of Prmcipal Erecutwe Ofter" mth " Signature of Prmcipo! beam e rijn er < i haimruJ A;?cnt." " Telephone Number," and *Date* at bottom of form.

13. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your recmds

14. More detailed instructions for use of this Dncharge A/omforing Report (DT/R) funn may be obtained nom OfHec(si specified in permit.

Legal Notice 'lhis report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to a port or faduw to repart huthEdly un result in civil penaLies not to exceed $10,0% per day of violation; or m criminal penalties not to exceed $25 000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95) FEMhmTTEE NAGE/ADDICWFerehrpWame'Lonness4(Dip,ueo 9BATt0NAL POLLUTANT DISCM4RGr mnemmaTION SYSTEM (N/ Form AgIINoved. NAh4E DISCHARGE MONITOReeG REPORT (DefR1 ? ? ?, f i 2 V%LLET OTiER 9?!!"T3N (2- F *? 17 7- F ?

gg{p y g3g( pggga OIWW No. 204,0-0004 ADDRESS ' "as ,er,e s ., ,

, 3. - 3 ) ]( 4 (g g g 3g} t PERMIT NUMBER DtscHAm NuMem j AT!i; aRVIn 07VD07F 7 VLy L 3MIP?f10P321 "1 15077 MITORWG PUROD M

3 f3 2 3 ?3 % V P 3 Y E L I. ? Y "04EE 3 7 % ? [ .3 9 YEAR MO DAY YEAR MO DAY ~

toCA N FROM ,s ?1 ni TO g; ti ,, ett va r- 7 ~; r H A v P t ec> (20 219 (22-239 124-25) (26-279 (20-299 (30 31) M; ***I*W N **'*' \\ v v ~1 e n*>*m *)u=%nnv PARAMETER 13 w w QUANW M LOADING I4 M W QUAN m M m m NO. mEmmCY SAMPLE 146-531 15 4-s 19 (30-4G I46-5M (54-619 OF 132-371, EX ,anty,$ TYPE t AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS m.s* ts40s; I n -70s SAMPLE 933 33 Sqq e 433ps y l >3 MEASUREMENT q PERMIT gun + gge c ye; TSqqq 1 1 REQUIREMENT ),9~ o p g-p Q . w{g/ ;y y [ s c e, a av .. - 3 7 - b y g r .t , 9 9 y ,, ,, ,- y r w rm - ir+yrwn* <-* nme-n ! SAMPLE yep e pep;; c;nce , r-j ,} ,L r i) w v, egg [ ',u, ,,. 3(, ' ' MEASUREMENT ( 19) j 3 , ,y, ,* t l . g n g e g-PERMIT tJ1Cp/ gAn ) , r; 3 3 1 y g p e e

n e. te; Anm 3 *) Q g'. !

,y,, , , 4 s vv 4 isq- ygrn; REQUIREMENT g, 4, .-- 3sn, wy , .- f r sy.e , SAMPLE egue; 3 '7e" 3un '"-' s' rr ' '. #. -' MEASUREMENT ~ t Ff 9 y getey-( 19) ? a ? 1 *i PI ? H G 41V M E T: s)gg PERMtT - gong 1 y 3 REQUIREMENT .nube e >>a ***de 1 .,5 '. > ._ , ,, M WICE/ MB ,gm, 3 r ,, - e3,-- y,,,, m g, n3p , p ., f , nru j r['pr y i: ' ~ y-ngy7' Ot; SAMPLE c e% g Mppe # M e e. a,r ?333 1' T 3 A i' i ' tl ? PLAdi MEASUREMENT 6 i W f g 3) , PERWT 99tSO 1 1 9 p3p y m 39g ;opweg sco y n 'M@cce 4 000 UGLY .S?p; 3gh.q7,, -e,3e i, g ; 3 r REQUtREMENT _g g , ,, ggyy , , , ,,n y ,. e. SAMPLE a MEASUREMENT PERMIT - , REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE , MEASUREMENT PERMIT - REQUIREMENT NAME/TTTLE PRNWCW'AL EXECUTIVE OFFICER I CE9TtFY UNDER PEhALTY OF LAW THAT t HAVE PERSONALLY ERAMINED AND TELEPHONE DATE AM FAMILIAR WITH THE INFORMATION SUDMITTED HEREiN; AND BASED ON , MY iNOUiRY OF THOSE INDIVtOUALS SMMEDIATELY RESPONSSLE FOR r '7 Jfavig urngor{ OSTAasetNG THE iNFORMATION, t BELIEVE THE SUSMITTED INFORMATION IS f! TRUE. ACCURATE AND COMPLETE. So"'aca"T ""a'7'ES FOR SusMiTnNa FALSE .NFORMATiON. iNCouDiNo , I AM AWARE THAT THERE ARE / - - - /[fg -- - ~ J/joy" I['/ 393 4113 R M chenistr7 -* ManaNer THE POS9BiUTF OF FINE AND IMPRISONMENT. SEE IS U.S.C. 91001 AND 33 MM OF NNEN 4 D %- , .U.S.C. 5 1319. #PenmNips weder smose s.eamos ggg i TYPED OR PRINTED e er ===.aum : er her. s nm.may .w hockets s , ras Ans. se se # F0,000 OFFICER OR AUTHOtWZED AGENT CODE MJteER YEAR MO DAY ; COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# srtschments heref 4 O / b [- IS_4.- Form 3320-1108-95) Previous editions ynay be used. tREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE OF ! O & 3/961003- M 34 1 ! - . - - - - __ - .-. _. _ - _. _ _ _ _ _ - _ _ _ - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - . - - _ _ _ - _ . _ _ _ _ . - - - _ _ _ . - _ _ . _ _ - _ . . _ _ _ _ _ _ _ . ~ _ _ - _ _ _ -I i PAlpenvork I[ eduction ActWotice~ I! j . Pubhc trportme bmden fcr this u Ilem of mfamution is esturutt-d to vary from a range of 10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months a5 sn C. cra i

pil T ': p%C D'l 6 41C lDi 4 [.Gil lb !3 I Il b' W(s es an A'w Crage per rt'qnmSC for Sorne m3,)Or [dCI!i!Ie ,

l mth a m. chLd .n a;ge h r 14r a.d mmor inihtw of 18 haurs per respmse, includmg time for reviewing l ua nu t e s archia t mung A , ac , grhaing and mointaining the d.ita nuded, and completing and ma e .u:q the cuLenca el uduuuu a 5 r.d coumab mpuding the burden estinute or any ctherlspect of l j th: ca t hon of inform .Wn. includiar serge 30 e for reducing thm burden, to Chief, Infornuuon Policy ; Brah, PM.2D Ui Eoimanaul Pmtectmn Ap ocy,401 M Strect, SW Washington, DC 2N60; and to the Of fice of lof 'rmtmn al Ryu!abry Af tain., Office of Management and Budget, Washington, DC 20503. i _ __ . _ . _ . _ . _.,_ . . - - .-.~..---.-------3 General Instructions 1.11 form ha ban partully comp 1ded by preprinting, Jisregard imtructions directed at entry of that infornution already prepnnteJ.

2. Enter "Petru tter Xaerealavimg Ad/ren (and facility name/ location, if different)," " Permit Number," and "Dmharge Aum/ve" where indicated (A separate form is required for each discharge.) l i

3. Eract datei;lqinnin;; anl endmg "Alomturme Pamd* covered by form where indicated. I

4. Enta each " Parameter" as speulied in muituring requirements of permit. )

5. Emcr " Umpf, .if, wm M" O:1 far t ch paraneter under "(?uantity" and "Guahty" in um(s specificd m permit.

" h :c"s. wnnalty 4nthtm oc at tre (;;eomcnic average for bacterial parameters) of all sample measurements for each pm

1 r oli md dwing T i , ; ":ng Penod"; "Alaronum" and "Ahmmum" are normally extreme high ad in m mt nc:ts W an. 1 daruq "V wdorm; l'eriod.' (Note to municipals with secondary treatment r;;t; m:ne nt - l'n:ct 3 LN a.i

ge of .~u@ mea 3nrements under " Iverage," and cnter maximurr 7-da) average of amph: maart , em stucd du:ing nica;tarmg period under "A/umnum. ")

m E: er */5 m:r ' ym " V M c.a h p .:n. der unJer "Ovantuy" and "Guality" as specified in pernnt.

7. Unda "'% Q"t;mt udci :cf :,ugde measd uents during momtormg period that exceed maximum (and/or riaanum or %) me a : ppogna c) perndt mjuirement for each parameter. If none, enter "0".

R 1.o u ' f rg:n n .f ' 9 i i c;h m " 'u :;4 i/cc carmert" (actual frequency of sarnpling and analysis used h r e nn r:aca m; pmo i) mi .n ' S , ;u iMjmmnt" specified in pennit (e g., Enter " Cont " for continuous umn "/ ~ for da pm , ak. "! N" f<.r et : day per month, "hW' for one day per quarter, etc ) 9 E m c r ' i, e 4 Q , * ; 6 a s ' mpi huwerment" (actual sample type used during monitoring period) and as " a /:cp;r m u " N g , f u r "Q ? " fcr indi?,'ijual sampic, "N/K'" for 24-hour composite. "N'A" for cnam oaus incrutann. .tc ) l0, W He s abt (.ns ( f pen at rmi:cmcris .uc repcried, attack a brief explanation to describe cause and corrective acticns taken, and u.lm ace (.ah i enon by date. I 1. If "va diNhnrgc au n during na ,aturing p; nod. cr.ter "No Discharge" across form in place of data entry.

12. L: vier "Name'inie v; lL m ufai l \ccu:n e Of:cci" uilh "Mgnature of Prmcipal Executn e ODicer of Authori:ed Ac ::t,* %le;'hme M 4cr." ra d "D ne" at bottom uf fann.

~ i

13. M .d ugned Repc:t to Dincet s) by date(s) specahed in pctmit, Retain copy for your records. 4 i

!4 More dewded mstrui has fer um of this Dacharge Afomtoring Report (DAIR) form may be obtained from Officc(s) ( specified in penmt Legal Notice : THs wpot :; requirtJ by a d3 U.S C.1318; 40 C.F.R.125.27). Failure to report or fadure to report truthfully can i re dt in t ml put :s!nes xt a t x ceeJ $l0,000 per day of violation; or in criminal penalties not to eweed $25,000 per day of siolatwo, or by in'posor.m :.t for not raore than one ye. r, or by both. EPA Fonn 331th! (Rev. 0 695) ! 1 i PERMITTEE NAhE/ ADORE;S(Jere.&FerduyNamvlerenes(Wt Nf,TIONAL POLLUTANT DISCHARGE EUMIB8 ANON SYSTas (NPDES / Form Approved. "A " DISCHARGE MONITORING REPORT (OMRf OMB No 2040-0004 4Ei"s? F5LLSY ?OJ 3 SMTIDN n-7 9 f r 7-191 21.1 TURBINE 0 ADORE:s a , 3. mt *997u!' 't* * (sg3P 05) ilLOG ^PF*NN8 ms ATIN; O A if I D 0:4 5 D 0 9 F PERMIT NUMBER orscHARoE NUMBER 7 ,, p74g{ j 33f?PIsGF07i e i 15 ? 7 MONITORING PERIOD 3 '{ FAcarTV 3,gy7p

7 g n g c; 7 p34qq 373,73y LOCATION N3 0 [ 5 C H @ R '; ! l FROM i3 1i: ! TO e, it .s .f Ct' l #CO

r. *TN* Q%9[] 39 o ') 3 A Y (20k211 (22-231 v24-25) 126-279 (28-299 (30'311 NON W*'* WN I***-

I3 Card Onlyf OUANTITY OR LOADING I4 Cad On/r# QUANTITY OR CONCENTRATOON NO. FRE M N F SAMPLE PARAMETER 146-531 154-619 130-45) (46-639 (54-691 or (32-37J EX ANAtyS,5 TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM 8."CS # 8 27 (64-68; (WCW SAMPLE +- e * - * $ 3 .; USet7 t e n t; t (

2) //

MEASUREMENT b.ff h, f ( O /7 had, 174I' i 3 9 PERMIT en+gg .. ,r+- m. +, , y_v,. er *

q' 7 -y"

"

g+* g3. nJ qggy m3

' e F L !! " 4 7 ; 7 w =, 7 g Lg: REQUIREMENT g . SII D 3 'I l 51L197, MT4L SAMPLE t u. e

9 ggp) ,

( 19) /~ 3JDoTin[D MEASUREMENT 9/ nA. s- 0 / s LT 335 33 1 ' - PERMIT e c g & s a- $ emp . ge$ " 3 ,' IDS - . ggra ;g g . 2 P P L 1 " $t ? ;ns ;5 y 4 tg: REQUIREMENT 43 A77 n A [I,C M T u ; / r, JfL 3%' ;,13 4 3 r SAMPLE we00+ tectet , (qq / 23~3t $1;55 7(73.gq;y 337 MEASUREMENT f,/ (( f,% C

gggg ;g hf 1 2 PERMIT P c e t fe t t0*0ec f 3 5 *. 13 23 30

7PLGJNP ';RT33 71 L O . REQUIREMENT $333 g ggg p,g 7 t y yg g g,g. 44g g

'Lah, IN C34DUI? DF SAMPLE 037Ct3 WC#04 M0op ( 03) ) P; W f3*';T*Ea! PL%N: MEASUREMENT Q,Og/ (),(p/ h f [ G3?90 1 1 PERMIT '909" 9P"PRT O C 9 *cci 3090$3 TJ C C 's @ C7e . E m f [cd I .T l >F/Lf8; at ", " S s 74 LG: REQUtREMENT qa yyc ngity gy ;p ces SAMPLE MEASUREMENT PERMIT . REQUIREMENT . SAMPLE MEASUREMENT , PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER a cERnFY UNDER PENALTY 07 LAW THAT I HAVE PMSONALLY EXAMWED AND TELEPHONE DATE - AM FAM:UAR WTH THE INFORMATION SUBMITTED HERElas; AND SASED ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSISLE FOR , , s David OrndM [ 08TAININo THE INFORMATION. I SELIEVE THE SUBMITTED INFORMATION IS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE s f, f//[// . _ _'y ,f 9 e sioNmeANT PENAtnES FOR SuSmTnNo *ALSE iNrORMATiON. iNetuoiNo - , ff o ** , z.1, 96 12 2U ar THE POSSISsUTY OF FINE AND IMPRISONMENT. SEE IS U.S.C. 91001 AND 33 ' ," M NUMBER 3 6113 t "' ' ,i e t ** v u.S.c. s 1318. essenses eneser swee sesame mer asawn smes as, se stom SIGNATURE OF PRWICFAL EXECUTWE TYPED OR PRINTED sae er masses = _ eraerween e menom and s years.s OFFICER OR AUTHORIZED AGENT CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af attechments heraf e a EkForm 3320-1 108-951 Previous edet:Ons may be used. fREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF ,. / 10 ,t s . ,, au , 3. s, L i Paperwork Reduction Act Notice _ i i i i , i 'Pubhc repartmg burden for this wilection of infornution is e<tinwicd to vary fmm a rang of 10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months as an ' ! aerage per rerpec for sone minor facilities, to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months as an aserage per rnpune for some uwjnr faihties, I with a weighted average for nujor and minor facihties of d huuss per re@onse, irutudmg urm for mirwmg , j mstnations, searching eusting data sources, gathenng and nuintaining the data needeJ, an.1 mmpt.: ting and l rcviewin;c the collrcuon of infonnation. Send comments regarding the burden etimate or any other epcet of j tha colle<. tion of infornution, includmg suggestions for reducing this burden, to Chwf, Inknmaion Policy Brarwh, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Wuhington, DC 20460; ard to the . I ' Office of Information and Regulatory Alfairs, Office of Management and Budget, Washington, DC 20503. I L _ . . _ _ _ . _ _ . _ _ _ . _ . - _ _ . _ _ . . _ _ . _ _ _ _ __ _ _ __. . _ . . . ..___j General Instructions . I 1, if form has been partially completed by preprinting, disregard instructions diroded at entry of that information already preprinted.

2. Enter " Permittee Name/Alaihng Address (and facility name/ location, if different)." " Permit Nmnber," and

Di.scharge Number" where indicated. ( A separate form is required for cach discharge.)

3, Enter dates beginning and ending "A/onitoring Period" covered by form where indicated.

4. Eriter each " Parameter" as specified in monitoring requirements of permit.

5. Erner "Nample A/cowrement" data for each parameter under "Guannt>" and "Uvality in umts specifi:d in p:rmit.

".lecrage" is normally arithmetic average fgcometric average for bacterial parar..ders) of all sampie acasucments for each parameter obtained during "Alonitoring Period", "Alanmum" and "Alaumum" are nern ally nueme high and low measurements obtained during "3/omforing Permd" (Note ta nemicipals with secor,&:v treatmad seqmrement: Enter 30-day average of sample measurements under "Accray." and enter mnmmm 74 average of sampic measurements obtained during monitonng period under "Afaumum "j fn Enter " Perm;t Requirement" for each parameter un&r "Guantity" and "Quahty" as sgcified in pcmut.

7. UnJer "No E1" enter number of s:miple measurments during monitoring penod that exceed n awum (arat'or ruinimum or 7 day average as appropriate) pennit requirement for ca h parameter. If none, enter "O.

8. Enter " Frequency of Analysis" both as " Sample Alcavurment" (actual frequency of :ampling and elysis used during monitoring period) and as " Permit Requirement" specified in penn:1. (e g . Enter 'Tet." fr continuaus monitoring. "I 7" for one day per week "100" for one day per month. "/10" for one day per cpruter, d : )

9. Enter "Nample Tipc" both as "Nample 3/casurement" (actual sample type twed dunng monimang ruiod) and a

" Permit Requercment," (e g., Enter "Grah" for individual sample, "NIN ' for 2440er emnpost. " , Ll" for continuous nmnitoring, etc.) 10.' Where siolations of penuit requirements are reported, attach a brief explanation ta dscnbe emise ..d correcti,e actions taken, and reference cach violation by date. I1. If"no discharge" occurs during monitoring penod, enter "No Discharge" across form in place of data c: try

12. Enter "Namer Title of Principal Executive Ol/icer" with " Signature of Prmcipal Dccany Wwer c '.1:aborad Agent " "Telephnne Number " and "Date" at bottom of form.

13. Mail signed Report to Office (s) by date(s) specified in pennit. Retam copy for your records

14. More detailed instructions for use of this Dsscharge Alonetoring Rcport (DA/RJ form may be obtained from Of fice(s) gecified in permit.

Legal Notice lhh, repnt is re(;uired by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or faih:re to report t;uthhdly can realt in civil penahics not to exceed $10,000 per day of siolation; or in enmin;d penalties not to cuecd $25.000 per day of violation, or by imprisonment for not rnore than one year, or by both. EPA Form 3320-1 (Rev. 08-95) N,* , PERamTTEE NAGE/ADOMIS(RmMrFasesf# ems 1 cenes(D@en# NATeoseAL POLLUTmf DeSCHAngg nenemaTKm SYSTEM IMADES/ Feem Apswoved. NAndE OW 13o. 20404XKM A?? 7 CH 1 % L L 21 ' N M M $N?Y3A 12- !

l'!-!" 's U fi n4FM'~C p yy ADDREZS p ,3, ***"* e -

m1 ( 3 g g n! O 51 12F45 PERMIMMBER ~ DOCHARGE NUMem 3.Tn; r m o nn.cooar r ; rr i' 1. 1 9:77 MTM PEIUOD MJOG SMTPotGPSR7 ct P % y p a; y4LL;y . pd kf K R 'i T 3 I I F YEAR MO DAY YEAR MO DAY I NMM FROM TO ~ 3 3t ni a r. ;Y 14 w.NOTEyn

M3,7-r O ng g . &g ' e g 3%

e++n, nsy*n n r~ v s , a s- 120>211 (22-23) (24-251 126-27) I20-291 13t>391 form. l PARAMETER (3 caret on&s QUANTITY OR LOADING I4 card on&s OUANTITY OR CONCENTRATION NO. mEcutNcY SAMPLE

146-52 (54-691 130-461 446-6M (64-691 OF (32-371 EX matygs TYPE t AVERAGE MAXIMUM UNITS MINfMUM AVERAGE MAXIMUM UNITS ss.ess ts4-ass tas-7m !

SAMPLE g,.933, ,3e339 .$i. w A. , f, ,, so . f > y

f. p

$ 1 "'"' ( 1,I g MEASUREMENT -a

v g -( / l q

-r or - s e. yp7y. REO IREMENT . . -, >e ci m Twyr Wet 7 11 u*vrMnv < - - . 'u W mag -m ., 4

23 LID 3, ?1f3L SAMPLE gep3 g3,37 .),,g, p g .,6 pq f- g ' @g i 3 3p; j g g MEASUREMENT y --

v,o,j -g 7; /, a g ( ) y gy l 7;y3g 1 3 3 PERMIT ' enu h ertge t 43 (c M tep } .0 ($_

Md/ 'Oh M 5pe,,en -g,:q y3rm REQUIREMENT m3 m e p. p.3 qvEr, ,ef, m .a ,

< [' n' y' ' IR '31Di]IT 3a SAMPLE PPi f*f t { a l} 3 eses 0 cesece Mtscoe g / 7 ' ~ ' N '? U 77 Ear??4T P L 's C I MEASUREMENT v, UD I Jt50 d"w / A r ^I8 O. i ) ? PERMIT ' 33050 ,er,n,e, L c e ;- y , e se r REQUIREMENT g gy . ,, 3p-pepggp p,yy estpg ceMp _ $3Mcc[ es? - kP&Ly 313 % , mn ,f; ,, n j SAMPLE 99et+ 3pgee $ p s e e. O . aM. u.W n ,qt3gtgp ~F p "- i s .--" MEASUREMENT W // M f f a ~ s e c g_ ( 19) g 7_36 y 5/ i l ' 3 T Nf 3. L . PERMIT upp ne - ghpg py y

9057 1 i

3 3 ppg ; gg py y gy y g3-v e r et - y* - o , q .- y yy; REQUIREMENT , . , . , , , y, , , , , ,.. f gn g i I 3L 1, PPCIL g c6??M W est t000th 040MC { 13) l / 2 0 5 ', ' PERMIT . nge- ,e m M t : MMR 1 [ 3 ytt MO% (g !!M*M C 1 / W KF/ PJ B - p r~ a r w y -n,e~ fay ry r REQUIREMENT p_ ,, ,, , , , , , ,,, 3 ; /g. Y ~ 33D, 7*9334MCE303 SAMPLE 339 39 geny gg gg; (iq CW /' 3 -) pgEg , 3 6 - -.., MEASUREMENT pf I,(/- y b 38 g /s , ! I 17142 ) PERMIT y p p e. - *M84 e 200 ***206 1 O REQUIREMENT 25 " 5A ' ' WICE/ :0MPQ - e c t, q t- e ? 733cT y*ta. ,, g 3 g,gg .pg g g ,, g pq SAMPLE i a MEASUREMENT PERMIT REQUIREMENT MAME/ TITLE PIWNCNeAL EXECUTIVE OFFICER i CERnFY UNDER PENALTY OF tmf MAT e HAVE PERSOIGALLY ENAMesED AND . TELEPHONE DATE AM FAMOUAR WITH THE INFOsmeATIOce SugemTTED HEREWe; AmeD BASED Oss =. l' MY NeOUIRY OF THOSE neDMOUALS testeEDIATELY RESPOef98tE FOR i l Lavid Orndorf OSTAmmG THE WFOmeADOIE,8 SEUEVE THE SUgemTTED mFORMATION IS O Ch em.stry Mannger TRUE. ACCURATE MD COMPLETE. I Ate AWARE THAT THERE ARE4 SGNWCANT PENALDES FOR SUBtMTTNeG FALSE WsFORMATbON. WCLUDme ' '- /[/ /b _ ff' / fL(/ e THE POSSIBIUTY OF FNeE AseD mePRISOefespeT. SEE 1e U.S.C. 91001 AseD 33 # 41~' yN b D ~1 *1*3 9D 1.>- a t0 U.S.C n 13te. emnasene asioner enese emeusse mer e m. sue mise ese se s70,ese SIGNATUIE OF M'AL EXECUHWE ggg TYPED OR PRNtTED aae er neure'ame ' er aorwe== e -w.su nw a ysams OFFICER OR AUTHORIZED AGENT CODE NUteER YEAR MO DAY { COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Aeference at stischments here/ A Form 3320-1 (08-9151 Previous editions rney be used. tREPLACES EPA FORM T-40 VnGCN MAY NOT BE USED.) PAGE OF 00337/?61003-0834 1 - x. . - _ _ _ - - A ~-_ _ n __ I 1 ' 7 ..- . . - . . . . - _ . - - -. , . - -. .~ - - ..- ., I Paperwork. Reduction.Act Notice .. ) .PuMie reprming burden for thb. Mh tion of infornatima is estimand to vary from a range cf 10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months us an I as enge per rep >nse for wme nur.or facihia , la 110 houq as an a, crape per re s punw for sup major facihties, , oth a u cy.ited r.tige ur af r and nuuor frihhes of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per respons includmg time for reviewing ! marustm < mhE;oimqJxa4 .m c gabmy and maintaining the data netded, and complaing and I a viewi ; th collcumn el iamcratian. Send concuents acpdmg the burden minute or any other aspect of th4 collution of miarnun a, ircluding g sdon, for rcJucing this burden, to Chief, Infunnation Policy , bach, PM 221, U.S. Eia iman.cnud Protation Agency 401 M Strect, SW Washington, DC 2040; ami to the O!! ice of Inforcation and Recuhuory Affairs. Office of Management and Budget, Washington, DC 20503. l ._ _ _. l General Instructions ' l L. If fann has tun partially completed by preprintmg, disregard instructions directed at eniry of that information n! ready preponted. ]

2. Fater "Pernutice Nained/odmg Address (and facility namc/ location, if different)," " Permit Number," and l

'"Th w harge Numbr* w here indicated ( A separate form is required for each discharge )

3. Enter dates beginmng and codmg "Af<nutoring Permd"casered by form where indicated l l

4. Enter' cAh "Parana Ic4 " af, specified m munitoring requirements of permit.

5. Fnter "Namph Afrawcmcnt" tia for exh ;urameter under "puannty" and "guality" in units specified in permit

't h m " is nnanal!) arnhment asenme (puncaic avemre for bacterial parameters) of all sample measurements P r ca;h p:n met:r oth ned darnT " A!.m:/wirg Permd", "A/aumum" and "Almimum" are normally extreme high

md icm n: 3 . < :w;t h, ubL u"cd darm;, "A /:'mte rm , l'ermd " (Note to municipals mth recondary treatment ru;'ntcmear Euwr 316y t.a ct y,' cf umi'k measurements under " Average," and enter madmum 7-day average '

Of rvtinfl e QWaSuremCi S Ghan cJ Gang men.tonng period mider "Manmam ") o Emcr !t " at ite imo ea nz" for <. ach p.aamc er under "(Anmtity" and "puainy" as speciGed in permit.

7. Under "Na ':t" enter .unM ef unpk masunucms dunng ruonitoring penod that exceed maximum (and/or nunimum or '-day an as i ppropriate) pennit sequ;rement for cach parameter. If nc,ne, enter "0"

? 8 Enu "/hp ra of. , a" tah as " n;>/c A / awment" (actual ficquency or samphng and analysis used dm:h m n er.:taion p o 1) ;ud n ">'n% t !?cquecm. nt" speciDed in pernut. (e g , Enter " Cont," for continuous man rahm "! '* iur > ; Ly re w A, IGo" for one day per momh. "130" for one day per quarter, etc ) 1 Em;r " M;4e D;r" b th a ".:mp! !!cawrewat" (actual sampic type used during monitoring period) and as " Pct sa !!ep lum (* _ g , Enter */?, # far mdniJual sample, "WUC" for 24-hour composue, "N'A" for cecdnuam momtunna cm ) 11 h te Uclatim t f smit reqmruncets are reported, a: tach a brief explanation to descnbc cause and conective actions tukea, aad rd ?'ence cach uebtion b) date. i1. If"na dm.hargc" oco rs c:uring morntoring period, enter "No Dr3 charge" across form in place of data entry. 12 Ew r "W ' ~ Tale ni rnnc:Ju! Denane (M]icer" unh " Signature nf Prinnpal Executive OJJicer of Authori:ed .4ge?.t," "Telephune Num!>er,* and "Date" at bottom of form 11 hhul sq.ned Reput to OfficeB) by dale (n speciGed in pennit. Retain copy for y our records.

14. Mo : detaikd instrouiens far toc of this Dmharge Afomtoring Report (DMR) form may be obtained from OfDce(s) speafied in permit.

Legal Notice This n pm is required by la (3 3 lLS.C.1118; 40 C.F.R.125.27). Failure to report or fadure to report truthfully can nau;t ia cml yeattics not a ( xce-J $10,t00 per day of violation; or m criminal pentdtics not to eucal $25,000 per day of viol 2 hon. or by impnwrunut for not more than one year, or by both. EPA Furm 3310-1 (Res. 0+M) PERMITTEE NAME/ ADDRESS (hweFererrhee'LorensegfD@ewi NATIONAL POLLUTANT Or3 CHARGE EUMMAftOel SYSTEM / Form Approved. NAME gggy3p y y, ( ( g y pgggp >;747733 NC W NN NT f t ?,ts 2n 3FH H tp . KE ,ggg m ADDRE23 P. 3. A3Y 4 MT N; :) A V I D 3RMD0"? """'"R'C PERMIT NUMBER t a cesCHmRGE $! UMBER ($GUR SS) A"h'I'3 0ma p ,,.p7g4{ .3[PP150PDPP 't 15377

E J O f2 FACIUTY <reyy7 ggLLEy t; 3 g g p 3pg7[3g MTMM M toCAmN FROM ea 11 ;i n TO 9 tt it ti CM '50 013CyAROC h ???

htfn: 3xVT3 3a M D 3 W 12&211 (22-231 124 251 120-27s (20-2s> tanssi NOTE: ReedInewmenene W D _ 4 % tonn. PARAMETER (3 cent on&J QUANTITY OR LOADMG I4 Csed On&# QUANTITY OR CONCENTRATM NO. FREOutNcY SAMPLE - 146-531 ISa-67) 130-45) (46-539 164-611 OF ' 132-371 EX ANAty,s TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS aE2. ass (s4 se/ res 7ap

SAMPLE $^ctee f.m s c s ?

as MEASUREMENT

e ^ M *,

( 72) -} 0 a mi ! ) ? PERMIT . Mane Steest r tea r, , ry scetep g,3 w icgj' ;;tA3 'P*Larve '; W ) $ 's V a. T l i REQUIREMENT ge33 -97373g, : p g g bg g g e9 4;gy s

17LTD3, 13rAL SAMPLE MEASUREMENT eM ut *"Ota t-n e c c e { 13}

3Jse1: 0gp 3 "t $, 3 0 1 ") ' PERMIT CMMe *cetSy

MN N3? 4W 33' 1 D ') .

NICF/ ;ttu vertgc,p ;33 t y s tg. REQUIREMENT 333; 33 e, y r; p gy my gnft g g7 4 l i t, a(O qart3E SAMPLE M7909 000S7? 0 0 3 e # ': ( 11) ?? ON " If T R 4",RLV 3 E p, MEASUREMENT 33 y;g ' PERMIT Oenen - eas } 3 *

0 c e r, icM S** 15 't Q .

1100/ ; R A U- , c' 7 7 L u v v ? ;i)qi V A T.:1 REQUIREMENT c a t 's < M ~ k y r; DATLO:MY M/ L M bit F rLgg 19 7)vg][? 04 SAMPLE ( 93) 770000 *"@> **3#70 !dt1 TPE8?a,gtf; pg;s- 6 MEASUREMENT hg jf) 4 ,

7. 7 3 r, P ! ) D PERMIT 90PO"*- _R 8' M P f actote 7 9 0* . ^900** ect 'WICE/ 25"LN cFL1?NT .; D S S V E Lg- REQUIREMENT e g y~ 'OMTLY t ;[ gp #003 MOKfh !

SAMPLE MEASUREMENT PERMIT " REQUIREMENT y SAMPLE MEASUREMENT PERMIT _ REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT h NAME/ TITLE PRWCFAL EXECUTIVE OFFICER CERTIFY UNDER PENALTY OF LAW THAT 4 HAVE PERSONALLY EXAMmED AND TELEPHONE DATE AM FAMiuAR WITH THE INFORMATION SUOMITTED HEREtN: AND BASED ON r. MY INQUIRY OF THOSE INOlvtDUAIS iMMEDIATELY RESPON9sett FOR - Dayid Crndor[ C=enistry Manager 06TAINING THE INFORMATION, 8 SEUEVE THE SusMITTED INFORMATION I$ TRUE, ACCURATE AND COesPLETE. siONincANT PENAtTifs FOR suomiTriNa FAtsE NFORMAr>ON. isectuosie" I Aes AWARE THAT THERE ARE r 'h hekQ, .,. ' / [J / / 8 41 393-5113 96 ' THE POSSSIUTY OF FtteE AND IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 - ' O~ u.s.c. s 1 sis. masene asunr snese sename awr menause anos se m #70,000 - 80008ATUllE OF PMA'L' EXECUffWE TYPED OR PRWTED w er _. ' .- er ansween s =same w J yearms OFFICER Oft AUTHOflIZE0 AGENT m_ _ n_ c_ NUtWER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# sttschments herof 6 b/3 Can f v"' % Form 3320-1 106-951 Previous ediuons may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) eean .4i, . * .,3 L uw .~, .~ , ,..x>, PAGE i OF u c __. . _ . . _ _ ._ _ _ _ .._ _ _ _ - _ . . __ l Paperwork Reduction Act Notice ! I I i Public reporting burden for this collection of information is e.tinacd to vary from a range of 10 boam n an ' average pet response for some minor facilities, to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months as an :ncrage tw a puse f..r sune :rajm f cihties , j with a weighted average for rnajor and minor facilitics of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per respone, including tinr for reviaing ' l mttrmtmns, scarching existing data sourets, gathering ar,d nuintaming the data needed, md wn.pktan; and j reviewing the collection of infornution. Send conunents regardmg the burdta conman: or ey od cr a pt of ; j -this colicction of information, including suggestions for reducing this burden, to Chief, Intornuten Policy l Hranch. PM-223, U.S. Environment:d Protection Agency,401 M Street, SW Wadangten, DC 20460; ar.d to the Office of Information and Regulatory Affairs Oflice of Management and Budpt, Washington, DC 20503. 3 s _ - _ . _ . . . . . . . - . _ _ . . -.._.___..__..__.---.__...-._-.._d General Instructions ' t. If form has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted.

2. Enter

Permittee Name A/ading Address (and facility. name/ location, if different)," " Permit Number," and

" Discharge Number" where indicated. ( A separate form is required for each discbarge.)

3. Enter dates leginning and ending "Alonitoring Period" covered by form where indicated

4. Enter each " Parameter" as specified in monitoring requirements of permit

5. ErIter " Sample A/cavurement" data for each parameter under " Quantity" and "pualay" in units specified m pennit.

" twrace" is nonnally arithmetic average (geometric average for bacterial parameters) of all mple meamrements for each parameter obtained during "A/omtoring Period". 'Alaumam" and "Almmum" are nonmdly e :tteme high and low measurements obtained during "Alomtorrog nriod." (Note to n.unicipaN unh secondert treatment aqmrement: Enter 30-day average of sampic measurements under %erage." and enter nuumum 7-Jay avere,e of sampic measurements obtained during monnonng period under "A/awnum ")

6. Enter "Perrmt Requirement" for each parameter under "puant ty" and "punhty" as spcified in penmt

7. Under "No Er" enter number of sample measunnents during monitoring period that acced nmi>r.um (and/or minimum or 7-day average as appropnate) penmt requirement for each parameter if nonc, ener *0"_

S. Fater ' Frequency of Analyus" both as " Sample A/easurment" (acurd frequency of sampling and ulysis used dming monitoring period) and as " Permit Requirement" specified in pernut. (e g , Etaer "I'cmt," Ic wntinoc us monitoring. * //7" for one day per weck. "/dO" for one day per month "/S0" for one day per quarter. cm )

9. Enter " Sample 7)pe" both as " Sample A/easuremeni" (actual sample type used dming monitonng jciad) and : .

" Permit Requirement," (e.g., Entr.r " Grab" for indihdual sample, ' '/HC" for 2 4-hour compose "" T for , cmtinuous monitoring, etc.)

10. Where siolations of permit sequirements are reported, attach a brief explanation to dsribe cause ;u d correctwe l actions taken, and reference cach violation by date. )

11. If"no discharge" occurs during monitoring period, enter "No Disc harge" acass form in place of data e ny. I

12. Enter "Namemtle of Principal Execunvc Oficer" with " Signature of Prmcipal benane Ol)he. w luthormJ l Agent," " Telephone Number," and "Date* at bottom of fonn. j

13. Mail signed Report to Office (s) by date(s) specified in penuit. Retam copy for your records

14. More detailed instructions for use of this Discharge Afonitormg Report (DA/RJ fonn may be obtained bom Ollicc(s) j specified in permit.

1 Legal Notice 'IE report is requiied by law (33 U.S.C.1318; 40 C.F.R.125.27). Faulure to report or failure to report truthfully un result in civil penalties not to exceed $10,000 per day of violation; or in criminal penaltics not to en eed 525.0C0 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 33204 (Res. 08-95) PERMITTEE NAW./AD0 FESS (Je Fererr A'einsilecomae(Didbrent) NATIONAL POLLUTANT csSCHARGE EUMINATION SYSTEM (APDES) Form Approved. NAME DtSCHARGE MONITORING REPORT (DMR1 OMQPjo 2040-0004 ie*U>c '( A L L

7 074*L 3p;**[?- (2-7 ' If 7-78) 33Iy 2 3 91 rj P y4 ADORES 3 9 ,3 , pI ] ( ;il F 15) 1234S FERMIT NUMBER DISCHARGE NUMSER p _

1T*"; 7g7[p 3 7 e fy () y V H I

P [ b ", P 7 d! t 15'7? MONITORING PERIOD "IJ3?

FACILITY "i?Il (1LLm

PO4E7 ? ? A 7' I l c YEAR MO DAY YEAR I MO DAY LOCATION tr un ore.,ua y a g ~

FROM : 13 13 TO nrl t* ,a g ene ,ere. n, n, (2cLgff f)).23) f]4.g$f g]$.2/) (J8-f$f g3o.3rj NOTE. Reed Instructions before esmpleting this form. yy 3 .r (3 ce,d OnlyA QUANTITY OR LOADING (4 Cerd Oritys QUANTITY OR CONCENTRATION NO. N Q*JENCY SAMPLE PARAMETER 146-531 154-691 (30-451 f46-531 (54-611 or i (32-371 EX ANess TYPE ; AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ess, fg,_,,, fa ,7 SAMPLE 3 .. g S .s, 3 g e. 3 y3,py y' / MEASUREMENT [,3, [ ,[ (,S_[ ' 30 [M , 333gr - t PERMIT - 3 pee. 3 3 e e 9: 3 . g-; > , ;) ' wegge 9,g gycg/ aga

.

.1 q: yI - (. 3 - , , , . ,

REQUIREMENT 33 wnrm9 ' e * " t 's ~: v 79u < SAMPLE A U ' ' 7.e,-'* 5 c* 3* ,e g g MEASUREMENT ,33-e, p3 e 3 3 % c .~ / b <? M_' U.. ( 19) ~g g bi Iire? ann PERMIT n y, p m35' e u-3 , . 1, } ) , .cpaget 39 50 'WICM/ 20 d P -i -. c r > yr ~ y9,,, REQUIREMENT 3g,, m .3 ,, p. n , n-f. 37- .,3 3 , y SAMPLE *****' ( ~ 3) M COC' O // m ., "***C Iy . ') i10 ! I , qn 'LJ". "421 T il! A T .t " N ! Pi.tA' MEASUREMENT O, M 7 E. O ' 607 b /7 # M4 . t 1 ,--c- 9 3 n PERMIT 7,, q q 3 nemy, ngn; nogg ' egegg e cee ggLy ;ggsat l s hyrergY 3,-- v ; r_ i ; REQUIREMENT y3 7y ngyy ,, ,_ s - - e n. n .'. d L G ' I f " , Il T 1. . SAMPLE -u+-- taa~$ - e++ . r 1^ q / MEASUREMENT O# #

d hM

' ' 9 I D '] A L n PERM!T gg% ngen + acug p p,)gy p ;P0 H T 3 ,' 3 9 [.. h . ,,. ,J .,;.,; 3 REQUIREMENT +e7 kTCE/ ':F1R ,s3g y, , , - - y- ,y - -. f g ,, , , , p g SAMPLE ~ 3 g ,' ,. ) q ' ~ e r - , ;" MEASUREMENT y e-3, gee 33u cegoeg ac3;e3 { 13) g / 30 bb

qr- gL 1 PERMIT Y g o c. s i y 3 REQUIREMENT n0eate t t t3 5 t ?

r t , -T C # 2 0 7 7 '; O 3 CCt*CS- ' / '5!fCE/ iR A D

.,y[ ,3 ;3 U yir,t 3 ,, m un . ~ . , , . , ,, n 3 , ~9%r ,,a 5 a ~n3 - -3 )s y s~--~ u ) 1: 1 SAMPLE MEASUREMENT gne3e. e .e 3 3 y nny: [' ~ p' { 19) j / 86 GdY. 8# ' ,,7 m , 27: ,qy , 3 n PERMIT 33epes- e n egs e see c*ent 23 p:

g[C?/ O n, p . '

h u. 'I

, , , ,; ', - [,ec or 3 y t REQUIREMENT e9 ,, gy- n 3 77 y ,, .gp amqq SAMPLE MEASUREMENT ' PERMIT REQUIREMENT NAME/ TITLE PRWCIPAL EXECUTIVE OFFICER I CERTWY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE I AM FAMILtAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MY INQUtRY OF THOSE fNDtVIDUALS IMMEDIATELY RESPON96LE FOR b - - OSTAINING THE INFORMATION. I BELIEVE THE susMITTED INFORMATION 8S / DilVid OrndOT[ TRUE. ACCURATE AND COMPT.ETE. I AM AWARE THAT THERE ARE s SIGNtFICANT PENALTIES FCR SUBMITTING FALSE INFORMATION. INCLUDtNG r /' +>^'[* d{_k. . 412 NJ"3113 ( L. em ; e . i t -, n - THE POSSIStuTY OF FaNE AND IMPRISONMENT. SEE 1e U.S.C. 91001 ANO 33 %. '? 'o u.s C. s 13io. dFwiemme ensur anese asennes mer becaMe smes see se tro, coo SIOf6ATURE OF PfulfCML EXECUTIVE TYPED OR PRINTED amt er ===enien i . etaerween s maarne ow a remms OFFICER Oft AUTHOfMZED AGEffT g NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# etrachments herol fu* R; e 5PATneaY f lo. ., T ran s S A u l' ds w h e- e g T'e a slv < mT NT1 m a c (

c. .

Form 3320-1106-95) Previous editions rney be used. (REPL. ACES EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE OF . 00331/961303-3S34 1 l Paperwork Reduction Act Notice j l l Pubh: repmtiry burden tar this co!Lx tion of information is eatinuted to vary f rom a range.of 10 houn, as an f i e erg : pt r imponse for rome nn 2.g f,uilitiu, ta l10 hourg as an avenge gr response for mme major facilities, i { mth a wm;hkd c ewge for mqu< a cu_.or f acilities of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per itsponse, includmg time for reviewing l sratructhms, sm hn:g emhng d.da soure , gathaing nd maintaining the data needeJ, and completing and I tevwwuq the cohuivn of infcnoura. Send tununem tegarding the burden-estimate or any other aspect of l tho co!Ixtmn of infunmhon, inchiding sugumons for reducmg this burden, to Chief, Information Policy , Branch, PM-221, U.S EnvuonnenLd Protation Aguney,401 M Street, SW Washington, DC 20460; and to the {j l Of fite of Icfornution and Repubtory Af fairs 01tice of Management and Budget, Washington, DC 20503, I General Instructions

1. If form has twn partiaHy completed by preprinting, disregard instructions directed at entry of that infornution already preprinted.

2fEnter "Pernatee Name3/mhng Address (and facility runnc/ location, if difTerent)," " Permit Number " and "Dm home Number" w here indicated ( A separate funn is required for each discharge.)

3. Enter dates beginning and ending "Alomtormg Permd" covered by fonn u here indicated

4. Enter each "Paramctc/ as speaGed in moni'oring requirements of permit.

5. Emer "hplc Mcammenf data for exh parameter under "(Juantir and "(>uahty" in units specified in permit

", h cwe n nann aly ,anhmeic average (geomenic averape for bacterial parameters) of all sample measurements ter t ,ch paunutur ut twned daru,g "Mamtarum Perwd", *Alatunum" and "Afinimum" atc nonnally extreme high ui t low incamemut A.incJ during "Alarutorme Permd" (Note to municipals uith second.uy treatment requenam. Emer 10 day age of umpte m&menients under "Awrage," and enter maximum 7-day average cf sampic mecouremeub obtamej (knng monitoring penad under "Alawnum ") % En'er "l'ema I:cean men!" ter ; a h p; . anc!:r under "psantity" and "Guahty" as specified in permit.

7. Coder

Vo lx" tmer numMr of senple mutbanucnts dodng monitoring period that exceed maximum (and/or nunimum or 7-day , s t , c ut; gpmprim) penuit requirement for cach parameter. If none, enter "0".

3 F ra *iire pa cy cf . ' e y , " In h as

Ja,ple Meaumcat" (actmd fregaency uf sampling and ancdysis used d aing nicmtoruu: pcchd) and as " Perma knimrement" specified in pennit (e g , Enter " Cont," for continuous no utum;. "I ;" for n day p;r o ch "I 30" for one day per month, "F90" for one day per quarter, etc.) j 1 Ena "Nar;'ic '/)pe" bath . ' , rj+le Memurment" (actual shmple type used during monitoring period) and as "iVrnal Rep e cmer,t " g Erder "Gr# for indisidual sample, "N#C" far F hour composite, "N'A" for cenonuaus monitorin4 cte.)

10. W!ae Golatmns of ynnit : up:hemeMs are reported, attach a brief explanation to describe cause and correctwc xtions taktn and ruf en nce cxh violation by date.

1 L. If % dixharge" ocenr, dunng monitoring penod, enter "No Dacharge" across form in place of data entry.

12. Emcr 'Vame Tule v) Innapa! iaecutwe Olpccr" with " Signa:ure of Prmeipal Executive ODicer of Authori:ed Ap nt," *Te'ephorw Number l and " Dale' at bottom of farm.

13. Mail signed Report to CEice(s) by date(s) rpecified in pctmit. Retain copy for your records. I 1

!4. Mme detaled instruuias for ox of th:s Dnchage Afon toring Report (DMR) form may be obtained from Office (s) ! j specified in pcrmit. l l Legal Notice Thia ieport is reginred by hw (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can iedt in ciul peradties not 'o o ceed "310,000 g er day of violation; or in criminal penalties not to uceed $25,(XX) per day of deLuon, or by impisor ner.t for not note than one year, or by both. 1 l l i EPA Form 3320-1 (Rev. 0 MS) i %e = PEnamTHE NAME/ ADDRESS Neraryhaarem== e@@mw) NAnoNM PouuTANT DescHMGE a-noN sygTEM (APDfS) Form Approved. " DesCHARGE MONITOf4NG REPORT (DMRJ 9f*if' VALLEY P-34ej 3rA?ON (2-r si tr7-rst 111 dig 3EL GugU,0m,% y - "'9""t'< f9T

APPm e,OS-3 W ADofESS ? . 3. 311 4 (SU3d ') M ty[y- 0 AVID 3RKCORr PERMIT NUMBER De9 CHANGE NuMSM p . p7y7g M r P a U ',P 0 2 r va 15077 MoonTm Peuoo M333 FAN gqgyg4 74gggy p g g E 77 r,7 g y I 3 YEAR MO DAY YEAR MO DAY ~

toCA N FROM TO 13 1t :i 'e n i1 30 $2C 20 nISCH&scr 3*Pr: O a v I r, 3?v711? (Jo27/ (22-231 (24-25A (2s-27s (28-2s/ (30'3rj NOTE. Reed Instmeelene Wl h) tNo. 4 00 fem. , PARAMETER 13 cent W MANTITY OR LOADWG I4 cent W MANTITY OR CONCENTRAM NO. mEQUENCY SAMPLE 146-531 (54-611 (30-461 140-53 tS4-sti or (32-371 EX AssAoyers TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,sm f,,.,,; fagyo, SAMPLE ,4 $?n;+; $e0??) #3*330 ( 12) b / MEASUREMENT [oM 7e /.h- / hA b 6339n v } 9 PERMIT c19 9t arc 9?he#0 7 SCO 6,0 MMCD 9.O. JETNLT iRAS- l REQUtREMENT q ver rnv r gals; 7 4 L'? ; 2005 VTwfMU* M .S. Y T

U *r ' "ff '

r,' T'M! SAMPLE re

S * *: $ nt&O;? #t3C2) { 19) r k'hcD"hgg s[ / [-

. MEASUREMENT a M htw b 7 3 r; 3 0 t 1 3 PERMIT *00$t9 @$00*O-G S * *- **D?p0 ^ ' 33- 1;00 e 'JEEtLi ;EtB f ?cytnee '; 4 T C 1 7 & r,il . REQUIREMENT ecee gg st i p 'py ny 'My am fi f gye ,y9 -4 ea * :- SAMPLE 3 ? O *- 0 ^ M ? t *: S ( 19) f2 % M *7 "! S I . MEASUREMENT b,[ b$ hh / [ bh gjcqg 1 3 . PERMIT $0t?Oc 2 0 '*C L* 0 r tee 15 20 _

3) . . GMLY ;RAB REQUIREMENT s e e r, q r w e ; 9 ,. q , f r i, ; tong 'g hpc g g T L if : My { *,t 3 F *t A I MC/L !

q, w , 7, C)aD3[" 37 SAMPLE ( 13) ** W 2 *? N U ##' " g / 6,()D[ eqq~ rpngP,rup p {, k g - MEASUREMENT [,[)C/ { ,3n n [ $ q PERMIT RgpO"? . F L' '5 0 P T COtt?? W E" ,

1. DM -

60 JEULY STIMI grctav2e 74)39 7 4 L'i , REQUIREMENT y;g'gy- . n a T T,Y vt CG > C"O ! SAMPLE MEASUREMENT i PERMIT REQUIREMENT - . SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT - PERMIT _ REQUIREMENT - NAME/ TITLE PRINCFAL EXECUTIVE OFFICER I cERnFv UNDEn PENALTv oF LAW THAT e HAVE PmsossAuY EXAAANsED Afs0 - TELEPHONE -DATE-AM FAMsUAR vutTH THE BsFosumATtoss SugusTTED HEnEm AfsD BASED oss uv moumv or THosE usoiveouAts masEosAtav nEspossmoLE Fon - ' - c O n N- & n d o"- T^ "a mE neronuAno=, e emE mE sueuimo wronuAnow is > 8 f^ Chen &* cry Itanagn Ta"uf."AccunATEAno connetETE. I Am AwAnE MAT THEnE AnE / sammcA=T PE==nEs con sumamTTwo cAtsE unonuAnoN. metuossa) ' '/[' / f[ /_ p ~/ry[l'[jU 412 393-5113 '96 12 20 THE U.s c.PossesuTV op ensE s 131s. mannes wumrApso sweeonenn19aNAMMT. assa,sse mer eurAmm SEEesos18 aU.S.C. 9,1001 Afs0SIGIIATUIE as #ro.ase 35 OF NN/EMECUTWE TYPED OR PRWTED COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af erfschmerits herel aaer er murenum : er essween s samame est s year.J OFFtcER OR AUT namn AGENT $ NURSER YEAR MO DAY e* h i g P.- sa m we w er. m . uon. m.y6.u..o. < REPLACE. EPA rORM T.A. w Cn MAY NOT .E U.ED. n . ,n.a _ , ~. m, , AGE , OP e C __ _ _ _ _ _ _ _ . _ _ _ _ _ . _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ - . _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ ______ . _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ l Paperwork Reduction Act Notice - - l l .Pubbe repnti'ng burden for this collection of infornution is eatinuted to vary fmm a range of 10 bum u an averge per resp >nse for some minor facilines to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months ss an average pedesponse for wme rwr1 fditics, l seith a weightcd average for major and rninor facihties of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per respon% induding tiw for teviewmg j i ' m>trus tions, searching existing data murces, gathering and nuintaining the data needed, and compidmg and reviewing the collection of information. Send co:mnents regarding the burdemet.timate or any other avect of ! this collation of information, including suggestions for reducing this burden, to Chief, Information Policy i Bramh, PM-223, U.S. Environnwntal Protection Agency, 401 M Street, SW Washinson, DC 20460; and to the l Office of lofornution and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. < l _ _ _ _ . . _ _ . . _ _ . . _ . _ _ . _ _ _ _ - . . _ . _ _ . _ . . _ _ _ . . _ _ . . _ .._ _ . _ __ b ! . General Instructions 1 . L If . form has beca partw, apleted by preprinting, disregard instructions directed at entry of that mformatio1 already preprinted.

2. Eqter "Permntee Name A/ ailing Adderss (and facility name/ location, if different)." " Permit Nenber," and

" Discharge Number" where indicated (A separate form is required for each discharge.)

3. Enter dates beginning and ending "A/onnormg Period" covered by form w here indmated.

1. Enter each " Parameter" as specified in monitoring require nents of permit.

t Eqict "Sampic Alcaturement" data for each parameter unos "Ouantuy" and "puainy" ia nits specifi;J in perr;ut ".ieragc" is normally ariihmetic average (geometric aserage fa bacterial paranaters) al s.m1pic measurement R4 each parameter obtinned during "Mannoring PerhP; "A!arima,n" and "Almiam re norrmdh c .treme high and low measurements obtained during "A/om/cring Permd" (Note to munic, J uith scandary treatment icquirement: Enter 30-day average of sample rncasurements under "Averap ." and nter maximma 7-lay averge of sample measurements obumed during monitoring period under "Matimmn ") fc Emer " Permit Reqwement" for cach pararucter under " Quantity" and "Gaa/ny" as sp.afied in pennit.

7. Under "No Ft" enter number of sample measurmems during monitoring perioJ that excccl nwomum (and/or minimum or 7-day aserage as appmpriate) permit requirement for cach parameter. If none, emer "O"

8. Enter "Frequemy of Analysis" both as " Sample Alca3nement" (actu:d frequency cf .amplaq and wh ns ued during momtoring period) and as *Permd Requirement" specified in perm:t (e g . Enter 9 'ont." fm conunuous monitoring, "l7" for one day per week, "/U0" for one day ocr month. "I W for one day pcr quarter, co )

9. Emcr "Seple 7)pe" both as "Sompte A/casurement* (actual sample type m.ed dunng monitarir.g riot and as

" Perma Requirement,' (e g., Enter " Grab" for individual sample "N/A '" for ? t hour composit; " W " for continuous monitoring, etc )

10. Whcre violations of permit requirements are reported, attach a brief explanation to describc: cause sr d correcth e actions taken, and reference cach violation by date.

I1. If"no discharge" occurs dunng monitoring period. enter "No Discharge" across form in phee of data atn. I2. Emer "Name/ Title of Prmcipal Ibecutne Officer" uith " Signature of Principal Em unee c #cci t f.Nhorir d Agent,* " Telephone Number

and "Date" at bottom of form.

13. Mail signed Report to Officc(s) by date(s) specified in permit. Retain copy for your records

14. More detailed instructions for use of this Discharge Afondoring Report (DA/R) form may bc obtaincd f:om Officets) spccified in permit.

Legal Notice lhis reput is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failme to rcport or fai:ure to report truthfully c.n result in civil penuhics not to exceed $10,000 per day of violation; or m criminal penalties no: to excad $25,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95) PERMffTEE NAME/ADDRE25 W FadhW1.esmas p# =W seADOseAL PouUTAseT IN9 CHARGE sua"TICOs ersm Fosm C - d . NAME f # OW No. 20404004 f2-N i M A Y E .'l V5LLET ~ 93VP 3 T ft ? I 3 '? '* ***r'= " " 7- N !!*I? 2. "; S R V IC ; W A gg + gggg,gg ADORE 23..;, L 33( :) , (g p p 25) 12315 PERMIT NUMBER ENSCHARGE NuMhtR 1 f 8; . M11D 21eb3aT Fm PI9AL 4 3 III P ? I i 7 P R I P% 15077 MOBHTORNG PHUOO 9UOR 3 M % % " il Y $ l l *? I POWC2 3 EL Pf 3' YEAR MO DAY YEAR MO DAY , LOCA M pgog . > r, 31 n3 TO n( ,i ia pa :n n y e a 4 p r t. g% se, NOIE- **'I***'*- s-=n. n + 1 n ' 3 o a n , n r~ 120'21) 922-239 (24-251 (2&271 t23-299 (30"311 - - - - - - 13 cet ei&J OUANTITY OR LOADMG I4 osM my OUANTITY OR NTION NO. ' REQ

CY SAMPLE PARAMETER 146-52 154-619 (30-45) (4652 150-691 or (32-3n EX 3 tys,S TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS m2-am fs4-sef 16S 7cf A

'L79, [1 7 3 C ) 'J l ? 37 MEASUREMENT k)g h <W ( 91) 0 % 3 C te ': 600$C? CO$Mc ' i F!! f *M Af fg d r 9Livi GW 1 9 3 PERMIT 7, g p p pgppg7 g3pgg ,pgggy 39,934 g,, y xLY $r)

, e e y r. .. ,33c ;, , 3, REQUIREMENT , ,,, p,,,, , ,,, ,,

SAMPLE , MEASUREMENT PERMIT 4 REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT - REQUIREMENT NAME/ TITLE PRNGCNDAL EXECUTIVE OFFICER ctRnFY UNoeR P9eALTY OF LAW THAT t HAVE PERSOteAdY ERAamfeED AfdD TELEPHONE DATE AM FAMIUAR WTH THE BfFORMATION SUBMITTED HEREIN: Afs0 SASED Ost O ' MY tNQutRY OF THOSE WeDIViouALS IMMEIKATELY RESPOstSIBLE FOR j * (/, 08 "8 ". i seurve me sueMiTTso WFoRMam is David arndorf TRu"e. "'AccuRAT' A "'"no^"cOMFtaTE. i AM aware THAT TweRe ARs _ MIRCANT P9eALnES FOR SuBMITNI FALSE ##ORMAN. WCL@ WAG) y-. /U, h . - W intrY "M" nag"- Ch ', ' *12 393-0113 Tus POSSieruTY OF FWe Ano mare =SOwMe=T. See is u.s.c. e soci Ano sa - 96 12 20 S4GIGATURE OF MAL EMECUTWE AREA TYPED OR PRNGTED .U.S.c. s isie. m:man.ier emme as or ====== a.sueusse .: rassw s monom mer eienMs ans amesemi es, se sfo.eep orytcER oft AUTHORIZED AGE 9ff NUteER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference of strechmernes here/ ,9'

r NO / SC. k t'L (4 L Form 3320-1106-95) Previods editions may be used. IREPLACES EPA FORM T40 WIGCH MAY NOT BE USED.) - PAGE. OF 00375/961003--0634 1

.-_ - - ._. _ - - . _ a l Paperwork Reduction Act Notice - - - . --

Pahhc nprtmg bur &n for this u,Fecnon of infarrstmn is er,tinated ta vary femn a range of to hours as an n oye p r re pw.e for .t: n.2 mar fahth , ta i10 hours e an averne per reponse for some major facilities, l uth a wcighad n erage Nr mzim .md m uur tudm . af 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per respone, including time for reviewing m ant tia, ,un hing ed xting Lu murs e : cathenng and nuintaining the data needed, and completing and a vie.s mg the co!ketion.of mfoncution. Ssf emnmans regaiding the burJeu estimate or any other aspect of tha m!hction of mformation, induJmg 3ugphons for reducing this burden, to Chief, Infornudion Policy Bunch, PM 1!1, U.S. Eraironmenal Protectiun Anney,401 M Street, SW hhington, DC 20460; and to the O!! ice of information and I;eguLtary Af fain, Of fice of Management and Budget, Washington, DC 20503.

t. _ _. _ __ __

General Instructions

1. If fonn has twen partially completed by preprinting, disregard instructions directed at entry of dat information already preprinted.

2. Cater " Perm:tice Name Madmg ,ldJren (and fMility namellocation, if different)," " Permit Number," and "Dwharge hnber" where indicated (A separate form is required for each discharge.)

3. Enter dates t<ginmng and cudmg Ahmin, ring Period" covered by form where indicated

4. Enter each " Para":eter" as speedied in tuanitoring icquirements of permit.

' . . I nNr %r/c 3 f.mu a , m" d:ca for cash ptrammr under "(Juantity" and "Guality" in units specified in permit t h u " n normally anthmcoe nerage Geometric average for bacterial parameters) of all sample measurements f'r eM parameter (Oa ncd during %mlormg Pcrmd" "Maumum" and " Minimum" are normally extreme high ; aal low maurcmer; < btam d &ria); " t/rm:/orme l ermd i " (Note to municipah with secondary treatment I rev u e:uent Emer 3 )dn acrm; of sunpla measurements urder "Arrrage," and en.cr maximum 7-day average cf humple WCoulune;.l5 cbtam2d durms mOni!Oling pCIiud undCr " MUX: Mum.") h Euter "l'a m:t ih v.in : 1 rn" ta exh par:n:rier under "G:antity" and "Guality" as specified in permit. 1 Unja % 12" > mer 4 mber er unpic mcasmmems during monitoring penod that exceed maximum (an<Vor rmmnwa er ~ by werc t as wropriate) p nnit requirement for cath parameter. If none, enter "0". 1 Emer "Tn a m <f & :/rxn" ioih s " s , ple Ucaaurment" (actual frequency of sampling and analysis used d . tis <> memtarine pa i) and , "!'ont Regarrmen!" specilled in pernut. (e g , Enter " Cont " for continuous mow.uirc "! ^" for < ' , 4 p r M. "!GT for ene day per month, "u9T for onc day per quarter, etc ) 1 ) Enr % / ~/ig" Mb as hple Ucaurement" pctual sm;ph twe used dunng rnonitoring period) and as ' M nmt hpu cma.t " (e g , Enter "GraP far 6ndhidual sample, *N/K'" for 2 4-liour composite, "Nd" for i centinuaus momtonn? x) 1 1 la Wbut \ioblions of , mmt requoemcots are reported, attach a brief explanation to describe cause and corrective ' act: ens Mca, and rdmace cac h delanon by date. l

11. If "n 3 di d irge" ocenn during monitonng period, coter "No Discharge" across form in place of data entry. l 1? Unter %cDile <f I rwapal Encuhve Ojncer" uith " Signature ofPrmcipal Executwe Of]iccr ofif uthori:ed k nt " " Telephone Nmber," and "!) ate' at bottom of form.

13. Mil siecd Report to O!Tice(s) by date(s) spxified in pennit. Retain copy for your records. l I 4. Mme detailed instrucacas far tse u'this Discharge Momforing Re/> ort (DMR) form may be obtained from Office (s) specified in permit

!~ Legal Notice This ap rt in r~;uired by M (13 U S.C.1318; 40 C.F.R.12127). Failu-re to report or failure to report truthfully can redt ia t iul penthies not a _xeced $ 10.00) per day of violation; or in criminal penalties not to exceed $25,000 per day of viraluion, of by impnan a r.t for not more th;m one yar, or by both. EPA Form 3320-1 (Rcv. O M.8) l %e " h -. - .. -~ . - . . - . ~ . PERemTTEE NAndE/ ADORES 3(MeanteNaw' afr+pW NAnoNAL PORUTmT Ot9CHMet EUMBIAn000 SYSTEks IAN'DE31 Form Approved, pesCHARGE ReONITOfuMG REPORT ADAM / "" nog 3EAVER I A L L.T Y ~ O OW E 3 3?A.?I3M (2-ter (77-79# SLUDGI SPTTLING LMNo. m ADOREIS P. 3. 3)( 4 " 4" N 1E tM t' ($ UGH O$) H **[d* P ATrn: ouIo mooRr PERMIT NUMBER De9CHAReE NuuSER p ,, . p. 7 ( 9 d I P P U11; P O 9 ! P& 1507' ggg g MJOR FACIUTY gggygg pg((g; gg,p gpgpp3y I LOCATsON FROM 3a iL u TO :J a ti 52 . *t? 30 DISCMARGF l { tC* NOTE: Reest insenseleRe behNo casnpleting this form. AT*M: Dt7I3 3 ? ".* 3 9 F (2G211 (22-23s (24-26J (26-277 (28-29/ #3001j PARAhETER (3 N Ms QUANTITY M LOADMG I4 M W m M CONCENTRATIM NO. mEauENcY gggplE I46-539 154-6 t? 13046e im 96HI) oF (32471 EX AssmYses TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,ss.es, ,,y,, ,e r3 SAMPLE $$eue ocPop 49ece; ( [q , MEASUREMENT h . 7, /[ d b Qf 33400 1 ? O . PERMIT . e* pet $$eseo H $00 6,0 cco g eft . 9 gy ggggf 333-'

erL3re? ;>T33 T a t. g REQUIREMENT yce, . gy 4 yQ g g- p m pp 3]LEDS, T3 f A L SAMPLE 300te? 00S M S' espe" ( ig}

Co, g 333pgsag9 MEASUREMENT J 7,g 70, '( C 3g agg O')510 [ 3

" PERMIT **cA00 eeeeet i no ;stacae 3y 100- "d ICS / 2OMPD P > ?'t.G ? N P "; g l i : f 51. n REQUIREMENT pg3 y'4gg . g g gp gp og gp T L Ti , Ih 234D3I7 Op SAMPLE ( S 3} 032047 Oc5ced et0300 . j ! T3?" T P IA Trid 1 T ? L i ff - MEASUREMENT g, g)()i/ g,0 C f C- 2cy gg 5)*SD L ) ? PERMIT REP **P* 12*EDRT *CC**C*- , ****** 104880* ***- 'XICC/ P5TIMb '! ~r?L11E4? ';R759 "( A L!!! REQUIREMENT -gg gg; p, r ey 4 ., y 979 ggce- g yg -' SAMPLE MEASUREMENT PERMIT . '" ..* 6 REQUIREMENT i SAMPLE MEASUREMENT PERMIT _ REQUIREMENT > SAMPLE j MEASUREMENT PERMIT - , REQUIREMENT - SAMPLE , MEASUREMENT PERMIT ~ -- 1 REQUIREMENT ! I paaaarrTITLE PRNGCFAL EXECUTIVE OFFICER e cERnFY UNDER PENALTY OF UdM THAT I HAVE PERSONALLY EKAhelNED ANO Au FAmouaR wrTw Tree a:PoRanATross suommTTEo MEREiN: Asso santo oss TELEPHONE DATE-t uv meoueRY of TwosE asorviouALs naufosATELY REsPoNeoLE FoR , f ; Dayid Orndorf ceTanaNa TwE iNFonisAnoN, a sEutvf THE suesmTTED NerontsAnoes tt 1 g d 'A Wnistry Snna;pr TRut. ACCURATE AND COteFLETE. 1 Ane AnMARE THAT THERE ARES J 9GBsWCANT PEttALnts FoR SugemTTusG FALSE INFoRhtATioet. NeCLucune '[# , '/ / 'f { 'g KG THE POSSSIUTY OF Rest AfsD RAFRISOssesENT. SEE 18 U.SA i 1001 AfdO 33, seefe4TUIIE OF FM EllECENE 419 M b5113 % 17' 90 t TYPED OR PRNGTED u.scera isie. s.Raumans ans ' A wimmum r master sname ermeeween s menen amenens mer assasse mise ao se sso.co ame s , ears.s arrecER oR AUncoRIEED AGEIIT $'- 98URSER YEAR MO DAY COMMENTS

AND EXPLANATION OF ANY VIOLATIONS (Reference af atrechments herof o f~

De a Form 3320-1108-35) Previous editions may be used. tREPLACEs EPA FORRA T-40 WteCH RAAY NOT BE USED.) PAgE , OF [ - .,, a ,.12 f . . csata 3rv.a 3s ,a x y-,- -g v. . - - - . - - - - -.4-g -My-w. iw--- +.e +-erwaevw"ir- w--.>p-w w-4 M w d- 4y.,.&a & & T4w etm-- - - . >> + Paperwork Reduction Act Notice , . Public reporting burden for this collection cf infornation is estinated to my hum a range of 10 bour, as an avenge per reponse for some minor facihtw3 to !10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months as an average per reemw for anne wlcr L t!ite, { with a weighted average for nugor and imnor f acilitm of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months p"r recpmw, incluJmg tim for reviewing ' wtru tions, scarthing existing data sources gathermg and nuinuning the data ne sled, acJ cow.plerior and = reviewing the collection of mfornution. Send comments regardine the builn utinte w . r,y other upct of , this collection of information, including suggestions for reducing this burden, to Chizf, Infornution Pohey ; Branch, PM 223. U.S. Environmental Protection Agency. 401 M Street, SW Wo.hington, DC 20M0; ar.d to the j Office of Inforuution and Regulatory Af fairs, Otfice of Management and Budget, Washnwton DC 20$03, .__ j General Instructions 4 I..If form has been partially completed by preprinting, disregard instructions din:cted at entry of that information already preprinted.

2. ' Enter *Perminer Name Alaihng <fddren (and facility namc/ location, if ddferent)," " Permit Nu,nber

and "Ducharge Number" where indicated ( A separate form is required for cach discharge )

3. Enter dates beginning and ending "Alonitoring Period" coscred by form where indicated.

4. E1iler cach " Parameter" as specirted in monitoring requirements of permit.

f

5. Enter " Sample A/casurement" data for each parameter under "(hannry" and " Quality" in nmts specified in permit.

"decrage" is nonnally arithmetic ascrage (geometric ascrage for bactenal paramctero of a!! wmple measuiements for rach p:trameter obtained danng "Alonitoring Permd"; "Alawnum" and "Ahmmum" are nbanally esticmc high and low measurements obtained dunng "Alomtoring period." (Note to municipa!s with und.ir, treatmcot regnuement: Enter 30-day average of sample measurements under %ergy." and cuer nminmm 74i3 averge of sample measurements obtained during monitoring period under "Alaumm "j

6. Enter " Permit ilequirement" ior cach parameter under "Quantay" and "Quah:y" as syctfled in permi'

7. Under "No Et" enter number of sample measurments during monitoring penod that exceed maxunum (.md'or-minimum or 7diy aserage as appropriate) permit requirement for each parameter. If nane, enar *o".

R. Entu " Frequency of Analysis" both as " Sample A/easurment". (actual frequency of ampling and canl3 ris owd during motmoring period) and as " Permit Requirement" specificJ in perm 1. (e g . Enter Tout " im continnons monitoring "/7' for one day per week, "/dD" for one day per momh. "1. 90" for one day per grrter. c: 1)

9. Emer " Sample Dpe" both as " Sam;te A!easurement" (actnal samp!c tyg used during monitodng y riad) rmj m

" Permit Requirement " fe g., Enter " Grab" for indwidual sample "24Ht ' for nhour composiv " t. I fo r conimuous monitonng, etc.)

10. Where violaticas of permit requirements are reponed, anach a brief exphu'.ation to describe cause m d currecove actions taken, and reference cach violation by date.

I1. If"no discharge" occurs during monitoring period enter "No Discharge" across fonn in place of data c. tr3

12. Enter "NwneMule of Principal Executwe GJ]icer" w1th Signature of Prmcipal Eventwe Odder < ' .ttahorced ilgent," " Telephone Number," and "Date" at bottom of funn.

13. Mail signed Report to Office (s) by date(s) specified in permit Retain copy for your records

14. More detailed instructions for use of this Dacharge Afonimring Report (DA /RJ form may be ob':uned fiom Offices) specified in pennit.

Legal Notice lhis report is required by iaw (33 U.S.C.1318; 40 C.F.R.125.27) Failure to report or failure m reput truthfully ou result in civil penalties not to excexd $10,000 per day of violation; or in criminal penalties not to eneed $25,000 per day r.f violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 03-95) & s .* PERMITTEE N AME/ADORESS Fm Fereksy #===w feeen== effWarsed NATIONAL POL 1UTANT DeSCHARGE EUMINAMON SYSTEM (WDESJ Form Approved. NM DtSCHARGE MONITORING REPORT (DMR) .ey<q e -s1v. ru .. y '1 <w > r3(i,. 12-1 6s (17-199 s19.. . . . y. *g y .n r se cae

- t~z~. 1. . e OM.8.N..o.

" Approval 2040-0004 expires OS-31-E8 . ' ' * ' * ' a ADDREIS ,.,7 , qq s (3gpg ) rg } y j *; 5 PERMIT NUMBEa DISCHARGE NUMBEM A T r i; it?TP '1? < '1 0 e r F F I !i A L ' ;i ! P C 7 ; 9 3 " r :A 15s7' MONITORING PERdOD ' M i FAcaffY $i4V>3 Y A*.L /? 'S4Fi ! ? 1. T T3a YEAR MO DAY YEAR MO DAY LOCAT m FROM - tt ,; TO o( ,t in e-e .3 g T e 2 y nr e g g 4es (2a2t> (22-231 (24-251 (26-271 (28-281 (30'3rj NOTE: Reed instructions before completing this form. -. .. %. yy 3 ,t xnn-r PARAMETER '3 C"'s ontri QUANTITY OR LOADING (4 Card On&# QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE 146-53) 154-619 (3 H 51 (46-531 (54-619 oF (32-37p EX ANALYSTS TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS m.ex f,,_g,, f,3_7, ,4 SAMPLE y........ ~ ,, . k A,3 y - ' ~ .' -. ' 9 . . [% 7,(( O 3() def MEASUREMENT a PERMtT p g g g .g e g. ,J go gg ggy ! 3 3 n ry - I 3ep33, g,3 333 1 .,,,7 _ .. ,s 3, , , , , . REQUIREMENT c, , , , , , , , , , , y. 7 , , y . ,,,,,,3 ,J*1'~, P J f A. L MEASUR ENT 3.I, 3 E[ I O det b t i ] ' " F. ? ? 3. D , PERMIT ^ W il

W E* i 2^*

~.<,13 1 3 REQUIREMENT CSMOC 3 ',,i, I00 MI N kl3

,t . . , . , , , - , , , , y ., .. ,, ,. 7 y ., , . . - , , y, , , , , SAMPLE gm. ( yq 3{5 = v ,, ;g7gq ggg.3s g ,. ,. ; 3 '7

t p

. A, e . g p k a g, y g><s, W#M# * ' Y M PERMIT gg gew; gg ggy :ggg

- s;; t ) .) m 3pe 99,gg3 e 3 REQUIREMENT 3

,, ,, ,s77y y ,, ,,,f, ,, 7 3 .- r _ 7 s. 4 ;y " p y 3 I -- 3 .. SAMPLE { 3g e33343 9 9 3 g. , n 3 *: : n A ,,, v ag ,A 3, p p r g c 3 <. , p nthk7 MEASUREMENT C ,0 C [ (), CO[ ' 3C h,l 330; 1 ) e PERMIT g qge, p u g y ,, c;,g, % ,, g n . cnng . ;c; g ,y .<; ; y 5 7 y ,- ..>nn n , s . ,- .y . - . REQUtREMENT ,, , , , , , , ,. , g.,, ,,y,,, SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT ' PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PfDNCFAL EXECUTNE OFFICER 8 CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALA.Y EXAMtNED AND ' TELEPHONE DATE AM FAWUAR WITH THE INFORMATION SUSMtTTED HEREN: AND BASED Ced MY INOUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSISLE FOR } /' * = T i OSTAIMtNG THE INFORMATION, I BEUEVE THE SUBMfTTED tNFORMATION IS / [ DaV id U.TH CO !"i. TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT TI'ERE ARE / 'y -[, // j [f g)'J - SIGN 4FICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING ', , s, 393-5113 , 3 CherA e t rv 2:ana Pe' / *+ 1 4 o6 . , , 1& t0 THE POSSt51UTY U.S.C. s 131s. aRenneseOF enserFINE aneseAND IMPRfSONMENT. - mer 6 came anee as SEE.18 so a top stONATURE U.S.C. 91001 ANDOF 3GPRIf0CIPRL EXECUTfvE TYPED OR PRINTED ena er me=6n n u - er s n.e.a s mones ent s ms OFFICER OR AUTHORIZED AGENT g NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refersnee e# attachments herel .C

9. >

g Form 3320-1106-96) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF m mnvm m t !- . . Papenvork Reduction _Act Notice i . Puhhe repcrug burden for this colhxtion of information is estinuted to vary from a rangeef 10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months as an 1 avuage pa re pone fer we nc ur failine, to 110 houis as an average per response for unpo major facilities, with a v.cwhted aventge iur nwor and nunor facihtics of 18 boun per response, includmg time for reviewing m e,ru f mns, searchicg eMing data sourm, pthermg and nuintaming the d.ita reeded, and compleung ,md mmwg the whaiva of inforaw.tiou. Sund corrnents reprding the burden estimate or any other aspeci of Mus colixtion of infantuthm, mda&ng suggenions for reducing this burden, to Chief, Information Policy firanch, PM-223, U.S. Environmental Prot stion Apacy,401 M Street, SW Washington, DC 20460; and to the l Office of Icformation and Regulatory Af fairs, Of fice of Management and Budget, Washington, DC 20503. L__ _m_ _ _. _ _ . _ _ . . ___ _ _ _.- _ _ _ General Instructions . l. If fm m bx, been parthdly completed by preprinting, asregard instructions directed at entry of that information aheady preprmted.

2. Enter "Permitice Name Aladmg Address (and facdity name/ location, if different)," " Permit Number," and "Dnd,a>w Numtier" where indicated ( A separate form is required for each discharge.)

3. Enter dates beganing and ending "A/vmtormg Penod" covered by form where indicated.

4. Enter each #rarama Ice" as gecified in monitoring requirements of permit.

S. Emcr Nam!* Alcawccrent" data for etich parameter under " Quantity" and " Quality" in units specilied in permit " h vace" rs nonnally aruhmuic nerare geometric avempe for tutterial parameters) of all sample measurements fer r 'ch par:aneter ottmcd du mg "A/ntmmy Perimr; "Alaumum" and "Alimmum" are normally extreme high znd low memmemer a abtah ed during "\!nm/cnng Period" (Note to municipals with secondary treatment rtquaement Enkt 3%ia) auqy of runple racasurements under " Average," and enter masimum 7-day average cibmp!c nu;asuranci.t> ebL0aeJ during ruuniturmg permd under "Almimum ~) o En!cr "?cimn ! van acnt" for each pt r s act ur.Jer "Gaantity" and "Guahty" as specified in permit. 7 Un;f;r " W '!r" cu a caber of ump!: mtzmments during rnonitoring period that exceed nunimum (and/or min; mum or '-day a rwe :' 4propriate) p;ra,it requirement for each parameter. If none, enter "(r. R i:ud "Frn;m cy of h dj o ? loth as %ple ifcaxurment" (actual frequency of sampling and analysis used dmirg mennetiru; ;x:id) aoj , S 'enm! !!cpirenc/:/" specified m pcrmit. (c g.,' Enter " Cont " for continuous rNpacrin:' "/ '" for m day pcl weck. "197 far one day per month, "l&d" for One day per quarter, etc.) e, Encer %p?c '!)pc" bcth as %niple Tfeasurement" (actual sample type used during monitoring period) and as - h;/ Repirrent " (e g., Er.ter "Gra!" for indiviJual sample, "N/K!" for 24-hour composite, "N?t" for eo:numads inomtormt, ete )

10. Where uolaucus of r%t requirements aic reported. attach a brief explanation to desenbc cause and corrective actions wken, and :cfriace cach violation by date.

I1. U %c divharge" occm dunng monitoring period. entcr "No Discharge" across form in place of data entry. i 1.L Emcr "Nawfihle v;'i nnapa! thecutive CDicer" with " Signature of Principal Executive Officer of Authon:ed 4cnt " 7c!rph ne Nw>dwr," and "Date" at bottom oT fonn.

13. Maii 3.igneJ Report to 0IIiec(s) by date(s) specified in permit. Retain copy for your records.

14. More dettuled instrua.cn<, for use of this D.xchame Alom!oring Report (DMR) form may be obtained from Office (s) l

\ spdfied in pernat Legal Notice l Thb arport a required by b (33 U.S.C 1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can l rau t in chil peraltics r.ut a cueed 110,000 per day of violation; or in c6minal penalties not to excmd $25,000 per day ) of violation, or by unprisor ment for not .nme than one year, or by both. ; l i l EPA Form 3320-1 (Rev. 0693) PERMITTEE NAMEIADDRESS(3mAMerantrNewLorenes(Abew) D'ADONAL POLLUTANT DISCHARGE EUMMAMON SYSTEM /NPLtESJ Form Approved. NAME - - N MRMG NT (D ,4gygy 7g(ggy pgg g gpg7773y _ tt 7 137 gg7$pp g g g pOM8p,,4 AooREu n.3. m2 ~n-< PERMIT NUMBER DeSCHARGE NUMSER p (su n as, ^*a""t'S #

iTrs; _OlyIS 3?NDORf ,

y{qg{ 3MIPPEalPORT ?? 15077 MONITORING PERIOD ED FACIUTY zyggu z 73ggp7 p .p p p ;74773g LOCATION FROM f: ii ,1 TO 96 ii 1.1 *** 43 n iSCR A M';r l j te 4"*4: *r A 7i ) 3v'lD3uv (20L2rJ (22-23/ (24-25# (26-27J (26-2s> f30'371 NOTE: Road instructions before coinpleting this form. PARAMETER (3 Card OWJ QUANTITY OR LOADING I4 Card OrWJ QUANTITY OR CONCENTRATION NO. FREouEwCY SAMPLE 146-531 154-619 (30-45) 446-531 (56619 or: 432-311 EX pNums TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS M82 (6+681 tsS7a SAMPLE 3a MEASUREMENT seeten eccett h, 'f f e*:7C** 7, ,2 p ( 12) C /[k/ [g[ a . t g 71 1. 9 PERMIT cccett e$ ente ' See 6.0 ocettt g,7 yggty ,gg3 -pp!q- <*-

o3 - y s (g. REQUIREMENT gegg ,, g y g g ,g p y p p 4 qq 3 3 LT 9 ;, y m. [ s L SAMPLE MEASUREMENT aateM cemtre OctAtt ( 19)

O / gg r; J 3 p g g g () $_, { /(), O [ yy 4 %75]1 1 1 , PERMIT Occ*?? 0$etcy # 7+t 23 0 0: St JS gg' gggL{ 030 7

; T, rf i -t ? 91,7" 7qLa REQUIREMENT yee, q zpg 9gpgy sg ogfg

) [ r, f . ,, ;43t3; SAMPLE $3tt^t t e t ": n 0 *- a n t t ( 19) / / f 7. O O N >f?1-ORAV *, l' ? . MEASUREMENT [ [) [g h fg "jg % g ] 1 ') PERMIT Meert S$$tp3 ty; --3 9 $ 7 c c LS 20 Pgg(1 ;R;;5 REQUIREMENT .- p q y { y' ; , y . i' r L 1. V 7 q l '3 c ; y A Lg. -; 3 3 g r; 4g7 4q7 NT*13,7s, 1133t [g SAMPLE 7 tee' N00%33 *>$te: ( 11) J J T *s L (95 8) MEASUREMENT AJM J )3611 i ") . PERMIT 0?ttte $ c 0 ? *r * ' S70 3007t* EdOyt qgp3RT 'rgny gngM , < e,9 4 y - ;.> ; - - , to REQUIREMENT ??*0 NO A7G' h fR Y M C;/ L e t ' .! , 79 : D. D '! [ ? 3; SAMPLE ( 'J) 'y?tt? ce?>c7 CO -7 M .e yag4yw(%i pg3 MEASUREMENT g ,f) g d,ggg h A ,/y $g C'157 1 ^t ., PERMIT 33P3O? H E n D 8t i 3 CO MS 0tc000 -****ue 000 M I L] ;0dri! ' - P t. J " F 7 7>]t~ W A LJ. REQUIREMENT ,, a 3 y .; .ng7ty gg 3. g 4399

< ,AI[JF SAMPLE "r e ^' c *- $ N C S ? '

e 0 0 fe e $ ( 19)

MEASUREMENT MM ) i l ) d l 11 J PERMIT $ 4CO M *ce* c r r 30t cr$#3cc R934* - R C P 9 7:Y GhKLY ;R A:3 4 ^F L1Fer ; E 15 ^. 7 7 L:t REQUIREMENT SS$3 eg g70 ~ gg y y{ 5 ;;/ L ,, SAMPLE MEASUREMENT PERMIT

REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PER$CNALLY EXAMINED AND TELEPHONE DATE AM FAMiUAR WITH THE INFORMATION SUOMITTED HEREIN: AND SASED ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDeATELY RESBON98LE FOR /

2M' i d' r

OETAINING THE 8NFORMATION, I BEUEVE THE SUBMITTED INFORMATION t$ i) S \A y[ [/ [ / f) [.g *f \g' -. gI M} U" '. /i TRUE, ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ARE $sGNtRCANT PENALTIES FOR SUDMITTING FALSE INFORMATION INCLUDINGf , I t he' *~ '< t r >" lia n a v e' THE POS961UTY OF FINE AND IMPRISONMENT. SEE IS U.S.C. 91001 AND 33 - 4 I 'a 39- 3,q1) ,_ . > q6 . 1.) 9* J i u.S.C. t 131s. pensees eeMar stese seenme mer mcwe sws ase se #r0.000 880 NATURE OF PRINC#AL EXECUTIVE AREA TYPED OR PRINTED ead er manmeC eraerween s memns and 6 yeams OFFICER OR AUTHORIZED AGE 9fT CODE NUMilER YEAP bO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# effechments herof .yp

-!v: 17 5 - 4 9 ;7 p v ic [ 77 7 [ , a7 * - '* L v nuc7c; c,org3 gs : 7 3 y, g y g n ,

O, t Ef% Form 3320-1 (06-95) Presous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF i D ,3, _< 'r;/3 . L u. 1 l ..-,....__-_...._m. .,_m . _... . - . _ . - . _ _ . . . _ . . . . . _ _ . . . , _ , . --_7., - ..m .-..r _ . - . - ~ . _ - . - . I l. Pap,erwork Reduction Act Notice s I,

i i j 'Puhlic reporting burden for this collection of infornution is estinuted to ury from a rang of 10 Loars a an l l

l average per response for some rninor facihties, to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months as an average pa resporv fur some nyt facihties j ! I with a weighted average for nwjor and min.;s facilitics of 18 bours per rerpume, including fint for rpiewing l j l . instruction % searching eusting data sources gathering and nuintaining the data rwe&d. and complet;ng and l reviewing the colle<. tion of information. Send conmxats regardmg the burden estiuute os my.mher acct of i this en!!ation of information, including suggestions for reducing this burden, to Chief, Infornution' Policy j Hranch, PM-223, U.S. Environmental Protection Agency 401 M Street, SW Wa3hingtoo, DC 20E0; and ta the Of fice of Infornution and Regulatory Affairs, Office of Management and Dudget, Washington, DC 20503. i - _ . _ . . . _ _ . . _ _ . . . _ . . . _ _ _ . _ _ . - _ i l 4 i - General Instructions l

1. If! form has been partially completed by preprinting, disregard instructions directed at entry of that infornution alteady preprinted. l

(

2. Enter "Permitter Namediadmg Address (and facility namcIlocation, it different)," " Permit Nainber," and !

" Discharge Number" where indicated (A separate form is required for each discharge ) )

3. Edter dates beginning and ending "Afomtormy Period" covered by form w here indicated j

4. Emer cach " Parameter" as specified in monitoring requirements of permit.

)

5. Edier "Samp/c A/cawrement" data for each parameter under "(!uantity" and "Guahtc in units specifist in pcrmit. I

",f,rcrage" is normally anthmetic average (geometric ascrage for bacterial parameters) bf all sample meamrements ; fot cath parametcr obtained during "Afomforing Period'. "Alarimum" and "Ahnimum" are nonnally cutreme high and Iow measurements obtained during "Alomloring Pcnod." (Note to municip* with s=ondary treatmera regmrement Enter 30-day ascrage of sample measurements under " Average." and unct muirnum 74 average of sample measurements obtained during monitoring period under "A/aumum ") i i

6. Enter " Permit Requiremeni" for each parameter under "Quannty" and "Quiay" as sp.ified in permit. {

7. Under 'No Kr" cnter number of sample measurments during monitorini; period that exceed masimam (ami'or minimum or 7-day average as appropriate) permit requirement for cach parmneter. It none, enwr "0",

R. Enter " Frequency of Analystf both as'" Sample A/camrment' (actual frequency cf samphng and calysis used during momtoring period) and as " Perma Requirement" specified in perm;t (e g., Enter " Cont " fy cominuno monitoring. "10" for one day per week, "I00" for one day per month, "/ 90" for one day per quarter. eu )

9. Enter "Samp/c 7)pe" both as " Sample Aleasurement" (actual sample type used dunng monitonog pt -ind) and as !

" Permit Requirement " (c g., Enter "Grah" for individual samp!c, "N//F for 2-t-hour composte " W i" for 1 continuous monitonng, etc.) i i

10. Where violations of permit requirements are reported, attach a brief explanation to descnbc cause ai d corrective actions taken, and reference cach violation by date.

I1. If"no discharge" occurs dunng monitoring period, enter "No Discharge" across form in place of data entry

12. Enter "Name Title of Principal Executne Officer" uith " Signature of Pnncipal Executwc t@cer < (Authori:ed '

Agent," " Telephone Number," and 'Date" at bottom of form. l

13. Mail signed Repon to Omce(s) by date(s) specified in permit. Retain copy for your records l

14. More detailed instructions for use of this Descharge A/onitoring Report fDAIR) form may be obtamed tiom Office (s) l specified in permit. I Legal Notice i lhis report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report authfully can 1 result in cisil penalties not to exceed $10,000 per day of violation; or in criminal penalties r W to emed $25.000 per day j of violation, or by imprisonment for not more than one year, or by both.

i EPA Form 3320-1 (Rev. O!(-95) l .__._a

m. m ,. m .m . . . . _ . _ _ . . . .

_ .m___m _ .. . - ~ _ _ _ . . . _ _ .,_._m. ._ _ _ , . _ , _ _ , . . . . . . _ _ , , _ PERMITTEE NAME/ADOflESSta=wer .re,# st.c.m.mehrono sir.TiOneAL PottuTAss7 DescMARoE a ma=aTiOss sYsTea S/ Form Approved. N NAME 3gggg3 74( y p-) g g g :; !i?I3N E NN N/ri-rd GUTPt.LL 013 . m aNo. N 4 I ADORCS ? . % i'l l 4 ' D5%<1% PERMIT NUMBER De9 CHARGE Simah84 (504R 05) #@' N' A!!%; OiVIO '1 P. 9 D D p y 7 ,,ppggg 5 R E ? ? I B ~; P 3 R T ?2 15077 MONITOResG PEMOD FACILITY 3yggy y 7 g rd P Y P OV 41?17 M N YEAR MO DAY YEAR MO DAY _ LOCATION FROM +o Ai et TO sa al >a 304-WO DISC'! A RG? l_l CC7 NOTE. Reed ineeModene before comPlating Wils fenn. il r ! W : a !t i ! 3 ') R N a 3 % (20L271 (22-231 (24-251 (2s-271 (28-291 (30-3,j PARA 9ETER (3 cow m&# QUANTITY OR LOADING (4 Caen&s OUANTITY OR CONCENTRAMN NO. PREQUtseCY SAMPLE 146-537 154-679 (30-46) 146 639 16+6t9 or 132-371 EX ANALYsus TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS esa fggggj ggg7o, i 34 SAMPLE $ 3 0 *r 0 * ??ttt: . g~ [ C300?> ( 12) / '78[7 MEASUREMENT __ . , L q p h 7 hrd 334')0 [ ] 3 PERMIT. .0000t*~ - 7 7 0e0 0~ r ttar ~ v.O- Ottt0* 9,0 r H KI,Y J itM i i F r !. *1 P a r ; ? 7 9 7 7 A L ,, - REQUIREMENT ecye -gyhsg ygdag ~3 Flai 19 30 SAMPLE ( 91) b*tcci tt0nCO %?3c00 / /

1 P '.1 ?RE4715MT~)43 tJ ' "hMEASUREMENT LE O,003 de Cdf O b[

5')930 1 ) 0 . PERMIT RepO?? '0?PSRT $ 0 $ 7 0;& '. *CO*SS~ C Cy

4 3. -- ~300 r $KELI SS?IM ecPf.JEar 74335 V t. L ; - REQUIREMENT g gy; pg yty 3 g wg3 s 4 coes j

aL3aI?i2, 73rAL SAMPLE 30t m cMPOO ?*">0** ( l '1 ) .~L

$./ f h 3C [g h ,y3r9ggg MEASUREMENT 8, d( 59363 1 ) 3 PERMIT : Occt0^., O MtF3

SCO :- Oy

3 4 2 R 5'i$ D 3 5* : .LHEPOR7;-

W ICf / RLOTC recL!)Pyr Ca191 ir 1 L g - REQUIREMENT p e. e m agr Dy g.gy Q gy q3/L 33hyg '

SAMPLE i 2 ' *"7 MEASUREMENT < (),, f 4k[ . O hg6 . PERMIT m REQUIREMENT l SAMPLE Ij MEASUREMENT K p f(' Kgg b [1, 77 hb PERMIT . + - ~ REQUIREMENT ^ ~ SAMPLE f gd^M . MEASUREMENT 3 /f"~ h y fg4 ~ PERMIT ID REQUIREMENT , SAMPLE 2 DjQ a 'y 7 MEASUREMENT Dd J h 7j f' hg PERMIT x h REQUIREMENT < NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER e CERTIFY uNoER PENALTY OF LAW THAT I HAVE PERSOfsALLY EXAAAnfED AND TELEPHONE DATE AM FAMIUAR WTH THE 198 FORMATIO 84 SUBMITTED HEREIIt: AND BASED Ott 9

MY INQUIRY OF THOSE INDIVIDUALS IMesEDeATELY RESPOedSIBLE FOR .

/ 1 OSTArNING THE leeFORMATION. I BEUEVE THE SUShetTTED tesFORMATIOce is j 1 /i/ ' heyA/M-' David Orndort- rj pu 4Aen e 4 s-,,. y d, anage1 TRuE. ACCURATE . AseD connetETE. i Aas AwAnE TWAT TwERE ARE s suosericANT PEpsALT1ES FOR SUBMITTING FALSE sesFOReAATIOes. IseCLUDelee $f' 7, seesIATWE OF PRIIgGPAL EXECUME i %t2 39J-M-13 96 ,, a ,., .0 THE POssieruTY v.s.c. s isie. s%a.ne OF FiesE.ANDiew su. IMPRIS.Of0 a MENT. SEE 1s U.S.C. 91001 .= sro.coe AND 33 TYPED OR PRINTED .as er ' - _ - r ers.sw. s===. me sm mer and ume s ms me OFFICER OR AUTHOARZED A0EIET $ NUMBER YEAR MO DAY f COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference erstrechmetres heref 0127 53ALL 6F % D UCH AM" Of FLOP *T"; 7'1LTOM M VIql9LF F3?N I4 JT9T8 ! 41 '? TRA M AFOUff?S. ; t fN m/ , ry h M()b4,$!Ydhniha4r*(Y N Al hdQ6 h41 [h(i ~ Vi n / LN h*~ /1 f I. TV WMb I v1 ** b h ,Q EgForm 3326-i 108-951 Previous editions may be used. 4 (REPLACES EPA FORM T-40 WHICH MnY NOT BE USED.) q,,g / ,s, . . s 3 - ,, .,>s- ,, PAGE OF s 1 4 - _ _ _ . _ _ _ . _ _ _ _ . _ . _ _ _ . _ _ . . _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ ___.__m.___.<__________._._.._._____.__._______.__u__ _ . _ _ _ _ _ _ _ _ _ _ _______A_ ( (- . ..-_...n. . . . _ . ~ , ..--- .---~. -, .- -..- _. - . . - . - - - - i Papenvork Reduction Act Notice i Pubhc reporting burden for this collection of mfonnanon is estinated to wry f rom a rug or110 he o an ! average per resp <mse for some minor facihues, to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months as an avuage per retone : for .any ev cr fhhhes, I with a weighted avmge for nujor and minor facilitio of 18 houp per responu incluJmg (ina !or reviewmg instnuiont warching existing data sources, gathering and nuintammg the dau naded, and wu,p;cting and . reviewing the collection of intorouttion. Send comments regardmg the burdca catiman: or m ohr a pect of ihis tollution of infamation, including suggestions for reducing this burden, to Chief, hkrmann Policy Hrinch, PM-223, U.S. Environmental Protection Agency 401 M Street, SW Wnhington, DC 204Mi; ted to the Of fice of Information and Regulatory Affairs, Office of Management and Budget, W,tshington, DC 20503. j , . , . _ . - --.4.-%.-- -...->--,.,4 - - , - . . - - . - . _ . ~ ~ - - - . . - - - - . . - - - . . . - - - . , - -- --~m.-- --C.---o-+- . - - - - - - - - i i

General Instructions

1. If form has been partially completed by preprinting, disregard instructions dhected at entry of tbt infurnution

already preprinted.

2. linter "Permitter Name3/aihng Address (and facility name/ location, if di1Terent)," " Permit Nmnber " and ,

"Ikscharge Numl>cr" where indicated (A separate form is required for cach discharge.)

3. Enter dates beginning and ending "A/omforing Period" covered by form where indicated i

4. Enter each "f arameter" as specified in monitoring requirements of permit.

5. Emer "Nample Alcosurement" data for cach parameter under " Quantity" and "(Juahty" in units specified in pennit.

"Arrrage" is normally arithmetic aserage (geometric aserage for bacterial pmameters) of a!! sm;ple mcamrements' s for each parameter obtained during "Alomtoring Period" "Alarimam" and "Almunum" are nemudly estrcme high and low measurements obtained during "Alonitoring Period." (Note to nurripds with sccondan Ircatmcnt t reqmrement: Enter 30-day average of samp!e measmements under " Average " and ci:ter mxamura 7-lay average of sunple measurements obtained during monitoring period under "Afactmum 5 . 6. Enter " Permit Reqmrement" for each parameter under "guantity" and *Gnahty" as sufied ir permit j

7. Under "No Et" enter nurnber of samp!c measurments during niomtonng period tu cutd maxnt;um (and/or I minimum or 7-day aserage as appropriate) pennit requirement for each parameter. If none, entt "v'.

8. Emer " Frequency of Analysis" both as " Nam;>le afeamrment" (a tu:0 frequency of s uuplig and nualyis used 1 during momtoring period) and as " Permit Requirement" specified in penmt. (e g . Enter "( ht? & contmuom

, monitoring, "//7" for one day per week, "/do" far one day per month. */ 90' far one day pei rpmter, c:: ) j s

9. Enter " Sample npe" both as " Sample 3/easurement" (actual sampic type used dunng manifug ioJ) and m )

" Permit Requirement." (c.g., Enter " Grab" for individual sample, "2.I/R' for 2 bhour conpout " s A" for l l contmuous monitoring. etc.) j i

10. Where violations of pennit requirements are reported. attach a brief exp!anation to des r;tx: em a d cariccuve actions taken, and reference cach violation by date. -

, t i1. If "no discharge" occurs during monitoring period. enter "Na Dacharge* across form m place of data uny

12. Enter "NameNitle of Principal Executwe qtTicer" with " Signa:ure of Prmes;,al JOcm.twe Q11cer c' iu: hon:ed i Agent," " Telephone Number " and "Date" at bottom of form

13. Mail signed Report to OITice(s) by date(s) specified in pennit. Retain copy feryour records

14. More detailed instrucuons for use of this Dacharge Alom/cring Report (DAIN) fonn may be obtamed from Otfice(r.) {

specified in permit. ! Legal Notice j Uns report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or f ailure to repoit uuthfully can rc+ ult in civil penalties not to exceed $10,000 per day of violation; or in criminal penakies not to exceed $25 000 per day ; of violation, or by imprisonment for not rnore than one year, or by both. i . EPA Form 3320-1 (Rev. 08-95) N.. . yERasTME NAA.EIADORESS Wenesis==vimeses(Dd wl EATIONAL poLLurmt meenARef su.m.mATNus sYsfes MFDES/

g x ,,,, e ,

.A E - M-- (17-m 3 L3 *e 3 a y ya3y ADORE 55 p ,3. a g a; .f r 4 7 4 ;,t g y p 3 ;g g 3 y + r t a 3 33y 4 (2- m '(sUBR 05) I Ngg,3m RW NUMBER DN N 1??3; DA7IS DRSDORP P ,( 71 \L SHI?PD ~,P3?? . PA 15077 MOferTOR50G P9 POD NAJOR ! 4 E R V :. 2 WALLET S0WEP 5?1TT5Y YEAR MO DAY YEAR MO DAY - r LOCA"* FROM u t, 13 nt TO g r, 11 23 g e s' gn n g ees NOTE: & y e; M- g 9 3 r- M % term.

a.

T st . 11e y r 3 #} t a r51 n e (20 211 422-231 124 251 426-271 120-291 130 311 PARAMETER (3 W W QUANTITY M LOADM to N W QUANTITY OR CONCENTRATM3N NO. vnECUENCY SAMPLE I 146-539 tustI (30-461 146-539 964-0tI or (32-371 EX angysis TYPE AVERAGE MAXIMUM UMTS MINIMUM AVERAGE MAXIMUM UNITS ass.es, ts4-ser tem :

t SA g Jl ':0?"'S t *: P f: 7 5 0$305h (1 g uana 1 y a PERMIT REQUIREMENT n.p g pmg . 0 20 ) 0. s o~"M % 0 ~ ~ ' k e w '* + <-+ 'C/ an wd pa

e r,a r r y ;333- ret :v .- $0S> wTeraw SAMPLE pggey

' LN Iw :POU[? Og C ,4V/ g n 3) egyp3 g33eg / [j 3 a n ' ; p c a p 3 : =; p ptxy. MEASUREMENT d,CO/ ' [6I 4:03c i 3 a PERMIT p g-9 7 q w es p ,7 - g n gn- m m-; ~ gpfg' og ,g7 gg 2eryq,4r p.., y 3 y ,, , REQUIREMENT ,n 3g 47,, ,g ,,, _,, , j ~ SAMPLE MEASUREMENT ; PERMIT i REQUIREMENT SAMPLE MEASUREMENT PERMIT : REcutREMENT i SAMPLE MEASUREMENT ! ' PERMIT ~ f REQUtREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT I NAME1 TITLE PIW.CNDA1. EXECUTRIE OFFICER t cEnTIFY UNDEn PENALTY OF LAW THAT I HAVE PEnSO8 SALLY tw asamm AND TELEPHONE DATE AM FAMeUAn WITH THE INF00meATION SUBMITTED HEnEsN; AND SASED ON " MY INQUenY OF THOSE esotVIOUALS IMedEDeATELY MEr oesseLE F0n ' ' OSTAfMING TME INFORMATIOse, t SEUEVE THE SutamTTED iseFOnsaATl00618 Daviu Orndorr- TnUE. AccunATE ANo coMetETE. sioNmeA.N.T i AM AwAnE TWAT TwEnE AnE - so i -j>g/ Mjf y - /,y O TnE pas oTv o PENA,LT,i.Es ron s.u.,ssa:Tr.u,MeFALsE inseomnarions, sectuoisse ( - Chems trv Manager NE nis T. sEE is u.s.c. i 412 .,93-3113 ., 96 12, 20 u.s.c. t iste. aReamme,moasismr snes,osemanee me e $4GNAWRE OF PRBecNL EXECUTTWE TYPED OR PRefTED mis er =====n=' erase s assaan r nce.m, Am e iooi Asso =in s venre.s es, as sto,coe 33 - OFrecER OR Atm00nt2ED AGENT 3,g, NuteER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af strechments hers/ Form 3320-1108-36) Previous edatione may be used. (REPLACES EPA FORM MO W99CH MAY NOT BE USED.) PAGE OF 00359/961003-DG34 1 Paperwork ' Reduction Act Notice ! l Pehhe npting horden for thi . othxtion of intornunon is estimated to vary from a range pf 10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months as an n mg > pat repons for some ran or f.aihues, to 110 hour0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months .s as an average per re:,ppnse for some major f ailities, mth a v.c:ghWJ any Hr major and a;inur facihties of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per responm including time for reviewing inummns, s..achby ewog dm sonrns, g A ang and rnaintaining the data needed, and completing and roiewmg the wuce:icn d nfwaution. Sed curama:6 segarding the burdea estimate of any other aspect of tha couahen of infmrnrum induang suggesions for redacing this burden, to Chief, Information Policy 11raneh. PM-2H, l'.S. Er unmmenul Protection Agency,401 M Street, SW Washington, DC 2040; and to the i O!tice of Icforuutmn and Regubtory Af fairs, Olnce of Management and Iludgtt, Washington, DC 20503 i, I _ _ _ _. _ _ _ _ .. _ _ _ _ _ _ _ _ _ J l l General Instructions '

l. If fann ha been partially compieted by preprinting, disregard instructions directed at entry of that infonnation already prep;inted.

I

2. Enter "Pernutice Name Atmhr,g .L!dreu (and facility name/ location, if different)." "Pnmit Number," and "Dochave Number" w here inicated (A separate form is required for each discharge.)

3. Enter dates bepaning and ending "A/onitonng ?< rmd* cosered by fonn where indicated

4. Emer cach " Parameter" as speafied in monitoring requirements of permit. ;

5. Entcr %rle Alcmurcment" d.ca for each paramcter under " Quantity" and "Guality" in units specified in permit.

i n x" n numuMy arithmche ;m rage Qcometric ascrage for bactenal parameters) of all sample measurements W ca :h puann.ter d t ned dming "3!*n.umg Perm,!"; "Afann.um" and "Ahmmum" are nonnauy extreme high and hm in casure uh staired danny "3/anuoren /

m d." (Note to municipals with secondary treatment recp u m ent Emer 3 Mn au me of sunple measuremt s und:r " Average," and enter inaximum % day awrage rf samph: n=asuremen obtamed dunrg monitaring peric under "A /aumum. ")

6 Emer *?nm:t ncpow. nt* ha exb par mmt unkt "Quanniv" and " Quality" as specified in pennit 7 Unir % /Y enNr anAr of um p!c measmments danng monitoring period that exceed maximum (and/or tr.mimum er Lday am as aignmacie) gumit ret;uirement for each parameter. If none, enter "0". F Wa "!'rnpcmy of t !L :P bcth as "Y., tr/c A! murment" (actual frequency of sampling and analysis used ' 1;rk merjtering psi 4 ad . '?cennt i:cydrement" sWcified in pennit (e g., Enter %t," for continuous c a u H in, "I 7" for 4 c: da pu u eek. "/W for one day per month. "U90" for one day per quarter, etc.) L Er"cr "Sr 7 <!Ttre " bMS n "N wple Mcou.remen!" (actual smnple type used dunng monitoring period) and as h , Rcquiremon." a g. Unkr hb" for individual sample,. "2.tf/C" for 24 hour2.777778e-4 days 0.00667 hours 3.968254e-5 weeks 9.132e-6 months composite, "N'A" for centincom momtorm?. etc.) M % ! ac Wohtiens of n md icymranents are reported, attach a brief explanation to det ;nbe cause and conective attiens taken. and rcfmuce ca.h vmbhon by da:c. I1. If "no discharge' occt rs ,hony, rumtorir , pcriod, enter "No Discharge" across form in place of data entry

12. Unter "Nanu'litle vj Prmo;'al Eucatn e Ofcer" vith Signature of Pnncipal Executive 0))icer of Authori:ed

. lynt " "fe!ephone Number," and "Date" at bottom of farm.

13. Mml signed Report to Officc(s) by (bte(s) specified in permit. Retain copy for your records.

14. More de' ailed instrucions for ose of this Db; charge A!onitoring Report (DAI/O form may be obtained from OfTice(s) specified m permit.

Legal Notice This icpat is reqared by bw (33 U.1C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can ratdt ia . nit pmaltin not a n.ceed $10,000 p r day of v.obtion; or in criminal penalties not to exceed $25,000 per day et s iolatio, or by imprin.wnt for a t more than one year, or by both. EPA Form 3320-1 (Rev. 01-95) PERMITTEE NAME/ADDRESSWrerebryNm 'Incen (Defbroer NATIONA POuUTANT rWSCHARGE EUMINATION Sv8TEu (NPOES/ Form Approved. DISC NAME e er 7 OMB No. 2040-0004 n e s 4 3y 3 7;[L y 3qj< 7g ,;, E MONITORING REPORT (DM EE'" ADORE 23 P . 3. '1I 'l ' '3 7G'< ' ' ' ' * (503L S 's ) 30 !*P\; .) iV 13 7 o N i, ? t y PERMIT NUMBER DesCHARGE NUMBER p m 7{p4( 277 '

1 7.--,>4

"' ng , -' ' 7 ,~ .

, . ' 9' 7 ,' MONITORING PERIOD FACILITY ',.r.s 1 = .3 y e. < sqe- .3. ~ i. i t e. . t - , YEAR MO DAY -YEAR MO DAY __ LOCATION FROM ; ._ 3i TO ya ,i s1 %0: dO ?!CCi!AP0- l 6&7 $ ? ?' : n3 i*3 7 ' N n ' 9 i' 12a2f1 (22-23/ (24-251 (26-27/ (2a-29/ (34371 NOTE: Reed inetmCtions before coinplleting this for PARAMETER 13 cent onNs QUANTITY OR LOADING 14 Card om&J QUANTITY OR CONCENTRATION NO. FREOUENCY SA W 14 s-5 31 <st-sts mst 146-53) est-st? OF (32-371 EX ANAtygS TYPE AVERAGE MAXIMUM UN!TS MINtMUM AVERAGE MAXIMUM UNITS n $3; gg ,_sas reS7a

( -) ,

T= ); alt- 30 SAMPLE ( 31} t>T0;* **??? cccts-g / - - . ,; 3 , pgg, MEASUREMENT d , (g 4 (), ()g f J t 6/ s 3' 1> 1 PERMIT p70* Orpopp 95&s0S c e6 4 's t & a c *;c e c+t ;my ;371p: - ,e . s: y;gi. REQUIREMENT , 4y n y7y y7 -, -39e SAMPLE MEASUREMENT PERMIT REQUtREMENT SAMoLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTWY UNDER PENALTY OF LAW THAT I HAVE PfRSONALLY EKAMINED AND e TELEPHONE DATE AM FAMIUAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON q /' MY INQUIRY OF THOSE INOMOuALS IMMED6ATELY elESPONSz9tf FOR j, f f e MVi 0i ~~1 d ( ' 06TAIN!NG THE tNFORMATION, B BEUEVE THE SUBMITTED INFORMATION IS TRUE. ACCURATE AND COMPLETE. e AM AWARE THAT THERE ARE; Q 17 f j%~/J/j'ffg i) g] [\ ' . !! e ?^ a r tV 14.5 g --[- . h[ / i./ SIGNIFtCANT PENALTtES FOR SUBMITTING FALSE INFORMATION GNCLUDING > ') i -- 3 's y 9, q i l 3 g 'O 3 3 +- ;',' THE POS981UTY OF FINE AND IMPRISONMEN.T. me SEE 18 U.S.C. t 1001 u.S.C. 6131s. smmenes ender mese s.esame#6.ew e av m r hiram na.e se se s o,000 AND 33 StGNATURE OF PRINCIPAL EXECUTIVE m TYPED OR PRNiTED and er man === n and s yearms OFFICER OR AUTHORIZED AGENT COOE NUMBER YEAR MO DAY COMMENp AND EXPLANATION OF ANY VIOLATIONS (Reference e# strechments heret ee .o. - h Form 3320-1 (08-95)Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) -,, al. - s 1 i . PAGE OF Paperwork Reduction Act Notice , Pubhc reprtmg burden for this co!!cetion of mformatmn is estinuted to ury fuo a range of 10 tours : . an average per response for some nunor frihtics, ta l10 hours as an average per recru fer ame myv f cihtit s, with a weighted avmge for major anJ mmor facihtiu of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per regn c, induJiq tin.- br soit u m; mytnu tions, searching existing data suorces rathering arl nuintaining the data necid, md waghong md reviewing the collectwn c1 mformation. Send conunents regudmg the burden utmue or ey t&r cpat of this collation of information, includmg surge.stions for reducing this bmJen, to Chia, fr t unution Policy ,

liranch, PM 223 US Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the Ol6ce of lolormation and Regulatory Af fairs, Office of Management and Budget, Washingtcu, DC 20503.

. _. . . _ . . _ . . . . . - . _ . _ _ _ . . . _ _ _ . _ _ . . _ . _ . _ _ . _ _ _ . _ . . . . __ . .I General Instructions

1. If. form has been partially completed by preprinting, disregard instmctions directed at entry of that inforraation already preprinted.

2. Enter "Perminer Name/Alaihng Address (and facility name/ location, if ddferent)." " Permit Number," and "Dgscharge Number" shcre indicated ( A separate form is required for each discharge.)

3. Enter dates beginning and endmg "Alonuonng Period" covered by form shere mdicaico

4. Emcr each " Parameter" as specified in monitoring requirements of permit.

5. Emer " Sample A/easurement" data for caeh parameter under "Guannty" and "Guainy" in units sp.cified m permit

".Qrrace" is normall3 arithmetic aserage (geometric ascrage for bacterial p trameters) of all s.m:pic an,arements for each parameter obtained during "Alonironng Period", "Afanmum" and "A/.nfma" ;ac nonnally utscme 1,igh and low measurements obtained during "3/omtoring Permd" (Neite to na.mciph unh unday treatment IC4partment'. Enter 30-d.ly 3\erage Of Samp!C rneasurCmOnts under "Aterop[ and enter mai mUl17-E) averjjg of sample measurements obtained dunng momtoring period under "A/arunen "j

6. Enter " Permit Requirec: nt" for each parameter under *puantit/ and "Gualay" as spctf ed in permit

7. Under "No fx" enter number of r.ampic measurments dunng momtoring perivd that exce(d maunmm (and/or minimum or 7-day average as appropriate) perrnit requirement for cach parameter. If nonc, en:ct "0"

8. Enter "Frequemy of Ana!y.us" both as " Sample Areasunncnt" (acuul f equency of sumphvg and uviyus uud during monitoring period) and as

Permit Requirement" specified in perm:t, le g ifnter 7 'ontf fr continucus monitoring, "l&" for one day per neck, "F30" for one day per month. "/W for onc day per quancr. em )

9. Enter " Sample Tire" both as "Nample Areasurement" (acmal sample type used dunng monitanng rio1) anJ as

" Permit Regmrement " (e g., Enter " Grab" for individual sampic. "NIR '" for 24-hour composik " 7 far , continuous momtoring, etc.)

10. Where violations of permit requirements are reported, attach a brief explanation to dsenbe cauw u d wrrective actions taken, and reference cach violation by date.

I1. If"no discharge" occurs during monitoring period, cmer "No D scharge" across form in place of data crtry. i

12. Enter "Name/ Tale of Principal Executwe Officer" uith " Signa:ure of Prmcipal Executwe fif.tcr vL k: hon:ed Agent,"

Telephone Number," and "Date" at bottom of form.

13. Mail signed Report to Office (s) by date(s) specified in ;>crmit. Retain copy for 30ur records.

14. More detailed instructwns for use of this Di3chage Afonitoring Refort (DAIR) fann nu) be r bt.uoed 00m OfTiceN specified in permit.

Legal Notice '1hm report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report authfully can realt in civil penaltie.s not to exceed $10,000 per day of violation; or in criminal penalties not to acced 525,000 per day of violatien, or by imprisonment for not more than one year, or by Nnh. EPA Form 33201 (Rev. 08-95) % e .* PERMITTEE NAME1 ADORE 33(NMFereehwl.eenas(D@uw! NATIONAL POLLUTANT DISCH AftGE EUhnNATION SYSTEM (MPDESJ Form Approved. i NAME DISCHARGE MONITORING REPORT (DMRA OMB No 2040-0004 i , gy a' '; ; i' "?- v y .,' ;i e' :: 1**PI?J (2-r si (71-731 gyr- '4 og'g'e T g *' g3 - Approval oupires 05-31 E8 Aoosgegg o , 3, 33y 3 -.-m 2< r< * , - - {ggpq s5g yyj4, 't i i 2 ; i)$!% 01rD3?F PERMIT NUMBER DiSCHARos NuMoER g, , y , T"9 N.33?e 7 e. ' 'i ? 7 ' MONITORING PERIOD 9%J0D FACILITY 1F\7?> 7 h L L ./ 7 M1 i, g rs ;7g?l7N YEAR MO DAY YEAR MO DAY LOCATION FROM i i x TO : g it 2- ee; .o n T p , a a y - -- 'g ep t-~g- mn?T\ 32 ,,a,. 420 219 122-239 (24-259 426-271 (20-23) (30-319 NOTE: Reed M W %% % Wm. PARAMETER (3 cerms QUAN W M LOAD M (4 ced Oners OUANTITY OR CONCENMATION NO. FREQUENCY SAMPLE 146-531 154-691 (30-451 f46-539 ^ (54-691 Or (32-37; EX ANALYSIS TYPE , AVERAGE MAXIMUM UNITS MINtMUM AVERAGE MAXIMUM UNITS ms; (64-60s r6s-7ar >j SAMPLE ;3 -= e 9 p a. p g M3770 ] O MEASUREMENT 7, 3 $ 7, / f 12) [ M PERMIT 005M M McM* -'na 3 ") g ' ' I J ' ' ^ ' " * - ;.0 7.4 Enu , c , , 31 . 7,n . ,, REQUIREMENT m , , ,, r * % e vrv" -" '-(z w r ? 1[ ~ ~ .. g' ' SAMPLE syceux y Wa A q. 3,;[' a)pt. MEASUREMENT y3 g. e :.m < O, 3 (u,3 { 39) ^ DgQ g

4 *s t t ) ; PERMIT g m .y popf e 73, ;ppen y 37 ggp .ggp7; y1 ,g. ;- . REQUIREMENT .g ,,

,q , , . ,, , , , 7 3- ,1 ,, 23:IMIT ]! SAME { , 39 9e3c3y e.333eg gepg 'l J a , I '8 MEASUREMENT O , C6 c,a- g< dd 3 , Meg ra m enu szn me / i?P9? 1 ) O PERMIT prpgp9 qcyq; mpy mm upp ep 7 ,' 7 '," 7gn ' REQUIREMENT .-;.p. 3-- 7 7 ,, ,3 , SAMPLE 33eggy m ai. p g 3 ,9 9 9 gg f '. .,i L 9 ? ! T R , yleAL - e. y q .J % ,o MEASUREMENT O,CO j,gd O ,/ h 4, mv? 1 1 g PERMIT gne tweep e ice 'ngee3 n,5 1,75- ggg(y ;ggg

. g r ,i f, a g- y., 7 ,_

REQUIREMENT e nn 3y- yyea y3y .-fy SAMPLE eeeegg // stgar c - 7 g; % ,- - e . gy m C (> C) g ggg O g ,, 7 g g { ', MEASUREMENT C), M /7 STf 1,06- 1 1 , PERMIT cuey ag e n n. q r y- . cm" 7.3 3.5 c3L7 1Aa 7 2 e7 g.se - ,. .g i 7 , . REQUIREMENT , , , , , ,,,, ,, ,5 g, ,,f SAMPLE MEASUREMENT l PERMIT t REQUIREMENT i SAMPLE MEASUREMENT PERMIT . REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERDFY UNDER PENALTY OF LAW THAT I HAVE PERSONARY EXAMINED AND TELEPHONE DATE AM FAMBUAR WITH THE INFORMATION SU6MtTTED HEREIN AND BASED ON ' My sNQUIRY OF THOSE INDIV100ALS iMMEDsATELY RESPONSISLE FOR / OSTAINING THE INFORMATION, I SEUEVE THE SUBMITTED INFORMATION IS .c ./2 5 )f (( ( h[ t .. , 03V I C1 OrnOuri. g TRUE. ACCURATE AND C0edPLETE. t AM AWARE THAT THERE ARE [, - SIGNIFICANT PENALTIES FOR SUSMeTTING FALSE INFORMATION, INCLUDING (.j, - - - - ' 416 qb

, 3

-ig ~ t3-) U- 3 Ch eLa1 E L 6!V 'MhaRCi THE POSSISIUTY OF FINE AND IMPRISONMENT. 3EE 18 U.S.C. 91001 AND 33 - < L4 U , u.S.C hen SIONATURE OF PRNOCIPAL EXECUTfVE g TYPED OR PRINTED .av ,. tme===

31s. ew.ame,.

_ :Mw mese esse,see er aerwes a monene mer.ae s,sie snee se se s to. coo weerar OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VICLATIONS (Reference a# errechinents heref g a ' '.: t r' a - .3 41 L y 13 7 I q 1 M -) o p? n"-! y 'a r t '; y ; ~ " 2 9 3 7 - ' ; (ja g% m w,n,} .

3q/L, (epp L;y;p IS 3; ,,- ,efL hl 1 34iLY dAA.) Form 3320-1 (08-96l Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USEDJ PAGE OF . 03353/161097-0334 1 j Paperwork Reduction Act Notice ______ 1 ' Puns r portirg burden f a this mHectma of infarnwinn is estinated to sary Imm a range of 10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months n an l avery p r respinw for some runor fuhtu ,, to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months a un average per response for some major facihties, w:th a ughted aveuge Ma mcc .anJ auwt fa;@ies td 18 houn per rexporwincludmg time for reviewing i l in arudbut, warchiq ming daa m aus pb:ing d maintaining the data needed, and completing and l rmw kg the c.ollaten of mfonnatica. Send.conuncats regudmg the burden estinute or any other npect of l thm toHatma of infomuiun, induJing supct.uions for reducing this burden, to Chief, Information Policy l Brm;h, PM-223 U.S. Er.urommntal Prutation Agency,401 M Street, SW Washington, DC 20400; and to the Of fice of Infornution and Regulatory Affaus, Office of Management and Budget, Wa.shington, DC 20503, [ _ .. _ . . _ _ . - _ _ _, .-. _ _ . . _ _ . . _ . _ _ . - __ _ . _ . _ _ _ General Instructions

1. If fann has been partiaHy completed by preprinting, disregard instructions directed at entry of that information already preprinted.

2. Enter " Permittee Namc 3/a:!mg .flirca (and facihty name/ location, if ditTerent)," " Permit Number," and "D&harge Numter" uhere indicated (A separate form is required for each discharge ) ,

3. Euter dates beginning and endmg "Monitarmg l'ermd"cosered by fmm where indicated.

4 Erder each *Parame ter" as specified in muutonng requirements of permit.

5. Frcr %n;*!c Alcmur. vm" data fer each parameter under "(Juantity" and "Guality" in units specified in permit.

'm eru:y" is nonnaH) Mhmuw a cmge geometric a, crate for bacterial parameters) of all samp!c measurements kr each primehr 01 u ud d,2iag "Ahmnoring twmd" "Mawmum" and "Mimmum" are normally extreme high i nt i.m a t r a ras uauld datiag "W i tormy l'rrmd " (Note to municipals with secondary treatment u q w m mt- Emer M-&y avcmp of sample meamrcments under " Average " and enter maximun. 7-day avemge of waple measunmuu uttamed cunng monitaring period under "Mawnum.") L Enter "Parnt 16 pre 7 cm" fLr c: ch paranuter unact 'puannly" and "Guality" as specified in permit.

7. (*nja "W !{r" cmcr ene Ar (i mmp'c nu surments dming monitoring period that exceed maximum (and/or mininmm cc 7-day awg: aw apppnate) peamit requiement for each parameter. If none, enter "a".

8 Eect 'h e ry f of . v!6 us" bcth as " sapic A!rasurment" (actual frequency of sampling and analysis used dmim; momturing puisd) a .d as "!'erma Rojmecm:nt" specified in penmt (e g , Enter " Cont," for continuous moniering, "! ~" for , 's uy p;r wtd, "/. 30" for ene day per month, "/S0" for one day per quarter, etc.)

9. Ema " San;!c 7)pe" beh as h

Meau.rcment" / (actual srunpfe type used during monitoring period) and as "arrmt Reprement " (e g., Emer " Grab" for mdaidual sample, "N#F for 24-hour composite, "N6f" for coctumaus momtorin3. etc )

19. Where siokhuns ci).c:mit Icquirements are reported. nttxh a brief explanation to describe cause and correctne attiens taken. and teffrcnce cach siolation by date.

I1. if"no dischxge" occon during murmaring period, enter "No Ducharge" across form in place of data entry. I2. Enter "Naa.e Tale of P: megal !acc:aa e iH!icer" uith " Signature of Principal Secutne O)]icer of,f uthonzed Agent " ' Telephone N:.r.ber

and "Date" at bottom of fann.

13. Mail signed Report to Omce(s) by date(s) mecified in pennit. Retain copy for your records.

14. Mere dsuled instruun ns fur use of this Dix harge Mom /cring Report (DMR) form may be obtained from Office (s) specified in pennit.

Legal Notice h repnt n required by 1;w (33 U.S C.1318,40 C.F.R.125.27). Failure to report or failure to report truthfully can restdt in ciul pectitier rmt o awed $10,000 pcr d y of vmlation; or in criminal penalties not to execed $25,000 per day of violation, or by inTnsor a c t for nct mere than one year, or by both. EPA Fonu 3320-1 (Rey, USM) PEntmTTEE NAhE/ADDfESS(J=MeForskyMunebrenen(fDg$lownr) NATIONAL POLLUTANT DeSCHARGE EUMessATIOes SYSTEM / NPDES 1 Form Approved. NAME gggyv7 7gg(gy p3g 9 37 gap 3g Ny% MNNS NT (D 18I? lC 3LI9G ADDREIS P . 3. 51T 4 "'"' 19 t? (SU3R 05) T Appr W y,"gsg as a

T ?? ; 3iVID OP4D0"? PERMIT NUMBER oesCHARof NuueER 7 77gg{

-t 3 r p n t s. 4 -n 3 0 -- - - pg '1 c; 3 7 7 w 4 '$ y' MONITORING PERIOD FAC"JTY gggf33 ggro,g3y p O ;i P 3 3!1TISP un a m na e m _ LOCA N FROM 4 3 i t. 71 TO -a li 3, OM NO 9 730 $8 3 M T l 600 t"M* Atvr3 31 113 e t' (2G2FJ (22-23s (24-151 (26-271 (28-281 (30'371 NOTE: Reed instructions before EEnplleting tNs form PARAMETER (3 M onM QUANTITY OR LOADWG (4 M OnM OUANTITY OR CONCENTRATION NO. MEQUENCY SAMPLE (46-53s (54-619 (30-45) (46-55 (SM11 OF (32-371 EX ANALYsS TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNI 7S n. ass fg4_se) (6S-72 SAMPLE t+7 O J 36 . Oct3e* 4*c?P: S t (r O 3 > ( ^ MEASUREMENT 7, M h',[M hd -) ? J g q 1 3 PERMIT ecctme e t Wi t e *?e 6 , f,} . tcc t;0 e 3,0 ~ytOg/ ;R3B <Pri1ML* ;' ); ; V3L" REQUIREMENT cee; gigy33% y g y y g g p, L sg eggp

7 LIL 2, !]f5L SAMPLE 23ete 09eOS: e050e> Qp f,, _ if % / ( 19) j @~

3 ; p g ; 7: q <, MEASUREMENT PERMIT N60007 r 5?S 300$0# 30 7Iov, f g -h CS , j,'g p / 2() MIOg/ h3

p ft 3 J r, ; C L 3 S 0 0 0 * */

13 0

. p 'Lf 7 7 ;133- g z t .. REQUIREMENT 3 4 ~ *- 'g) py; pgyg ng gf t gwp 1[i gwr SAMPLE A ": ? t $ P e%S ? S ( ] 9) 3 dcj Gf o") 17 JL ea ') at X ?g Y 9e MEASUREMENT /6,0 3%O 3 Y. O 14 % 5 1 3 PERMIT 03 3CN Me?? ? - #c' 15 20 30 NICc/ ma9 ' eet3 4r ;<;s n L+ REQUIREMENT -~ p. e t y) tyg pryty 'vg ggg ny y;f t 39ntg

- ?ntt PO?C?e O / [

v ; .. / , Iw ;)hpJ17 0+ SAMPLE ( C 3) MJ0tt P :t / , ' ';A01?si FLAN- ^ MEASUREMENT C , Q() / deco [ [5,[~ ' 530".0 1 } PERMIT wis??" 9'PDPr M%r 407046 *n*V44 '070 FELLY i$rI6"

/ P L 31 u

13731 Yhig REQUIREMENT n c) =, y - nnyty g y, . 4;9 cecc SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQtflREMENT NAME/ TITLE PRINCW'AL EXECUTIVE OFFICER 8 CERTIFY UNDER PENALTY OF LAW THAT t HAVE PERSONALLY EXAMINED AND TELEPHONE DATE AM FAMBUAR iMTH THE WsFORMATION SugeAITTED HERON: AND BASED ON r/ O MY INQUERY OF THOSE 80DINiDUALS IMMEDIATELY RESPON98LE FOR ,e j L iM i d JrOd0; { OSTAINtNG THE INFORMATION, 8 SEUEVE THE SveMITTED INFORMATiOet IS TRUE ACCURATE AND COM*LETE. 8 AM AWARE THAT THERE ARE s -

y [ hM 7g Uiff19LTV i nit ;' U 1 SIGNIFICANT PEhALTIES FOR SUOMITTING FALSE INFORMATION. lesCLUDING q THE POSSIStuTY OF FINE ideo IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 ' 6 i ~, q'q -s

r, y 13 g U' 9 lg A

u.S.C. e l a t e 880 NATURE OF PMNCIPAL EXECUTIVE ' TYPED OR PRMTED - w ormeren #Punemme _wMar w sersnese sa.sesusee menene aner maysmiewe y.ormsshoe se a, sfioco AREA NUMBER _ OFFICER OR AUTHORt2ED AGENT CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e#strechments heref .O 8; i Ek Fcrm3320-1 106-96l Previous editions may be used. (REPLACES EPA FORM T-40 WieCH MAY NOT BE USED.l -,, ~ ,; , . . / i a u .3, 3o .3., .> PAGE , OF r - - . _ _ _ . . _. _ . _ _ _ _ _ _ _ . . . _ _ _ _ _ . _ _ . - . _ . _ _ _ _ . . _ . . . . _ _ _ _ . _ _ ._..-.______.._____.__._____.__._m_._ _ _ _ _ _ _ _ _ _ _ . _ _ _ . _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . . . _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ . . _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( , . - . . . . . _ _ . . . . . - _ . _ _ _ . _ _ _ ._.._._.3 l j Paperwork Reduction Act Notice l i > , 1 l { Pubhe repertmg burden for this collee' ion of information is estimatcJ ta vary from a range of 10 b>ars as an ! oerage per response for some minor facilities, to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months as an average per responx for some n%or failith s, l bth a weighted average for trup and minor heihties of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per rnpons, in;iuding tina Mr resiewing i mstructions, sembing existing data sources gathenng and maintaining the daa nee &J as,d wmpicung and , ! reviewmg the collection el inicurnation. Send comments regarding the burdm estinate or any other aspect of i l ! this colkefion of infonmtion, including suggestions for reducing this burden, to Chief, Infornutmc Policy ! Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Wuhington, DC 2C460; and to the l [ Office of Information and Regulatory Affairs, Ollice of Management and Budget. Washington, DC 20503. ._... _ . .- _ . ~ . , , , . - . - . _ . . . . . _ - , ~ ~ _ - . . . _ , . , _ . _ . , . l General Instructions

1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information aheady preprinted.

2. Enter "Permitter Named /ailmg Addren (and facility name/ location, if difTerent)." " Permit Number." and

" Discharge Number" where indicated. (A separate form is required for cach d2scharge.) , 1

3. Enter dates beginning and ending "3/onitormg Permd* covered by form where indicated. i

4. Enter cach " Parameter" as specified in monitoring requirements of pennit.

1

5. Enter "Senp/c A/caxuremenr' data for each parameter under "Quantay" and "Gualny" in unit s specified m penmt.

"Arcrage" is normally arithmetic aver 1ge (geometric aserage for bacterial paumeters) of all sampic measurements i for each paramcict obtained during "Alonitoring Perma *'. "Alawmum" and "Mnimurf are noruudly otrime high and low measurements obtained during "3!onuoring Permd" (Note to municipak with secondar, treaur.cnt rcqnnement: Enter 30-day average of sample measurements under "herag" and caer amimma 7-day averare - of sampic measurements obtained during monitoring period under "3/aumum ")

6. Enicr " Permit Requirement" for cach parameter under "guantity" and "Qualay" as specified in permit 1

7. Under "No Es" enter number of samplc measurments during monitoring period that excetd amin:um (and/or ;

minimum or 7-day average as appropriate) permit requirement for each parameter. If none. cater "O*. l S. Enter "Frequemy of Analysis" both as " Sample Aleuxurment" (actual frequency cf nmphr g and analy sis used - during memtoring period) aad as " Permit Reymrement" specified in perunt. (e g. Enter Tont

fu contim:en; monitoring. "In" for one day per week. "lG0" for one day per month. "lw for one day per gaarter, era i

9. Enter " Sample 7)pe" both as " Sam;>le Afeasurement" (actual sample type used danng manhonng period and as

" Permit Requirement," (e g , Enter "Grah" for individual sample "N/K' for 24 hour2.777778e-4 days 0.00667 hours 3.968254e-5 weeks 9.132e-6 months composit: W . t " for j continuous monitoring, etc.)

10. Where sic!ations of penuit requirements are reported, attach a brief explanation to describe cause ed correctae actions taken, and reference each violation by date.

I 1. If "no discharge" occurs during rnonitoring period, enter "No Discharge" acron form in pbec of data ci in l 1

12. Enter "Name:7'ille of Prim, pal Executive 0))icer* uith

Signature of Prmcipal Exeaaive Gj!h er / khori:ed '

Agent," " Telephone Number," and "Date* at bottom of fann.

13. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your records.

14. More detailed instmctions for use of this Dncharge Atomtoring Report (DAlm form may be obtained from Office (s) specified in permit.

Legal Notice his report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or f ailure to report tsuthfu!!y can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to emed M5,000 per day of violation, or by imprisonment for not more than one year, or by both. g.m 337g_t (ney. 08-W %e9 PERMITTEE NAME/Af)ORESS(h=wrFareerhe 'Imsrs==(fLNA=0 NATIONAL POLLUTANT DISCHARGE ELamMATION SYSTEM (NPDES 1 Form Approved. DISCHARGE MONITORING REPORT (DMR1 No M N NAME If 7-rs/ g, .s , - .7- y ._,g.- - ;re 3

g. .

(2-f:~ $. 1 x< . Y & s. 7 3 .i r- ; y e =. App . $. @ M ru 05 M-E8

- '3 - '

ADORES 4 3, L 33y j - {gg3 eg} g jg5 t;,- s3;r- 3: 4 r3 9 ' , PERMIT NUMBER DeSCHARGE NUMBER y_ J t ? 7 r 'I ', a ; - - :a 1,r?' PAONITORING PERIOD "'JO' FACILITY y y DAY .)j .i 3 i " l .T YEAR MO DAY YEAR MO LOCATION FROM i- ? - ' TO q- t t 7, e3e 13 n r9ca

g n ; 3$^

.r<q. syr, 7 : n , (2a2ft (22-231 (2+251 (26 271 (28-281 (30 311 NOTE: Reed instructions befor completing this form. (3 cent on&1 QUANTITY OR LOADING (4 Conf On&f QUANTITY OR CONCENTRATION NO. FRECUENCY SAMPLE PARAMETER 146-531 (54-6 f 9 (36-45) 146-531 (54-6f9 OF (32-371 EX ANALySi$ TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 4243, fg, ggf fgg7, SAMPLE e. ,9 3 ,. 9 . e33 34, ,, MEASUREMENT - s;, t ) 3 PERMIT e e ,: 3 ~ a. er f. e. c .e o ^ ~~e ,3 sco3-g g,3 p3ggy ,yy . ,, ,. , ,. _ ,. ., 3 . ,, REQU REMENT y . .,,y. ,,.y, ,, , y,, y, ,. SAMPLE , 99337y 373e3, gm eg, (d) b-7, ' 3' ) 'Lo/'[. : ) , 9 j r '- MEAS'UREMENT ) u) ,g, _4,n a .< , u .4 , ( ) 3 PERMIT ;. g g , , 4 . r 7 , ,, c .t g g 3 gppy gpg 9; 7p 9 ,3 7 , , REQU!REMENT . , , _ ,,,, , , , ,,m. 7 :; p , r 7ap L SAMPLE y3e,- ~3ep;- ;~ygp, { y 4) MEASUREMENT , -. . , ;D ,J ) , , s 3, '

1

, PERMIT .,;.q ,s e gdeye e ~ p. 3 ..y ~ 3 n,g , ,95 ~g' .. y q,3 ~ ' ,;.,, y; y 1 7;3 s - ;,: ,. REQUIREMENT _ , . , q ,,, ,, ,, , ,,

p3 s vu - g e SAMPLE % y a. - ~e ene3 ;e~.a ( yq}

' ~ MEASUREMENT \ V i. I L i ? !. - ,7-,g g . PERMIT r,33333 e + .- y a . ,; , e ~ex g 3, y 3 , js pgygy ggg , ,. , ,,c.. g, REQUIREMENT , , , , , ,.,_,,g., ., , , y y 7, .4 m 7 f ,, SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE: *RINCIPAI . EXECUTIVE OFFICER 4 CERTIFY UNOM PENALTY OF LAW THAT I HAVE PFRSONALLY EXAMINED AND TELEPHONE DATE AM FAMlUAR WITH THE 9NFORMATION SUBMfTTED HEREIN: AND BASED ON MY INOUeRY OF THOSE INDIVIOUALS IMMEDeATELY RESPONStGLE FOR O^ ' L' d.C [ d t r! Ddtsri OSTAINING THE INFORMATION. I SEUEVE THE SUBMITTED INFOftMATION fS TRUE, ACCURATE AND COMPL ET E. I AM AWARE THAT THERE ARE SGNIFICANT PENALTtES FOR SUBMITTING FALSE INFORMATION, INCLUDING h[ b(L M yl/7[ ~J ,,,/ 1 i " { 'q 3 o g . )- { 1^"-e 0 (,' 6 '- ( ' , ' h , o' i n . r v. ~, n 1 4 THE POSSIBluTY OF FINE ANO IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 - U.S.C.5 1319. #tmmmes enWor m.se sannADS mey kicWe hies ap 50 $ OM SIONATtJRE OF PfuMCW'AL EXECUTIVE gg TYPED OR PRINTED .,w or mene.=mi : -- : r a.c s m.,im .,w a y.orms OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMEN,TS AND EXPLANATION OF ANY VIOLATIONS (Feference e# ertschments heref gf ' T -' ) ' " r ; ~13 ?! 74, >ge ejg[L -(c "r*',**= ", 3.n -3p(( * ^ T- .) g ( q 33745 ;3, e gg7~~s 3 s; ( y pqg7yg pqqgg 1 r ~r. , : ,- 1 7 ,> - ,,'-: 3 3 -e vt,- ny.7 n . ,, . ,- ,, , , e .,,,e- ,q< e , . y gy$ - .

u. 3. x . g .-r 4 .. , 1 . . 4 : vw .~ r e. w .

t Forn. 3320-1 108-951 Previous editu,ns may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 PAGE OF . 3 0 0 4 7 /1 b i O 'I 3 - 0 4 3 f. 1 Paperwork Reduction Act Notice Pubbc r pmting haolen I o this c< He ton of mfon ution is estmuted to vary from a range of 10 hou s as an verge [wt rey, e for m n:i ir Lcd:tn ' n i10 lu un, as an averge per respmse for mnw Trujor facilities, wth a * . gbted an ~ w r;up cd autu fm.iiitm of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per reponse, meluding time for reviewing m ams hons, urdany eti sing .bu ww , phcing and numtaining the data nceded, and compleung and u q; the co!Len t I infom. atma. Smd wmmcnu regs.; ding the burden estinute or any other a.spect of th.s c& tam cl infonutmo, includ,ng sua +tions lbr reducing this burden, to Chief, Infornution Policy ! !Panch, PM.221. U.S. Ervimnrrnu! Pro:,ttion Agency, 401 M Street, SW Washington, DC 2040; and to the Office of Icfornation and Ibegabtory Affairs, of th e of Managtment and Budget Wa3hington, DC 20503. I

t. .- - _ _ . _ . . -. . . - . . _..--.-...--.-a General Instructions

1. If funn ha twn partiaMy corr.pleted by preprinting, disregard instmctions directed at entry of that information already preprinted

2. Enter "/ Vrnutrce Nauu Ma,Iir:x Addren (and facihty nameAccation, if different)," " Permit Number," and "Dm harp Number" uhere indicated. ( A separate form is required for each discharge.)

'3. Enter datcs 1(ginning anJ cnding ".t fwitoring Permd" covered by form where indicated

4. Emcr each "Paracacter" as speciDed in memtering requirements of permit.

5. E ter "fam;!e A f+an mon" J ea fur uch parameter under "Guant ty" and "Gualny" in units specified in permit.

E h<rnc" n conmH) anthmwe a..;ry: Some:nc awrape for bacterial parameters) of all samp!c measurements ter~erh parw i ci t . d daring 'i!"n,lormg Perenti "Mamnum" and " Minimum" are normally extreme high nd hm ramma m;t, d cd daring "Wutorm / crmdf (Note to municipals with secondary treatment r;q w m eat Eaor 3 My aer m of s.uns n camremmts under " f reroge," and enter nuximum 7-day average - ef mm[h m;rurem; .ds ; bla&d d.amg taanuaru:/, peid under " Maximum.") F E m er "T 7 w ! b rarei w" far cad pmuu>. er und;t "Guantity" and "Gaahty" as speafied in perrnit.

7. Unj er "la li" a wr mkr ef unple neunnents during monitoring period that exceed inaximum (and/or munnmm or Ed a av;r me :.s ypropnate) nnB requirement fer each parameter. If none, enter "0".

it s % cr "!+ oja :0 n/ d o"tuh ".N mpS M aaurnant" (actu:d frequency of sampling and analysis used i duriq merotorins pcd d) "d i " Perm;t Re.parrv ml" rpccified in penmt. (c g., Enter " Cont." for continuous I manorin */ ," far r 4 pv wec "1M for en: day per month, "!M for one day per qu trter, etc.) L E m c r Wrj'le '/); c" M S a. " "n7 lc Meaorn , nr (xtual sample type used during moniloring period) and as

> n !n ,jurmemf (c4

ticr "GrA" for indnidual sample, "21//C" for 24-hour composite, "N/A" for connnuaus nmitorin" < Ic )

10. . Wre dolatict.s ef p:n m tcyn emenu at: mported. nuach a brief explaration to describe cause and corrective acticas taken, und refmace cih sielation by date

11. If"no dinharge" omrs dunrg m mitoring perioJ cc!cr "No Ducharge" across fonn in place of data entry.

12. Enter ".\ ae7n!: u I?ams"I bec'Hve Of] cer" sith " Signature of Principal Erecutive Oficer of Authorr:ed Age :.t " "Telephune M <!wr.* and "Date" at bottom c.f form.

13. Mul signed Report to Gm:e(s) by dat (s) specified m pernut. Retain copy for your records.

14. Wre d; tailed iminu nces for m of this Dm hary Maturing Ryort fDM/() fonu may be obtamed from Officc(s) speafied in permit.

Legal Notice His seport it required by ' a r33 UM.C. I118; 40 C.F.R.125.27). Failure to report or failure to report truthfully can nWt in civd p:nah at a oceed $ 10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day ci siolatien, er by impin mt for not more than one year, or by both. EPA Forrn 3320-1 (Rev. O l-95) . . - . . .. __ ., _ - .- . . _ m _m _ PERemTTEE NAME/ADOMSSWFerdunyNeum.Lc nas g(DWbrum# NATIONAL pot 1UTANT DISCHARGE EUMesADOst SYSTEM (APDES/ Form Approved. NAME N pjE N N N (D i U 7 I t; ? ,t K V SC9EE ogg 4 37gyga ggg,Lgy py gg gyps 7 3g et? ADDRESS '3 3. Y)I 4 T' 8 ' 9 ' E # ' 9 E i (3dH3 35) iWD A T ! *;; OAVID ORMDO*F PERMIT NUMBER psCHARaE NuMSER y . e{3gg 3 d l ? ? i N ; ?) 17 PA 1977 MITN PERIOD "U0 FACILITY jygypq y g g r, v y p 3 y ;> t, 3pgyy)y LOCATION FROM .: ii t. TO -a i. L 3, 3 *" 3 40 D [ S C 113 RF, ? l 004

3. ** ? I : DiiTJ O3N'OJQF (2S2tf (22-231 t24-25J (2s-271 (28-2s> (Jostj NOTE: flood Instruedone before cdnplleting this form t3 Cent On/rf QUANTl1Y' GR LCAD!NG (4 cent Ontys OUANTITY OR CONCENTRATION NO. FREoutNCY SAMPLE PARAMETER (46-531 154-619 iMW 146-539 154-671 oF (32-371 .

EX AmAtygs TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXiierJM UNITS esa gg4.gg; ggg7a 'LUW, [V C]';3UTT 33 SAMPLE ( 03) 0 3 n ap s Oc;ety c;>F:n? / t M i!3 fHei!334T 0Ltv, MEASUREMENT d, @,l_ d,C/[. h [ b[ ! S ') M a i 3 a . PERMIT R g p ') > ? 9PpO97 $$5000 ^;cotte caette. ce g g s,L i 73 T I n,; nen,Ory? ;1179 ytLp REQUIREMENT gn gy; e n, 77 y yy e3 3eee SAMPLE MEASUREMENT PERMIT - REQUIREMENT SAMPLE MEASUREMENT ~ PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT *, SAMPLE MEASUREMENT PERMIT ' REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERM 4T REQUIREMENT . NAME(TITLE PRINCFAL EXECUTNE OFFICER I CERDFY UNDER PEN ALTY OF LAW THAT I HAVE PERSONALLY EKAMmED AND TELEPHONE DATE AM FAMauAR WITH THE INFORMADON SUSMITTED HERErN: ANO SASED ON f 'Y f[* MY (NQUIRY OF THOSE IMOtVIDUALS IMMEDIATELY RESPONSIBLE FOR O 3 g fig j'ghg/ Aj 08MMNG M MWAN, I BEUEVE M SUSMIMD WNAN IS osvta ocuanf TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE i / / //[ f y (, Cheth s t ry Manaxe r StGMRCANT PENALDES FOR SUSMNG FALSE WFORMAN, WCLUDmG - - - 9g9 - 9D 1 "' *%* THE POSSISIUTY OF RNE ANO IMPRIS,ONMEN.T. u.S. SEE eney secam 18 eU.S.C. mise I ,1001 AND 33 se sto,oco SIGNATURE OF PRWICFA' 'L EXECtJTRtf , ' 393-3"113 TYPED OR PRDITED .ma.C.t istS. smemme r mersmnn :. _ .wa n m a.meum enumer am am..aw s v rms OFFICER OR AUTHORIZEO AGENT M NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af strechmoors herof eO se .

4 Form 3320-1 (06-96) Previous editions may be uSed. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) .m PAGE

) 3 .; / j 3 ;, y . g 3 ;OF - - - -- _ ___- ___- _-______- - ____- - -______ - - - _ ________ _ ~ _ _-__ ___ l l i Paperwork Reduction Act Notice l l l : } Pubhe reporting burden for this collection of information is estinuted t vary fwm a rang of K' hours as an j average per regense for some nunor facilities, to I10 hours as an average per rc>penw for some nic r fciht es, d uith a weighted average for major and minor facilities of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per responw, includiq tim br reviewing mstructions, searching existing data sources, pthering and maintaining the data n:cded, and carpicimp aaJ l reviewing the collection of infunnatwn. Send comrnents regarding the burden cathnate e r cay other a pect of l l this tollection of infonnation, including suggestions for reducing this burden, to Chief, Infonnation Policy j i lisant:h, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Wehington, DC 2040; and to the l Of fue of Information and Regulatory Alf airs, Office of Management and Budg4 Washington, DC 20503. l _ _ _ _ _ , _._ _ _ _ j General Instructions

1. If ' form has been partially completed by preprinting, disregard instmetions directed at entry of that information alr'rady preprinted.

2. Enter "Pernuftec Name/Afailing Address (and facility namc/ location, if ddferent)." " Permit Nu nber," and l "fucharge Number" where indicated. ( A separate form is required for esch discharge ) l

3. En.ter dates beginning and ending "3/onitoring Period" cmcred by form where indicated

4. Eriter each " Parameter" as speciGed in monitoring requirements of permit.

l

5. Enter " Sample A/camrement" data for cach parameter under " Quantity" and "pualitv" in units specifi;d in permit, )

".f rerage" is nonnally arithrnclic average (geometric aserage for bacterial pammeters) of a!! sampic meanucments for each parameter obtained during "Alonitoring Period"; "A/arunm" and "J!mucm" are nonnally esticmc high . I and low measurements obtained during "Alamtoring Period" (Note to municipals v,uh secondarj treatmect icqmtement: Enter 30-day average of sample measurements under %eraxe? and emer maaimma 7-da) average of sampic measurements obtained during tuonitoring period under "Afarimmn. 9 ) ti. Emcr " Permit Requirement

for each parameter under "Guantity" and *(hahty" as specuied in pennit.

7. Under "No Ex" enter number of sample measurments during monnoring period that exccid maximum (and/or minimum or 7-day average as appropriate) permit requirement for each param:ter. If none, enter "(I' 1 Enter " Frequency of Analysis" both as " Sample A/casurment* (actual frequency of sunpbog aad anahsts used Jming monitoring period) and as " Permit Requirement" specified in pernut. (e g.. Enter Tont " for continuous monitoring, "16* for one day per week, "160" for one day per momh. "/S0" for ont day per qwuter e; u

9. Enter " Sample 7W both as " Sample A/eamrement" (actual sample tvpe esed during, monitanng period) and as

" Permit Rerjuirement," (e g., Enter "Grah" for individual sample, "21/K? for 24-hour composite. "N A" for continuous monitoring, etc.)

10. Where violanons of pennit requirements are reported, attach a brief cap!anation to dsenbe cause :utd correctnc actions taken, and reference cach violatico by date.

I 1. If"no discharge" occurs during monitoring period, enter "No Dncharge" across form m place of data entry.

12. Enter "Nametritte of Principal Executive Officer" uith " Signature of Prmcipal Executne Oficer efluthorced Agent;" " Telephone Number," and *Date" at bottom of form,

13. Mail signed Report to Office (s) by date(s) specified in pennit. Retain copy for your records.

14. More detailed instructions for use of this Dncharge A/onitoring Report (Dllic fonn may be obtained fr om Officc(s) specified in permit.

Legal Notice lhis report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report t.uthfully m result in civil penalties not to exceed $10,000 per day of violation; or in cnminal penalties not to ecetd $25,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95) %eo e A PERMITTEE NAME/ ADDRESS s=ch AFerskryN 1. cess (D per==r) i c:t.TIONAL POLLUTANT OtSCHARGE EUM4 NATION SYSTEM (NPDES 1 Form Approved. NAME DISC ,, , ' ,, 7 .. ' , .3 , E MONITORING REPORT,/,0% 7 ay, .y , _.,.s. . OMB No. 2040-0Q04 ' ' Approvat e'xpires 65-31-O ADDRE2S ,3, 5 )( r " ' { g >; 7 3 m $ g "" ;3gy

7. . . ,-

n. 3 ;p PERMIT NUMBER OkOHARGE NUMBER p ,

. p I ; ,1 u .u r-. .( .- ' <enr, i ' MONITORING PERIOD '.$aO, , Fi'CtLITY '1" 7 in L L '? ' ia s TE *I J' YEAR MO DAY YEAR MO DAY LOCATION FROM TO ~ee '* o :_, ii 1i >' e, . T - m a. .e,- g ~n- . , s r+s (2& 27/ (21-23/ (24-25/ (26-27) (28-29) (D3pj NOTE: Reed Instructiores before% completing th '?a 3- ' & PARAMETER '# Cd On4J QUANTITY OR LOADING (4 Cerd on&J QUANTITY OR CONCENTRATION N O. FREQUENCY SAMPLE (46-531 (54-611 (36-469 (46-531 (54-69) or (32-371 EX ANALYSIS TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXtMUM UNITS N (nssi (6 m SAMPLE , 3 ~ ,. - se++.. s s ,

' ,* 3 MEASUREMENT

3,3 . ? 3 , PERMIT za*3+e ., + #. g g - .e ; s,9 searet ;, S ggg[y ; e, M

,, , _;,. , , REQUIREMENT 33 ,1.., 3,,, ,, ,7you -, g-,, <- -). , . p ,, - SAMPLE g g ;) ,ysfs . ,3 p, np3 . h () MEASUPEMENT t 7(y r s , ia t 57 ,g,

'><.3 +

) - PERMIT ; . p q , ., n r g e .- ,mgge + % ; .3 ; egg 373 p""q" , y' 73zg7 ~~' '" -s. .s , , : REQUIREMENT , , , ,y, .,, , , ,_ . _ , ,

?i,>J . r -) P y ?, SAMPLE cc . m. -

. y om y MEASUREMENT 7 99 .t m ,'m .0 t 3 PERMIT c c - e , 3. yt,ety , - n+9s; y * ,q t,35 g g .. g g ,333 , , , , . , , . , _,, ,, REQUIREMENT ,s . ., , , , , , , , , y ., ..,,f, ,) ; y. , 3 SAMPLE ,,4. -4 - 9 n e ., --e3-7q) MEASUREMENT ./' I f. * .; L ,; PERMIT : ^ 7, I 7 REQU5REMENT 4 e 3 3 ;- *; ~ 7 ^ t: S t 0 t. r t i :'- g ?. 3 l e5 CPd# ~ ' %A4 ,.. . . , , 7,. , ,. 9,.,,._., ,,,runo . -- / r SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERDFV UNDER PENALTY OF LAW THAT t MAvg PERSONARY EXAMINED AND AM FAMtOAR WITH THE INFORMATION ftuBM'TTED HEREIN; AND BASED CN TELEPHONE DATE [ (; , MY INQUIRY OF THOSE INDfWUALS IMMEDIATELY RESPONS:BL E FOR 'w D JiY . d )II JO t'i ,- '/ OST TRUE,AANtNG ACCURATE THEAND INFORMATION. COMPLETE. t SEUEVE I AMTHE AWARESUBMITTED THAT THERE INFORMATION ARE . IS ' b bd.dR - g I!anafe ii*!t.5E* ' SIGNIFtCANT PENALT'ES FOR SUBMITTING FALSE INFORMATION. INCLUDING ' ) 410 juj 411' ' ' 'J y g+, j, ,,. THE POSSIBluTY OF RNE AND IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 U.S.C. 9 1310. d%nsmes needer enese sesmenos neer escasse mies ass so # 70.000 StGNATURE OF PfuNCIPA'L EXECUTIVE AREA TYPED OR PRINTED w or ain-iia : .- .: r aerw.m. s nios.eM w s -s orflCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# attachments herel e#

- n Dl C N !\ f L <. -

Form 3320-1108-95) Previous. editions may be used. ~ (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF a ". ' 3 ; f ') 3 1 0 5 3 . ^ q 3 4 ; 1 ~ ! Paperwork Reduction Act Notice l l l Pubhc repodi:.g harden fm this. &&a nf udornunon is atinated to vary from a range of 10 hours1.157407e-4 days 0.00278 hours 1.653439e-5 weeks 3.805e-6 months as an j l r,mp gr ropnw for s r a mimr fuuines, to 110 houn as .tn aurage per responw for some aujor facilities, ! unh a ue:ghted average ha rrmt Lnd nunor facilitia of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per response, including time for reviewiny ! ; im:n uc:, ms, s wehicg ni t ng .L 2 , ,m c o y.uhaing ed maintaining the data rmied, and completing and remmg (be allatwa of afum.atian_ Scnd conunculi Iegarding the burden estimate or any other opect of th:s coHxtina of myrnaan, in;I tding sugptions for reducing this burden, to Chief, Information Policy , Unnch, PM-223 U.S. Ervironnwnlal Proation Agency,401 M Staxt, SW Washington, DC 20460; and to the ) ! Of fice of Information and Regu:atory Affain, OfDee of Management and Budget, Wuhington, DC 20503, 1 1 ( . . _ . . _ , _ . - . - . _ - . . _ . _ _ _ . . - - . _ _ . . _ _ _ _ - . _ _ _ _ . - 1 1 General Instructions 1 1

1. If form has been partia!!y completed by preprinting, disregard instructions directed at entry of that information j already preprmted. I i

2. Enter '/ 'ermutce Vame Mailing Addren (and facihty namc/ location, if different)" " Permit Number," and !

"Dh:harge Number" u here indicated ( A separate form is required for cach discharge.) 1 Entcr daics beguming and endmg "Mcmaorme Per od" covered by form where indicated

4. En:er em h " Parameter" as s;xaned in momtoricg requirements of permit. l

5. Ec:;r "V;mf* t.fmur ra' dea for cath p.tameta under "guantity" and "Guahty" in units specified in permit.

W ro c" n noo m uy ruhna acng: (gmmetric aserage for bacterial parameters) of all sample measurements f or wh pv. meter or uin:d durig "h wg Permd", "Marimum" and "Mmimum* are normally extreme lugh a i hm mmuru i ts < htwcd 6;im; ".'!,maorum n rmd " (Note ta municipals with secondary treatment s q-nt; m eat Enkt b day a ert.: of sampk neasurements under " Average " and cuter maximum 7-day average Of Mayl0 !Uca.1Gri1MentS U!CUnCd daling, WOnituliMg pCriod undCr "Ma.r mum. #) & Eater '/'mmt R; oro en! for ucch panuncter under "Guantity" and " Gun /ay" as specined in permit. IJn&r "Yo /2" cuer umkr of s.u. pk measurments during monitoring priod that exceed maximum (and/or mmanum or day w:r me t , appmprudei pennit requhcment for each parameter. If none, enter "O" A Ever "/:ry<my af a $ u" beth n "' m;3/c Me.:.u<rment" (actual frequency of sampling and analysis used f .!ing meterm3 ;wd) and s "/Yrm.t Ra;uremnt" speciGed in permit. (e g , Enter " Cont " for continuous momtving, " / " Or :>, e d iy pr v ;k, */ M far one day per month, "/80" for one day per quarter, etc )

9. Er'c r "%nja I)j e" is> as ' m;!c Aleanrement" (actual sampic type used during monitoring period) and as

$ 'erma fleptemni." (c g-. En! r %uh* for individual sxuple, "NHC*' for 24-hour composite, "NM" for em.tinuous momtonne, c'c )

10. Wkre sioL:ocos of p; rat rupmements are reported, attach a brief explanation to describe cause and corrective actions taken. and ref:rence cAh siohition by date.

11. If "va discharge' occm deong moutorine, pcrM cuta "No D!scharge" across form in place of data entry.

12. Umcr ".VameTale of l^nmund i rc.nawe O$cer" sith *Sgnature of Principal Executne Ofpcer of Authori:ed Agcnt.* '"leiephone Vuorr

and "Date" at bouom cf form.

13. Mml signej Repert to Ofice(s) by dite(s) scafied in permit. Retain copy for your records.

14. Niere detailed instruc tans ha use of this Diu hurge Ahmitoring Report (DMR) form may be obtained from Officc(s) specified in pcrmit Legal Notice This repert a requhed by % (33 U.S.C.1318; 10 C.F.R.125.27). Failure to report or failure to report truthfully can resu:t in cn d pena %s not a acced $10,090 pr day of violation: or in criminal penalties not to exceer) $25,000 per day el violation, er by imprium ra for net rnore than one year, or by both.

= EPA Form 3320-1 (Rev, OW) "% .p= . . _ - . . . __ 4 _ _. __ _ . - . ._ - _ FERemTTEE NAM /ADORESS#adsdeFer&tyName'Earemen(Dqdlmer) NATIONAL POLLt/ TANT DISCHARGE EUMW$ATION SYSTEM /MDOES) Form Apprr.ved.- NAE p q gg yg({gy a g g er g *yy773y , [ OR M M T(O tt7 $ 003 g3;3g;gy[q TLOMQ2040 GOO 4 p p P"" ADORESS P. 3. D1 1 D F ' 'W 1 % 901 % (UU3R 35) *Y a ~' T N ; 3iVTP JR vD0 RP , PERMIT NUMBER DiscHARoE NuMeen p ...yyy4g 5 4 I P D f .1 ~, e' '_M- *. . O t' 15D77 MONITORING PERIOD 1AJ30 FACluTY gga,yCg 7;;* E} py;gg 3 p g y ;'y g LOCATION FROM sa TO 5 Li JE **O Lt t 50 9I3CHA40? l_l 000 A?"1: "A P.1 I 3 3 P 4 01 P (2G2ss (22-231 (24-25J (26-271 (28-291 (Jasts NOTE: Road inesuctions before completing Weis form. PARAMETER (3 Card W MANTITY OR LOADM /4 M W QUANTITY OR NTRAM NO. FREQUENCY SAMPLE 146-53) (54-619 (30-45) 146-539 164-691 OF ! (32-37/ EX ANay$is TYPE AVERAGE MAXIMUM UNITS MINIM UM AVERAGE MAXIMUM UNITS e ,g,,j fgy, 'l34, iM C 3 V 3 J l r 3 'i SAMPLE { g 3} pgng3 g mg p y g .u g O y ET ~ ?421 ' 3 B A T i " M r P L A )y - MEASUREMENT 6,()d h (),d[4. S 5305? I ) 7 PERMIT Rap 3c? p g p q p ** c c g er y eggg3 , gggge . ,: n _q g .. 3, ' gm ? P 7 ?.U ':Nr 17157 Y a tri . REQUIREMENT ' R e., 3,3 n ,7 g 3g y33 SAMPLE - *** b **' NM d I-I MEASUREMENT d C, 3 4 O,3 bi.sc4g 2at h i Does fJee,sr, t / '/6 ~ REQ IR ENT . SAMPLE > , MEASUREMENT PERMIT ftEQUIREMENT ! SAMPLE MEASUREMENT PERMIT , REQUIREMENT , SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT . PERMIT. REQUIREMENT MAME/ TITLE PftWCFAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 4 HAVE PERSONALLY EKAMINED AND _ TELEPHONE DATE AM FAMILIAR WITH THE INFORMATION SUSMtTTED HEREIN AND SASED ON MY TNQUIRY OF THOSE INDtVIOUALS eMMEDIATELY RESPONSIBLE FOR Dily i d OrnJori OSTAANING THE INFORMATIOtt, i SEufVE THE SUDMITTED INFORMATIOes 49 )t ') V [. ,

7. J TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE \ j [f h w$# / /

ClltdiS L I'y 11Onay,C r SiONtRCANT P9eALTIES FOR SUBMITT3NG FALSE INFORMATION, IteCLUDING

- ,4 ar~

> 3 3., rJ 1 *13 gD i<> L g THE u.s.C.POSSE 86UTY waner n i318. #FwiNo. OF Rete.ANO m sensues IMPRISONMENT. mer w mi . e, SEE s 18 srom U.S.C t 1001 SIGNATURE AND 33OF PRWICW'AL EXECUTIVE , TYPED OR PRINTED saw or medawn : er esewesa s menes said s yearaJ OFFICER OR AUTHOnt2EO AGENT M NUteER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refersnee a# ettschments here) -

),, g j,,, , , , % , ( q ttf "

)r wit h6 ja' sis, w~ a 7 i w .x ~ +0 irQ 1) i~ fan . ,, , $,f m 4

5 / da ny w ) & Form 3320-1108-96) Previous editions may be used. IREPLACES EPA FORM T-40 WIGCH MAY NOT BE USED.) n, PAGE 7 y f 7.c y p .,3 - j3 (OF .-- _ . _ . _ _ __ _ . - _ _ _ _ - _ _ _ _ _ _ _ - - _ - _ _ _ _ _ - _ - - - - _ _ - _ _ - - _ _ _ - _ _ = - _ - - - - - _ . _ _ _ _ _ _ _ _ _ _ __ l f '

Public reporting burden for this collection of infornution is estimated to vary fimn a range of 10 Loan e an

{ aerage per repmw for sonw minar facilities, to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months as an average per respose for some may:t fccibhes, j j with a weighted average for major and minor facilities of 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per ree.panserincludmg tin- !ar reviewing . j mstructions, searching existing data sources, gathering and truintaimng the dau needed, ud completing and , l reviewing the collection of information. Send coraments regarding .the burden utimate or any other a:pect of l' rhis collection of information, including suggestions for reducing this burden, to Chief, lalonrution Pohey firanch, PM-223, U.S. Environmental Protection Agency, 401 M Street. SW hhington, DC 20460; ed to the Of 6ce of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. , l General Instructions

1. If form has been partially completed by preprinting, disregard instmetions directed at entry of that information already preprinted.

2. Enter

Permittee Name'Alailing Address (and facility namcIlecttion. if different)," " Permit Nu nber," and

" Discharge Number" w here indicated. (A separate form is required for each discharge )

3. Enter dates beginning and cadmg "Alonitoring Period" covered by form where indicated

4. Enter each "Parame!cr" as specified in monitoring requirements of permit.

5. Enter " Sample Afeasurement" data for each ptrameter under "(fuannty" and "Gualitv' in umts sycified m permit.

"Acerage" is normally arithmetic average (geometric awrage for bacterial parameters) of all sample namrements for each parameter obtained during "Alonitormg Perioif'; "Afcmmu,n" and "A/ nimam" are normally c,.treme high and low measurements obtained during "A/omformg Period * (Note ta nmnidpah with econdary treatment requirement. Enter 30-day average of sample measurements under " Average." and enter nt txunum /-b aserge of sampic measurements thtained during monitoring period under "Alaximum ") .

6. Enter " Permit Requirement" for each parameter under "Quannry" and "Gualay" as spcctfied in permit

7. Under "No Ex* cnter number of sample measurments during monitoring p;riod that execed manmum (and/or minimum or 7-day ascrage as appropriate) permit requirement for each parameter. If none, enter "0"

3. Enter "Frequemy of Analysis" both as "Nample Afeasurment" (actual frequency of Saraplir1g and ralysis ucd during monitoring period) and as "Pernat Re<juirement" speciGed in pennit. (e g., Enter "('o"t " for reminueus monitoring. "1/7" for one day pet ueck, "U30" for one day per month, "140 for one day per quaner, et :.1

9. Enter "X mple 7)pe" both as "&:mple Areasurement" (actual s:miple type used during monitoring puiod) and as "Pernnt Requirement," (e g., Enter " Grab" for individual sample, "2 /HI

for 24-hour composs TA" for continuous monitoring, etc.)

10. Where violations of permit requirements are reported, attach a brief explanation to dsenbe cause a:,d corrective actions taken, and ref*erence cach violation by date.

I1. If"no discharge" cccurs during monitonng period, enter "No Discharge" across form m place of data ertrs

12. Enter "Name/ntle of Principal Executive OJJicer" uith

Signature of Principal Executue Ojjicer & Authori:cJ Agent " Telephone Number," and "Date" at bottom of form

13. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your records.

14. More detailed instmetions for use of this Di3 charge Afonitoring Report (DMR) fann may be obtained fiom Of ficcts) specified in permit.

Legal Notice 1his report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95) e .s PERRAITTEE NAME/ADORESSta-hdeFerdMyhoviswaefDWlwund NATIONAL POLLLfTANT CMSCHARGE a -TION SYSTSA (APDESJ Form Approved. NARE N GEM N mG M T(N/ OM 2040 0004 " ,P{Vr i V A LL

t P34-, 3pAyi3i (2-f 81 (77-191 [ ve g g" 3 C p '~p:- -

a g- App.S, roverNo.expires 05-31-98 ADORE 1S 3. 3 , 9 3 g. . g ~m^"T* +" 'm a ' ( S'3 B F 35) 12 N d

" I' V ; ')1TI" 9.(9309i PERMtT NUMBER DISCHARGE NUMBER , p qiDOIGaMer .

1 1 V:77

AMU MONITORelG PERIOD

? Ell?? VELLTT '93RF 3IA?llJ YEAR MO DAY YEAR MO DAY ~ LOCATION FROM ni TO qr )* 3s 1- 4 -i n r v3 3regeunp g g aet 3 e e .; . n3 yr, ,4,nm,v - (Jo2rJ (22-23 (24-25) (26-27s (28-2.9/ (3S3rj . NOTE: Reed ,c. _ ' .__ before counpleting this form. PARAMETER I3 on&A QUANTITY OR I.OADING I4 M 0%rs QUANTITY OR CONCENTRAM NO. W oopm CY SAMPLE 1 g4g_ gg, gg4.gg, g3g4gp g4g.gg ggs.gry (32-371 EX ANALys$ TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS n 43, 164 68) (69-707 , 'L)W, I4 23403IT U SAMPLE v ,u gjo y)g ,. g z g y g3379 gg9g f , u r,r i n y MEASUREMENT O, 0C [3 % v d ug( ' (<5 / j ntas i3?57 ) a PERMIT qg y . p p e, $ ., p 399ge, yggyp ggg g 1 REQUIREMENT ~y 7 .5TINi ' :' N 1 - ec *1si? y3 e,' ,, , y ,, p,y7y ,y , _ , . , , , , SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPt.E MEASUREMENT , PERMIT ~ REQUtREMENT SAMPLE MEASUREMENT PERMIT - 6 EQUIREMENT SAMPLE , MEASUREMENT ! PERMIT , REQUIREMENT SAMPLE MEASUREMENT PERMIT I REQUIREMENT a - SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRMCFAL EXECUTIVE OFFICER i CERTIFY UNDER PEN ALTY OF LAW THAT t HAVE PERSONALLY EXAMINED AND TELEPHONE DATE i AM FAA#tLIAR WITH THE INFORMATION SUSMITTED HEREIN: AND BASEO ON < ; MY INQUIRY OF THOSE leeDIVIOUALS tMMEDIATELY RESPON98LE FOR i f-d NO OSTAaNING THE INFORMATION. t BEUEVE THE SusutTTED INFORMATION t$ 4 A - dial V l u. OTUCOrl- TRUE. ACCURATE ANO COMPLETE. I AM AWAAE THAT THERE ARE h (yJ[{f j/ y ..f@ / h, !

9GN4FsCANT PENALTIE3 FOR SUSMITTING FALSE INFOMAATION. INCLUDING - -

,.1 t 1 93-51;13 q, o- 5 , o ChGliS t. rY Eihn d?.t2 r THE POS99auTY OF FINE ANO IMPRISONMENT. SEE 10 U.S.C. t 1001 AND 33 , 1 a to U.S.C. t tais. m ammer sneae seams mePheben, mi e w se s70.000 SIGotATURE OF PMAL EXECUTNE TYPED OR PRWTED ens rmanamen: . - eraerween s monens and s pears.# OFFICER 0R AUTHORt2ED AGE 9ff NUMllER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# ofrechments here/ id l 6 8 8 - S_ l $A Form 3320-1108-969 Prov60us editions may be used. tREPLACES EPA FORM T-40 WeeCH MAY NOT BE USED.) PAGE OF 1N35/961003-Oi3% 1 4_ m _ - _ _ - A --"5-*# -. 4~ a , - - m-y m.--.. ~ _ . _ Paperwork Reduction Act Notice 1 l Pubbe nyntmg bunkn for thh tolken..a of inh,rnanon is esimated to vary from a range,of to hours as an aver.txt per repune for wnw nnnor facdito. to 110 hours0.00127 days 0.0306 hours 1.818783e-4 weeks 4.1855e-5 months as an nerage per retmse for some nujar facilities, ( with a wc:gbYd acrage kr n@r ;nd minor faahta, uf 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per regnse, including time for reviewing m o ru . nen s. veachiry eu a ng dra ou as pheng anJ r.uintaining the data needed, and completing and } toioung the culluaion W infurn_dwa. Scud tonurara.s repuding the bwden estimate or any other asput of thN colfation of infornutmn, including sup .aions for reducing this burden, to Chief, Infornution Policy . Branch, PM 22L U.S. Er thanntntal Pmtection Agency,401 M Strut, SW Washington, DC 20460; and to the Office of lofernution and Ryu!atory Af fairA Othee of Management and Budgtt, Washington, DC 20503. General Instructions 'I. If form ha; fo n partially completed by preprinting, disregard instructions directex! at entry of tbt inforuution aheady preprinted.

2. Enter "Permitice Na"re/3/aihng Addreu (and faedity name/ location, if different)," " Permit i ' umber," and "Docharge Number" u here indicated ( A scparate form is required for cach discharge.)

, 3. Enter dates leginning :md endmg "Monnoring Period"coscred by form u here indicated

4. Enter each " Parameter" as speaGed in monitoring requirements of permit.

S. Emer "Jample han-mon" data for each p,uamaer imder "Gaant ty" and "Guahty" in units specified in permit. , ".f maf is nen:ui!) ruimthe w,oge (y ume!nc aiemge for bacterial parameters) of all sample measurements { k r each pir.uncter oh >.rd during "Mearurmg Pwiod"; "Manmum" and "Mmimum" are normally extreme high l and kw meamren ate die "! danng "t/ mu.ormg Period" (Note to municipals with secondary treatment req mres, ut Enwr 1 K!ay nug: of mmpb m asorements under " Average," and enter maximum % day average et semple mauone:.ts obtaiual during mcnuoting period under "Marimum ") A En:ct "l'a md R e an" for cach pan mer cr under "Gaantuy" and "(Juahty" as specified in permit. L Under "No / t" enter , umber of sm:pic measunnems during monitoring period that exceed nuximum (and/or i mmhvum er Aday aver 4c as appropriate) permit requbement for cach parameter. If nonc, enter "0" ! R Eraer */"nya ncy of ., q v ich as Wrj)!e Mc.wment" (actual frequency of sampling and analysis used l dming netutaring pen m and w "P< ,na Rq.i cmmt" specified in permit. (e.g., Enter "Gmt " for continuous ! n;oM.mng. 'l " for n day p r weck * / Ju" for one day per month, "I 90" for one day per quarter, etc ) )

9. Emr %mpi, Trg" beh as

Nmple Mcawremem" (actual sample type used during mo itoring period) and as I "Pern:t Reprcmcru " 'e g , Enter " Grab" for indisidual sample, "NHC" for 24-hour composite, "M'A" for l

cuchnuaus menitorin". etc.) j

10. Where siolaticus cf pe:mii requirem:nts me reported. attach a brief explanation to describe cause and corrective att: ens I:4ca, and refetc ace each vmlation by date I !. If "na disdtaru" occurs Joring nomtoring peri 0d. tuter "No Diu harge" across form in place of data entry. l

12. E1 ter "NameTale y) Prwapal Execatn e (Wcer" uith " Signature of Principal Ericutive Officer ofAuthorized Agent " " Tele; hone % der," and "Date" at bottom of form.

13. Mail signed Repm1 to Omce(s) ty date(s) specifieJ in permit. Retain copy for your records

14. Wre detaild instrucnens for use of this Diu harge Monitoring Report (DMR) form may be obtained frorn Office (s) 9ecified in permit Legal Notice This a port is required by l m (33 U.S.C.1318; 40 C.F.R. l~25.27). Failure to report or failure to report truthfully can redt in civd penalties not w < xtred $10,fXM per diy of wolar:on; or in cruninal penalties not to exceed $25,000 per day of siolation, or by imprisor n1 nt for not more than one year, or by both.

EPA Form 3320-1 (Rev. OS95) % ,i g -. . = . _, . - PERMITTEE NAME/ ADDRESS #=M Fere,hwl.mema gfAsWed NADONAL POLLUTANY DISCHARGE EUMNdADON SYSTEM (NPDES 1 Form Approved. NAME G y e s ;, < ygLtry pg3pr 3 3py3s DISCHAR,y,E f3 MONITORING REPORT (DM,R,J f,3 3q773 1,, 7 ,, g g , OMNo 2 ADDREta ?. 3. 331 4 *

a ' ' 6 ? 9 '^1 F (S089 05) Apprevelycos,OS-3193 A

T 't ' OEV[D 3 P i D f) 3 p PERMIT NUMBER DsCHARGE NUMBER se ,,

, p{yy{ in ,r p p [ s s p,1 P ?. pg 5. 5 3 7 7 -- m g '3 5 0 ^ FACILITY qt .p<*. , MONITORING PERIOD ' ,e- "v 3. ( r ..=. >t o-+ry g t.o .o e, # t 4 4-iA* 3. I YEAR MO DAY YEAR MO DAY _ LOCATION FROM a it e2 TO -, &i : ; *M Mn 'J T 3 C O A D G C { { dng M?% '?YM* D%iTD 3 L '.i 3 ) D t' (20219 422-231 (24-259 12627) (28-299 f30-319 NM Reenllne leefore i form. PARAMETER (3 Carmi QUANTITY OR I.OADING I4 Car W I QUANTITY OR CONCEN MTION NO. FREcuchcY SAMPLE ' M6-639 154-691 136-459 146-55 154-619 OF (32-37; EX AN aYsr5 TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,v343; ,,4_ ,,; (6s-7ar 73 SAMPLE me*e?" / e S 0 9 ;'r ^:Saco ,p ( 2) MEASUREMENT 7, b 3 7. I O O 7 M 0 ? t q 't i '; m . PERMIT 0;cett C$$1N7 N 1 ': 3 . fi t$c777 4,Q gg, gly ;33 't t L a : REQUtREMENT ~ .y e >LJes? 173V M T :r r " M -ia a E D 9 5 - S1 ( L1) J T P u 3 '; " y , g, ,:[\ SAMPLE c3*" %+#!> 900c* p3 g( (p3 49 MEASUREMENT N - ) i' ;1 r 1 0 PERMIT tM*?9 St0C00 C ^ ' t fs O ? M { >M t? RMQD* ' t: g % y ;M;D "PLj^s* ;7'i30 f 5 L1: REQUIREMENT 2c w 3yg' y yd xy p r;f t TL+1TH7L ' !* 1, 73?A. SAMPLE ? W ? ^- O c c *- ; ' 27':002 ( 17) h w^ G.< f ,e=;3 MEASUREMENT { C,3 4 O, 3 U L,rp pqg -291 1 PERMIT *: 0 0 0 0 4 t 'r ? c M 05' *t*773 ' 1 ') 7 HEN :01 P ? L 2, rLt : g; ,331" 7F Lp REQUIREMENT eaa 10 AYO- PAILY MI MG/L D I S f' l ' LJ9 I ', .-' l u n J i '" 4 SAMPLE ( 2) t000e> mapaar neem ' i v 't r!g"5?N1 9LtN MEASUREMENT 2 7,[ f 3 3,70 O N'ly b6 4 l'3S1 1 1 PERMIT 2 9. O ') c t PecN"i 3007^C M00?? 4 " 300 006 AILY W Ti: ' 7 t' L I 4 Mr ,135; V A L1 - REQUIREMENT "3 97; 6 t t r, y 97 3; cece ~i8 03: t, ?17'L SAMPLE P C " ' ' 0'? P2 C 3 ^' T *( ? 4 ( 13) qwgL MEASUREMENT O* O [ bM / 7 Qg j)^: ' l PERMIT 3*0 N ^*^*7) . OM 'NW' '. :) L.21 r i4 L l idAo -rt3: av ;<,3- lit REQUIREMENT Men a 4t; j p 3 p h g jr eg/L ^ 3L, , SAMPLE Ju?"' < - "$' bN ( l it ) r. ty4 LgaLg MEASUREMENT O, C 6 b b ., T* MM 5?n na 3 7 PERMIT #M Ot 3CP"C# 7U^ " USS; . & J.5- 3il!h WUMD4 .L yr gilis y,Le REQUIREMENT echt ( 7"" G 3 MayIdUe sa/L U "l O 3 IU $1 s SAMPLE ' '?- * - ( ll) MEASUREMENT

St '

hh - - -t3: ' 3 PERMIT vM'<* #C*060 Mt2L" s Ec&Lf ; i? A b c(LJ. ' i ' :; , /iLU REQUIREMENT ? *: 0 *; NAt7; UD&fbM

-- StGNIRCANT PENALTIES FOR SUSMITTING FALSE IPeFORMATION. INCLUDING 'ki ' ' " ' '

07 ii3 ' I' THE POSSsSILITY u.S.C. s isie. me. enuser OF FIf8E.ANO meen sesames may IMPRISONMENT.

escease si.e se se SEE 18 U.S.C E s70,000 se0 1001 ANDOF33 NATURE FRINCIPAL EXECUTfWE AREA TYPED OR PRINTED mav er a=== men = 2 :ere ew a smeamomis s y s =.s OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference atartschments heref pa [4 4 -6 '. jgs [n M' ;f?3n++ ; S 'OnfY ecci p "109' ge , s i L 3 y y _2, q?edi;; *q? 3AILY M&trygg 73p 3?rz D ' f ,y r r j< g e 3 -r s (~' , , , ,9 g ,7 r,, f- re-- -- 77 s

/( y- 9 3grty ,

+=y,) , .5 454 wem 3320-1 (08-961 Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) -, .j3, , ) ,,.< PAGE , OF , , c ~ - - . _ _ . - ~ _ - - - - - - - - - - - _ _ - - - . - - _ - . - - - r i i Paperwork Reduction Act Notice - - . l )

Public reporting borden for this collection of mformation is e: tinuted tu vary from a rap of 10 kun as an j

[ j avenge per regmse for some minor L.cilities, ta l10 hours as an average pu mpum for mme nurr fAihties, l with a weighted average for major and minor f acilitic uf 18 hours2.083333e-4 days 0.005 hours 2.97619e-5 weeks 6.849e-6 months per re'pm.e, in,;luJiq tina h r roiewing nutructions, scarthing existing data sourtes, gathuring and maintaining the data ru&d and compktmp cod {' reviewing the collection of infornution. Send comroents regarding the burden mtinute er any other ma of j this collection of infonnation, including suggesnons for reducing this burden, to Chief, Information Policy I tharth, PM-223, U.S. Environnwntal Protection Agency,401 M Street, SW Wohington, DC 20460, ar.d to the ! Office of Informatmn and Regulatory _ Affairs, Of tice of Management and Budget, Wrohington, DC 20503. l l l 1 _ . - _ _ . _ _ - . _ _ . - _ _ _ _ _ .__ _ _ _ _ _ _ .=_ _ . . - _ _ . ____ ._..; General Instructions

1. If:fonn has been partially completed by preprinting, disregard instructions dintted at entry of that infornution already preprintei

2. Enter " Permittee Name:Alashng Address (and facility namcilocation, if different)." " Permit Nwnber," and "Dar harge Number" where indicated ( A separate form is required for cach disdtarge.)

3. Enter dates beginning and ending "Alomtormg Period' covered by form where indicated )

4. Enter each " Parameter" as specified in monitonng requirements of pennit l

5. Enter " Sample Alcasurement" data for each parameter under "guantay" and "guality" in units specified in permit.

51rerage" is nonnally anthmetic aserage (geometric average for bacterial parameters) of all sampic neasurements 1 for rath parameter obtamed during "A/omformx Period", "A/aumam" and "A/:n:mm " are ocoually otreme high l and low measurements obtained dunng "A!unaarmx Period." tNote to municipals with secondt.u treatment requirement Enter 30-day average of sample measurements under "Arerap," and uter maximum 7, lay aserage of sampic measurements obtamed during monitonng permd under "Alaumma ")

6. Enter "Permn Reymrement" for each parameter under "Gu<mtny" and "Guainy" as sp'eified in penmi

7. Under "No &" enter number of sample measunnents during monitoring period that excecd masiirann (and/or minimum or 7-day ascrage as appropriate) permit requirement for each parameter If none, en.cr "a" R. Enter " Frequency of Analy.m" both as " Nam;>le Alca3urment" (actial fra;uency of umpimg and analysis used during momtoring period) and as "Pernut Reymrement" specified in pernet (e g . Enter "( bat." fc continuous monitoring *//7" for one day per week, "/<30" for one day per month. "1S0' far one day per quarter e )

9. Enter "Smnple 7)pe" both as " Sample A/easurement" (actual sample type u3cd during monimring Fi od) and a

" Permit Reqwrement," (e.g., Enter "Grah" for indwidual sample. ".NHC" for Shour composite TA " h a continuous monitoring, etc.)

10. Where violations of permit requirements are reported, attach a bnef explanation to desenbe cmsc .u-d conedne actions taken, and refuence each violation by date.

I1. If"no discharge" occurs during monitoring perio<1 enter "No Ducharge" across fann m place er data estr3

12. Entes "Name?ntle of Principal Secutwe DJJicer" uith " Signature of Prmeiral becutwe &llce r u%:hori:ed Agent.* " Telephone Number." and "Date" at bottom of fann 1 L Mail signed Report to Office (s) by date(s) specified in penuit. Retain copy fer y our records

14. More detailed instructmns for use of this Dacharge A/omtoring Report (DAIR) fonn nuy be cbtain:d imm Office (s) speufied in permit.

' Legal Notice ' Ibis report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to repmt nuthfully can result in civil p:nalties not to exceed $10,000 per day of violation; or in crimin:d pnalties not to eneed $2S.000 pcr day of violation, or by imprimament for not more than one year, or by both. EPA Form 3320-1 (Rev. 08 95) A pr

ML20147B305

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ML20147B305

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