ML20155D096
| ML20155D096 | |
| Person / Time | |
|---|---|
| Site: | Beaver Valley |
| Issue date: | 09/30/1998 |
| From: | Orndorf D, Ostrowski K DUQUESNE LIGHT CO. |
| To: | NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM) |
| References | |
| NPD3VPO:0912, NPD3VPO:912, NUDOCS 9811030111 | |
| Download: ML20155D096 (36) | |
Text
{{#Wiki_filter:. , Telephone (412) 393-6000
?"o?L i "."PA 15077-0004 Shippingport October 27,1998 NPD3VPO: 0912 Document Control Desk U.S. Nuclear Regulatory Comndssion Washington,DC 20555 NPDES Monthly Report, EPA Permit No. PA0025615
SUBJECT:
Beaver Valley Power Station, Unit No. I and No. 2 BV-1 Docket No. 50-334, License No. DPR-66 BV-2 Docket No. 50-412, License No. NPF-73
Dear Sir:
Enclosed is a copy of the NPDES Monthly Repon as submitted to the Pennsylvania Department of Emironmental Protection. Sincerely,
><N l- usk:
Kevin L. Ostrowski Division Vice President Nuclear Operations and Plant Manager SLV/trs cc: D. A. Orndorf J. K Cool S. K. Hobbs i CentralFile y The Nuclear Professionals 9011030111 900930 PDR ADOCK 05000334 R PDR
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Telephone (4 t2) 393-600o Nuclear Group l P.O. Box 4 ' Shippingport. PA 15077-0004 l l l October 27,1998 NPD3VPO: 0913 l l United States Environmental Protection Agency Region III, Pennsylvania (3WM53) Water Permits Branch ' Water Management Division 1650 Arch Street Philadelphia, PA 19103-2029 NPDES Monthly Report, EPA Permit No. PA0025615
Dear Sir:
This letter fonvards a copy of our NPDES Monthly Report as submitted to the Pennsylvania , Department of Environmental Resources, Bureau of Water Quality Management. l Sincerely, ON . YN Kevin L. Ostrowski I Division Vice President Nuclear Operations and ; Plant Manager l SLV/trs Attachment l cc: D. A. Orndorf J. K. Cool S. K. Hobbs Central File w , The Nuclear Professionals i l
'Af Telephone (412) 393-6000 Nuclear Group P.O. Box 4 Shippingport. PA 150U-o004 October 27,1998 NPC.1VPO: 0914 Attention: "DMR Clerk" Department of Environmental Protection Bureau of Water Quality Management 400 Waterfront Drive Pittsburgh,PA 15222 NPDES Monthly Report, EPA Permit No. PA0025615 Oentlemen:
NPDES Monthly Report for Duquesne Light Company, Beaver Valley Power Station for September 1998 is submitted for your consideration. Sincerely, M (MI. Meo b Kevin L. Ostronki Division Vice President Nuclear Operations and Plant Manager SLV/tts cc: D. A. Orndorf J. K. Cool S. K. Hobbs Central File w . The Nuclear Professionals
1 7sp Teepnon 9in 393-e000 Nuclear Group P.O. Bos 4 Shippingport. PA 15017 0004 i October 27,1998 NPD3VPO: 0915 United States Environmental Protection Agency Region III, Pennsylvania (3WM53) Water Permits Branch Water Management Division 1650 Arch Street Philadelphia, PA 19103-2029 EPA Permit No. PA0025615 Reportable Occurrence
Dear Sir:
As required by the EPA Permit No. PA0025615, the following information is provided in regard to a reportable occurrence at Beaver Valley Power Station. On September 10,1998 the pH of the #1 Unit oil / water separator (Outfall 303) was 9.4, slightly above our permit limit of 9.0. Investigation into this incident revealed that the abnormally high pH was a result of draining the #2 Unit Auxiliary Boiler Steam return to a Unit #1 turbine plant drain due to maintenance activities. As a result of this incident, the existing operating procedure is being modified to include additional coordination with the chemistry group to prevent future occurrences. All subsequent samples taken in September were within permit limits, w The Nuclear Professionals
October 27,1998 NPD3VPO: 0915 Page 2 If you have any questions concerning this report, please do not hesitate to contact David A. Orndorf at 412-393-5113. Sincerely, cui [. W Kevin L. Ostrowski Division Vice President Nuclear Operations and Plant Manager SLV/tts cc: D. A.Orndorf J. K. Cool S. K. Hobbs Central File - Keywords: NPDES Reportable Occurence
._ . . . ~ . _ .._,a,,,,- . ' Instructions: g g. ~ Year: pi9g -
1.. Complete monthly and submit with each DMR. Attach addittonal sheets and connents as needed for completeness and clarity. Permittee:
- 2. Sludge production infennation will be used to evaluate plant Plant: M eW/:w _PN)p'4fge DES r'A16 L F,r/T f hc0 f: .< fru/w/>'...
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i performance. Report only sludge which has been removed frnm- NPDES: rA ooznis digesters and other solids which have been permanently removed Municipality: 5th/r,*ucx r f5vc ue // ! from the treatment process. Do not include sludge from other County: ggAucK. ; plants which is processed at your facility. ~
- 3. In the disposal site section, report all sludge leaving your For si'dgeu that is incinerated: !
facility for disposal. If another plant processes and disposes Pre-incineration weight = dry tons l of your sludge, just provide the name of that plant. If you Postiincineration weight =-
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dry tons t , dispose of sludge from other plants, include their tonnage in the disposal site section and provide their names and individual dry F tonnage on the back of this form.
- 4. If no sludge was removed, note on form. i SLUDGE PRODUCTION INFORMATION (prior to incineration)
HAULED AS LIQUID SLUDGE HAULED AS DEWATERED SLUDGE i (Conversion (Tons of i j '(Callons) X (% Solids) X Factor) - Dry Tons Dewatered Sludge) X (% Solids) X (.01) = Ory Tons n 3 r r.ooo .0000417 /, ga .
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i 4 i TOTAL - TOTAL s DISPOSAL SITE INFORNATION: List all sites, even if not used this month ! Site 1 l Site 2 Site 3 Site 4 : softon>n w mon cA Name: m%G reerntiTrun I Permit No.: /4 vo 20/2 5 Dry Tons Disposed: I,33 Type: (check one) . . Landfill : s Agr. Utilization j Other (specify) : County: Beaver (SSR-1 3/21/91) f,4k $0 S t gh1Fture - cilsp1 strJ teanER jo)97/77 Title Dat6 ' 412-M3-5Il 5 Telephone I
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' Instructions: yl Year: eqcrp,
- 1. Complete monthly and submit with each DMR. Attach additional ,
sheets and conments as nieded for completeness and clarity. Permittee: JN/)dESAI/' 4/,5/// cWJ/ /r'-
- 2. Sludge production information will be used to evaluate plant Plant: Jgw; x t ger / r' t'o r-r u < r Jr.,1 -
performance. Report only sludge which has been removed from NPDES: rA ooz a:5 digesters and other solids which have been pennanently removed Municipality: wyr,4tucx r xyx- a // from the treatment process. Do not include sludge from other County: f.;gA ucg plants which is processed at your facility. '
- 3. In the disposal site section, report all sludge leaving your for sludge that is incinerated:
facility for disposal. If another plant processes and disposes Pre-incineration weight = dry tons i of your sludge, just provide the name of that plant. If you Posti1ncineration weight ~ ~~' dry tons dispose of sludge from other plants, include their tonnage in the disposal site section and provide their names and individual dry b tonnage on the back of this form.
- 4. If no sludge was removed, note on form.
SLUDGE PRODUCTION INFORMATION (prior to incineration) HAULED AS LIQUID SLUDGE HAULED AS DEWATERED SLUDGE ! (Conversion (Tons of (Gallons) X (% Solids) X Factor) - Dry Tons Dewatered Sludge) X (% Solids) X (.01) = Dry Tons tisoo a .0000417 o , 9 t, .01 TOTAL - TOTAL = DISPOSAL SITE INFORMATION: List all sites, even if not used this month Site 1 Site 2 Site 3 Site 4 sottonm o f m e nA Name: SO%G reernwrtw1 1 Permit No.: /M o o 2 0 / 2 *5 Dry Tons Disposed: O.Ct t, ' Ig: (check one) - - Landfill Agr. Utilization Other (specify) County: B F a m e_ n
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() g gng f7 y /[ * (, g A s , , ; p,1 - REQUIREMENT cv u y AV3- L D L ILi' M, ;/ L ' NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT t HAVE Pf RSONALLY EXAMINED ANO TELEPHONE DATE AM FAMlUAR WITH THE INFORMATION SUBMSTTED HEREIN: AND BASED ON MY INOutRY OF THOSE $NDIVIDUALS IMMEDeATELY RESPON98LE FOR , OBTAINING THE seFORMATION. t SEUEVE THE SUBMITTED aNFORMATION IS 1 TRUE. ACCURATE AND COMPLETE. 3 AM AWARE THAT THERE ARE S.k j . , ; UJV1d Jr"dOrA # SGNIF4 CANT PENALTIES FOR SUBMITTING FALSE INFORMATION. hMCLUD6MG THE POS981LITY OF FINE AND IMPfuSONMENT. SEE 18 U.S.C 91001 AND 33 , u.s.c. e 33ie. sRwwm..msw an .e.e, mer menan mm . se se s o, coo SiONATURE OF PRNGCIPAL EXECUTfvE TYPED OR PRINTED .ad er mewume '- - -. : er aerw a manme and 6 yeero OFFICER OR AUTHORIZED'AOENT NUMBER ,, YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence a# strechments here/ A 4 t<4 d 5 ~,,y. <> , JOf g 5" b,a. t n, n 4, ~ rt !~ u ~< * ,p n : q + r. <, %. c/ a. m.. . AjM , - 7 ;
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cvn 6.,em 3J20-1 (08-951 Previous editions may be used. (REPLACES EPA FORM T-40 WeeCH MAY NOT BE USED.) . .,. . ., PAGE OF L s . . u / 1 ** s i s :~LJ- x
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Paperwork Reduition Act Notice . l Public reporting burden for this co!!ection of infornution is estinuted to vary from a range of to hours as an average per response for some minor facilities, to 110 hours as an average per response for some major f ilities,, with a weighted average for major and minor facilities of 18 hours per response, eviewingincluding time instructions, searchicg existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of informAion. Send commenM regarding the burden estirnate or any other aspect of this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
! Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 2(M60; and to the
~ Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
, General Instructions :
- 1. If form has been partially completed by preprinting, disregard instructions directed at entry of that intornution already preprinted.
- 2. Enter " Permittee Named /alling Addren (and facility name/ location, if different)," " Permit Number," and :
"lsischarge Number" where indicated (A separate form is required for each discharge.)
- 3. Enter dates beginning and ending '3/onitormy Period
- covered by form where indicated. t
- 4. Enter each " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample Ateasurement" data for cach parameter under "Guantity" and "Guality" in units specified in permit. i
" Average" is normally arithmetic average (gametric average for bacterial parameters) of all sample measurements for each parameter obtained during "Alonitanng Period"; "Alanmam" and "Afinimum" are normally extreme high ;
and low measurements obtained during "3/onitoring Period." (Note to municipais with secondary treatment ,
. requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average
.of sample measurements obtained during monitoring period under "Afarimmn. ")
6, Enter " Permit Requirement" for each parameter under "Guantity" and "Guality" as specilied in permit.
)
7, Under "No Er" enter number of sample measurments during monitoring period that exceed maximum (and/or mi.imum or 7-day average as appropriate) permit requirement for each parameter. If none. enter "0"
- 8. Enter " Frequency of Analysis" both as " Sample A/casurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in pernut. (e.g., Enter " Cont," for continuous i
. monitoring, "N7" for one day per week, "100" for one day per month, "u90" for one day per quarter, etc.)
- 9. Enter " Sample 7)pe" both as " Sample 3/easurement" (actual sample type' used during monitoring period) and as !
L " Permit Requirement," (e.g., Enter " Grab" for individual sample, "R/IC" for 24-hour composite, "N'A" for j, continuous monitoring, etc.) ,
'10f Where violations of rmit requirements are reported, attach a brief explanation to describe cause and corrective y actions taken, and rebence each violation by date.
7 1
- 11. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
l 12. Enter "Name/ Title of Principal Erecutive OBicer" with "Signatu're of Principal Executive 0))icer ofAuthori:ed Agent " " Telephone Number," and "Date" at bottom of form. 4
- 13. Mail signed Report to OITice(s) by date(s) specified in permit. Retain copy for your records.
14, More detailed instructions for use of this Discharge 3/onitoring Report (DA/R) form may be obtained from Omce(s) specified in permit. L Legal Notice L This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report tmthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rey,08-95)
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_a s PERMETTEE NAME/ADORESS W Fareeha==='t comadbg$wuss) NATIOe6AL POLLUTAsfT DISCHARGE GURMNAfl006 SYSTtpd $1 Form f_ _ Cf. 2 #
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REQUIREMENT 1 NAME/ TITLE PRINCW'AL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I MAVE PERSONALLY EXAMINED AND TELEPH M DATE AM FAM4UAR WITH THE seeFOResATION SUSMITTED MERElet; AND BASED Oss i f-MY INQUIstY OF THOSE IsfCIVIDUALS tesMEDIATELY RESPOedSIBLE FOR / r
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- PAGE OF yu,a.,7/35,0rQU~,Ls3 x
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_Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
, average per response for some minor facilities, to 110 hours as an average per response for scimo major facilities,
- , 9ith a. weighted average for major and minor facilities of 18 hours per response, including time for r'eviewing
- j. instructions, searching existing data sources, gathering 'and maintaining' the data needed, and cornpleting and j' ; reviewing the' collection of informations Send cormnents regarding 4be burden estimate or.any other aspect of iq : this collection of information, including suggestions for reducing this burden, to Chief, Information Policy :
Hk iBranchf PM-223, U.S.- Environmental Protection Agency,:401 M Street, SW Washington, DC 20460; a'nd to the i j p Office ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
> # 1 u . / General Instructions *
- j 1 If form has been partially comhleted by preprinting,;di.sregard instructions directed at estry?of that information i
.faiready preprinted. _
L2. Enter
- Permittee Name/A/ ailing Address (and facility namellocation, if different)."
- Permit Number," and
' " Discharge Number" where indicated. - (A separate form is required for each discharge.)
~
- 3. Enter dates beginning and ending "Atonitoring Period" covered by form where mdicated.
- 24. Enter each " Parameter" as specified in monitoring requirements of permit'. .
f
- 5. Enter " Sample A/easurement" data for each parameter under "Guantity" and "Guality" in umts specified 'in permit.
"herage" is normally arithmetic average (geometric average for bactwrial parameters) of all sample measurements for each parameter obtained during "Alonitoring Perio</'; "Alaximum" and "Atmimum" are normally extreme high and low measurements obtained during "Afonitoring Period" (Note to municipals with secondary treatment requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average s 1of sample measurements obtained during monitoring period under "Alaximum. ")
6? Enter " Permit Requirement" for each parameter under " Quantity" and "Guality" as specified in permit. 7..Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or day average as appropriate) permit requirement for each parameter.- If none, enter "0". (8, Enter " Frequency of Analysis" both as " Sample A/easurment" (actual frequency of sampling and analysis used
,y during monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont," for continuous
, monitoring, "//7" for one day per week, "100" for one day per month, "l/90" for one day per quarter, etc.)
- 9. Enter " Sample 7)pe" both as " Sample 3/easurement" (actual sample type used during monitoring period) and as
'" Permit Requirement " (e.g., Enter " Grab"; for individual . sample, "2,f#C" for 24 hour composite, "N/A" for.
- continuous monitoring, etc.)
10J Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
- 11. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
[12 Tenter "Name/Dtle of Principal Executive Oficer" with " Signature of Principal Executive Officer ofAuthorized
' Agent * " Telephone Number," and "Date" at bottom of form.
- 13. Mail sign'ed Report to Oflice(s) by date(s) specified in permit Retain copy for your records.
. '14 Mnre ddtailed instructions for use of this Discharge Afonitoring Report (DAIR) fonn may be obtained from Of! ice (s) specified in permit.
- Legal Notice
' This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can
- result in civil penaltien not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
-of violation, or by imprisonment for not more than one year, or by both.
- EPA Form 3320-1 (Rey,08-95)
4 PEWANTTEE NAtOADORE23W=e,#=wimen.eero.#-=w esAnONAL POuuTAart osecseAmer mesmAnces sYsfes / Femi Approwed. ' 4 NNN NAME. WEA\LS V M.I.dY.M 4Ch M hTI M- IF 7-f j OOlcDhCOhTINkMATOMB h 20400004@ , ADOREss F. O.: SOX 4 PALO N 1% C~ t 'S (SU S B . 3 5)' #"'I N II~'" ETTN; ; DAVID 0h3D0KP PERMIT NUMBER oescHAmeE sounenER y ' ,.. y7g4g E -
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, FROM n v u, TO 1; 4 .2 - MC NO f.I SC ti 8.hG f f. _l J (- 4*C it ??: DhVlD G .4 5 D C 5 .f 12&211 122-2 3 124-269 126 279 (20-291 (30"313 M R*** IR*'***'I*** 5 ****PI *'I** *'I* M-PARAMETER is M W m LOADme (4 w W m M CONCENTRAM NO. mEouescY gagpLE 146-5M 154-611 (30 461 44 6-5 s 454-61) Or ! 432-371 EX angygis -TYPE-AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM - UNITS som fu pg
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i REQUIREMENT ; SAMPLE ? MEASUREMENT T PERMIT } REQUIREMENY l SAMPLE MEASUREMENT , PERMIT . l REQUIREMENT - ; I NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER e CERnFY UNDER PENALTY OF LAW THAT I HAVE PHtSOI8 ALLY ERAMIDsED AseD ' AM FAMtuAR WITH THE 100FORMATIOmi SUBMITTED HEREIN: ANO maesn Oss TELEPHONE - -DATE MY INQUIRY OF THOSE leeOlVIOUALS eMa#EDeATELY RESPOB8SIBLE FOR r e OBTAINING THE IhFOfteATIOss.1 SEUEVE THE SUBemTTED INFolHAATIOes IS '3 j/
- j d, Avid D.rnduri. TRUE. ACCURATE AND COMPLETE. 8 AM AWARE THAT THERE ARE [ / f. - J ' F.' , <[ ,
SIGNIFeCANT PENALnES FOR SURRATTmG FALSE WFORMATIOpt, IIICLUDeB8G F
,.s""'. * , THE POSSeBauTY OF FtBGE ANO leAPftSOfsAAENT, SEE 10 U.S.C. 91001 AssO 33 .4 oa9 r.?, c, . . . I U.S.C. e 131o. amenemme eewise stems essawee may m + a shise ao se aro,cco esGNATURE OF PRWICIPAL EXECUTIVE - - -
TYPED OR PRINTED ener er moeimame ' -erseaween a menske most 5 yeems OFFICER OR AUTHORIZED AGENT M A NutERER ~' YEAR MO DAY ! COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# stischments herof ' ! aawaum 3320-1 (08-95) Previous edecone may be used. (REPLACES EPA FORM T-40 We#CH MAY NOT BE USED.) - . - - , . . - PAGE OF I u 0 43 C / ,.7 0 3 2 0 0 1 J ? J 4, t
. _ . - - _ _ _ -- -. ._ . . - . - _ - . - _ . - . - . , _ - _ - _ _ . . _ . - _ - . _ - _ ._ - . . - . _ - - _ _ . - _ . _ - - - - _ . _ - - . _ _ . .----.-_-_ =. _--_-_~*
1 -F f. Paperwork Reduction Act Notice i
;Public' reporting burden for this' collection of information is estimated to vary from a range of 10 hours as an _
, yaverage per response for some minor facilities, to 110 hours as an average per response for some major facilities, jjl'1 , owith a weighted average for major and minor facilities of 18 hours per response, including time for r*eviewmg instructions, searching existing dMa' sources, gathering and. maintaining the' data needed, and ' completing and reviewing the ' collection of information.. Send comments regarding the burden estimate or any other aspect of 1 y this collection of information_,'in'c luding suggestions for reducing this burdenj to Chief, Infornution Policy L Branch, PM-223, U.S.; Environmental Protectick Agency, 401 M Street, SW Washington, DC 2N60i and to the
_ Office ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. 4
- , . .~ _
General Instructions
" I1. If form has been partially comi eted bl by preprinting, disregard instructions directed at emry of that information J .. .'already preprinted. ,
"2? Enter " Permittee Name/3/alling Address (and facility name/ location, if di1Terent)," " Permit : Number " and "D!scharge Number" where indicated. (A separate form is required for each discharge.)
- 3. Enter dates beginning and ending "Alonitoring Period" covered by form u here indicated.
- 4. Enter each " Parameter" as specified in monitoring requirements of permit.
' 5. Enter "Sompte Afeasurement* data for each parameter tmder " Quantity" and "Guality" in units specified in permit.
. " Average" is normally arithmetic average (geometric aserage for bacterial parameters) of all sample measurements for each parameter obtained during "Alon.itoring Period"; "A/arimum" and "Alinimum" are normally extreme high
, and low measurements obtained during "Afonitoring Period." (Note to municipals with secondary treatment requirement: Enter 30-day averag'eof sample measurements under " Average." and enter maximum 7-day average
- i.of sample measurements obtained during monitoring period under "Afaximum ")
4 6i Enter " Permit Requirement" for each parameter under " Quantity
- and " Quality" as specified in permit.
s 7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximurn (and/or
- minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
- f. , (8. Enter " Frequency of Analysis" both as " Sample A/earurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont " for continuous
. monitoring, "l/7" for one day per week, "140" for one day per month, "l/90" for one day per quarter, etc.)
- 9. Enter " Sample TApe" both r,s " Sample A/easurement" (actual sample type used during monitoring period) and as
" Permit' Requirement,"- (e g., Enter!" Grab" for individual sample, ."24/IC' for hour composite, "N/A" for
. continuous monitoring, etcJ
' 10.jVhere violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
- 11. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
Lt2. Ennt "Name/Dtle of Principal Ewecutive Oficer* with " Signature of Principal Executive Oficer ofAuthori:ed Agent," " Telephone Number," and "Date" at bottom of form. J13, Mail signed Report to OfIice(s) by date(s) epec!Ded in permit Retain copy for your records.
- 14. More detailed instructions for use of this Discharge AIonitoring Report (DAIR) form may be obtained from Office (s) specified in permit.
Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can
. result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both.
EPA Form 3320-1 (Rev. 08-95) I e I
. . . ,_ . . . ~ . . .
PERhetTTEE DtAhE/AOORESStwFersherAmm.t u q/L4Dereerp esATIOesAL POLLUTANT DescHARet EuMosAftoM system (fuPDESt . Form Approved. * *
- NAME- Ot4C
_yAypp yA1L;5 g g g p .gg1qy MONITORWG REPORT (DyRJ Z ! M No C y,
- ss ,.a. m4 - = m s m ;3r ^P-vai dos-= '*
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YEAR MO DAY YEAR MO DAY LOCAnw FROM . t v2 TO ?: < r ON 66. OI SC 36 RG E. @4 CM t.TI 3 : M VI D vbN701F (2G21A (22-23/ 124-25s (28-27; (2e-2sp (Jo'sts . NOTE: Reed instnacelens betere coenpleting this forsen. (3 CrMn4; NANW M LOADWG I4 Canton &f OUANTITY OR CONCENTRATION NO. mEcumCY SAM *LE PARAMETER 948-SM 954-619 130-469 (46-55 (64-691 cF (32-37; EX ,,,,gy , TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ses.4m gg,,, ggye,
,. SAMPLE . rt g r e e c o r.. c o ; o w n e r. ( ig, MEASUREMENT gOmeg 1 ; (; PERMIT *$cccc- ^ ccMoc :c ac 6,Q 9040cc 9,0. W g-g - ggp rfr .vt'T ,. ;ia W A L, REQUIREMENT rz e w p ; g y gj- 's qg a g Sg
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; . .v.13 50350 .;. C U . PERMIT 116 yO97 - R t-( O M T p r.:sc c o a eccpc. 0 $ $cy4 200c ggQ 3f 4%
REQUtREMENT i :4 - .-si ,Fie V f L; gg gyg npyty y nc. 49,4 C ! .. t,2J, IVI4L SAMPLE - wr c e ' 6%c? 4 o c- c o c i ( 19? u
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- MEASUREMENT
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. :L3 /EW REQUIREMENT or .y 4yggggg jpp gg gg SAMPLE l MEASUREMENT l ; PERMIT REQUIREMENT _
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~
l PERMIT + REQUIREMENT I ( SAMPLE l MEASUREMENT l PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER t CERTWY UNDER PENALTY OF LAW THAT I HAVE PERSO8 SALLY E7 -ED AND TELEPHONE DATE AM FAMILIAR WITH THE IItFOsmeATIOes SUBMITTED HEREst- AseD SAsED ON i MY INQUIRY OF THOSE $NDIVIDUALS IMMEDIATELY RESPONSOLE FOR ! OSTAINING THE INFOstesATIOes, 8 SEllEVE THE SUBMITTED INFORMATIOtt IS . g#(f[- a-
?
David Ornder[ TRUE, ACCURATE AND COMPLETE. t AM AWARE THAT THERE AAE SIGNIFICANT f7NALTIES FOR SUBMtTTING FALSE INFOftAATIOtt, ItsCLUDeteG L, f y[~ [ * / I Chenistrs Man p g* t- - THE POSS184.ITY u.S.C. OF FateE e 13ie. m m.m., m Afs0 IRAPfuSCtetAE.NT. SEE is U.S.C. nwP A.caum, an s sro. 9.,1001 coo AfsD 33 seGNATUIIE OF PIIIIeCIPAL EXECUTIVE 4i7 393-5113 48 IC 27 TYPED OR PRINTED mworman-na a wese s menew. mar s yes,as OmCER OR AUTHOltl2EO AGENT CODE NUMilER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference at attachments here) EPA Form 3320-1 (06-95) Previous editions may be used. tREPLACES EPA FORM T 40 WHICH MAY NOT BE USED.) PAGE OF-
) ,. 3 7 g p
.. .- _ - ,A _ ~ _ _ .. _ . _ _ _ _ . _ _ . - _ - ..
._____.1,'
I (Paperwork Redu~ction Act Notice l JPublic rehrting burden for this collection of information is estimated to vary from a range of 10 hours as an
- f. average per; response for some minor facilities, to 110 hours as an average per response for some major facilities, with a ' weighted average for major and minor facilities of 18 hours per response, induding: lime for ieviewing
~
instructionsi seaiching esisting dats sources,'gath'ering and ' maintaining ihe' data needed, and completing and reviewing the collection of information.' Send' comments regarding the burden estimate or any other aspect of-lthis collection of informadon, including suggestions for reducing this burden l to Chief, Information Policy Branch, PM-223, U.S. Envimmnental Protection Agency,401 M Street, SW Washington, DC 20460; and to the l [ Office of Information and Regulatory Affairs. Office of Management and Budget, Washington, DC 20503. ; 2 - , , .
-,. )
- .- General Instructions :
(~
+
, 1. Jf form has been partially completed by preprinting, disregard instructions directed at entry of that information 4
already preprinted.
' ! 2. Enter
- Permittee Name/Malling Address (and facility namellocation, it different)," " Permit Number," and i
; , " Discharge Number" uhere indicated. (A separate form as required for each discharge.)-
~ 3. Enter dates beginning and ending " Monitoring Period" covered by fami where indicated.
1 -> 14, Enter each " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample Measurement
- data for each parameter under " Quantity" and "Quahty" in units specified in permit.
" Average" is normally arithmetic average (gcometric average for bacterial parameters) of all sample measurements
..for each parameter obtained during " Monitoring Permd"; " Maximum" and " Minimum" are normally extreme high ,
and low measurements obtained during " Monitoring Period." (Note to municipals with secondary treatment requirement: Enter 30-day average of sample measurements under " Average." and enter maximum 7-day average l of sample measurements obtained during monitoring period under " Maximum.") e
- 6. Enter " Permit Requirement" for each parameter under "Guantity" and "guahtv" as specified in perndt.
- 7. Under "No Er" enter number of sample measurments during monitoring period that exceed maximum (and/or
, f minimum or 741ay average as appropriate) permit requirement for each parameter. If none, enter "0" ,
t L 8. Enter " Frequency of Analysis" both as " Sample Measurment" (actual frequency of sampling and analysis used
'during monitoring period) and as " Permit Requirement" specified in permit. (e.ga Enter " Cont," for continuou.
- monitoring, "l/7" for one day per week, "l/30" for one day per month, "l/90" for one day per quarter, etc.)
19sEnter " Sample 7)pe" both as " Sample Measurement" (actual sample type used during monitoring period) and as
" Permit Requirement " (e.g., Enter " Grab" for in~ d ividual sample, "NHC" for 24-hour composite, "N/A" for s ; continuous monitoring, etc.)
K 10.? Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective iactions taken, and reference cach violation by date. 11 - If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place c f data entry.
- 12 Tenter "Namenitte of Principal Executive Oficer" uith " Signature of Principal Executive Oficer ofAuthori:ed 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 Discharge Monitoring Report (DMR) form may be obtained from Office (s) specified in permit. Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can resun in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not ta exceed $25,000 per day Lof violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95) s ,
< ~ - ~wa '-
s ,, v e--es. s em v av me e ~ s we -
9 etRMITTEE esAtaE/ ADORE 35tJeruferee wtaramaavogenaars ' esATIOseAL POu.UTAseT Ds9 CHARGE EutepsATIOes ev3?as (NPDES) . . Form Approved. * *
- DISCHA~GE MONITORWG REPORT (OM#1 '
NOME- . , r-
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( $ d h ti C 3) A ! I *i i - S A '4 I L 0hLD0RF PERMIT NUMBER DesenARoE semanssi y 7Iygg , r s- . a u r c ..y Ma,,.n.<-nq , aA ,e..!--
,-ay~ , . t
- x. n.u d< a~
y 7 FAClu1Y YEAR MO DAY YEAR MO DAY 2 MTION FROM ;e '. , TO <
- > 0% !! G 615 C(!! n ~, F - ' Coc
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- l. M % : D A y 1 W G .; E n ;t f 12O21) (22-231 (24-259 (26-27) (28-29) 13& 319 NOTE: M M W compMing % %
PARAMETER (J CeM %# QUANTITY M LOADING I4 cam %# QUANTITY M CONCENTRATION NO. mEouescY SAWLE . 146-53I 154-619 (30-45s 14 6-5.19 964-691 EX or (32-371 , gysis TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS som f,,,,, gg,.m p ., SAMPLE cucc*c c e t c .M covecr .( Ig. MEASUREMENT t2400 1 0 y PERMIT coccce coe%& pcc g , 0.y -o%ces. ; 9, g gg g - gy F FT ,, L ' ? , 6.5 ; V ; L', REQUIREMENT oc cc . g p ; g-g . ~e g g q,yg gg , ti04 , 15 J O Ta D u l '" Og SAMPLE ( g 3; sc9cc- occuc; ac cw a,1 . . c, ;.- - , y , ~.._.4g , e , , n. a MEASUREMENT
. -. o 2 y S0050 '. f Q . PERMIT F. L p O n - - g r p(e p, T 40ccou 57cc0Ag c449cc if; ce g g ggg - m $g )j REQUIREMENT
;e j .r , : e e, y3y pg- 3yg . n j ., ; 7 #7 ,. c 374 C n u. ' r . % C , R I A ., SAMPLE . '. r- c e cwccc ecocx ( ly j
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uc uxe MEASUREMENT ( ,j v ( } g , PERMIT Mecc .Mccec- :#e ccce** :C. 5 T. 2 54 WEEAL GkAF
,e j3g REQUIREMENT gna Q ... g g qgg;gg 3,y i
. c y , t 1 ,1, FL: E SAMPLE act en 6 ? r C"Ws. ( 19
. e , ,a MEASUREMENT i e n., u e. .i. : i n jna 1 7 u PERMIT G o u M. %90cc ;%c :Jcccoo .0, 2 pg. WML GRAB.
'. J c t ~ r j b .; V 7. U.) REQUIREMENT , O ;ygg Q jg Qg' gr SAMPLE MEASUREMENT
- PERMIT REQUIREMENT i SAMPLE i MEASUREMENT PERMIT .
REQUIREMENT SAMPLE i MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCW'AL EXECUTIVE OFFICER e CERTIFY UNDER PEssALTY OF LAW THAT I HAVE PERSOfsALLY EXAAAIDsED AssD TELEPHONE DATE AAA FAh48UAR WITH THE 10sFomaAATION SUgaelTTED HERE188: AND BASED Oss 44Y INQUIRY OF THOSE WIOtVIDUALS lasa4EDIATELY RESPOIsSISLE FOR i /'.. I OSTAsNtNG THE INFOluaATIOes, 9 SEUEVE THE SU8441TTED lesFomaAADOes is f
- 1*/ . ,-s; David Orndorf TRUE. ACCURATE AND COnsPLETE. I AAA AWARE THAT THERE ARE StGNERCANT PENALTIES FOR SUBestTTNsG FALSE INFOfudATION. NsCLUDING L
h74 ' ' Chem 8 t rv ff anaeer THE POSSleauTY OF FNs u.S.C. a isie, s%assa.E.AteDisier IRAPRISGesh4ENT. SEE 18 U.S.C 51001 AfsDcop 33 30GIGATURE 015 PRWICIPAL EXECUME 4 I. 2 34)=5I}3 4N IU 27
- mee. .s. sus , w sb . N, se s ro. AREA TYPED OR PRINTED ma.r er nianamen : _ reveer n e asnemur s y ras OFFICER OR AUTHORIZED AGEffT CODE NUMBER YEAR MO DAY
- COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/ererece e# strechmerrts here/
I i f EPA Form 3320-1 (08-95) Previous editions may t>e used. (REPLACES EPA FORM T-40 WHICH MAY NOT SE USED.) PAGE OF
,. c, .v, J, ,as / '3 O U 7 L,e 1 ,, > rr . - - _ _ . _ - - -. ___ - _._____ a_ - --- - - - - _ - - . _ _ _ ~ _ _ _ - . _ _ _ _ - _ - - - _ _ . _ - - - , ., ,- - - -. .
{ k V , Paperwork Reduction Act Notice Public reporting burden for this collection of infornution is estimated to vary from a range of 10 hours as ta ; average pei response for some minor facilities, to 110 hours as an average pe: response for some major facilities g with a weighted average for major and minor facilities of 18 hours per resporise, including time for r"eviewing
~
instructions, seaiching existing data sources, gathering and maintaining 'the data needed, and completing and reviewing ,the ' collection of information. Send conunents regarding the burden. estimate or any other aspect of ithis' collection 6f information, including suggestions for reducing this burden; to Chief, Infornution Policy H Branch, PM 223, UA Environmental Protectiori Agency,401 M Stred SW Washington, DC 20460; and to the . t i Office ofInformation and Regulatory Affairs, Office of Management and Budget,- Washington, DC 20503, General Instructions
~
i 111If form has been partially completed by preprinting, disregard instructions directed at entry of that infornution already preprinted.
~
- 2' . Enter
- Permittee Name/3failing Address .(and facility name/ location, if different)," " Permit Number," and
" Discharge Number" where indicated. (A separate form is required for each discharge.)
- 13. Enter dates beginning and ending "Alonitoring Period
- covered by form where indicated.
n.
+ n 4. Enter each " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample A/easurement" data for each parameter under "Quantitv* and " Quality" in units specified in permit.
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements-for each parameter obtained during "Alonttonng Perlocr; "Alarimum" and "3/inimum" are normally extreme high and low . measurements obtained during "J/onitoring Period * (Note to municipals with secondary treatment '
requirement: Enter 30-dcy average of sample measurements under " Average," and enter maximum 7-day average
. of sample measurements obtained during momtoring period under "3/axim:4m ") '
6;. Enter ~ Permit Requirement" for each parameter under "(Juantity" and " Quality" as specified in permit
- 7. Under."No Ex" enter. number of sample measurments'during monitoring period that exceed maximum (and/or
; minimum or 7-day average as approp.. ate) permit requirement for each parameter. If none, enter "0". .
- 8. Enter " Frequency of Analysis" both as " Sample A/easurmeni" (actual frequency of sampling and analysis used
?during monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont," for continuous l monitoring "1/7" for one day per week, "l/30" for one day per month, "160" for one day per quarter, etc.)
, 9. Enter " Sample 7)pe" both as " Sample A/easurement" (actual sample type used during monitoring period) and as
- Permit Requirement," (e g., Enter " Grab" for individual sample, "SI//C" for 24-hour composite, "N/A" for t continuous monitoring, etc.)
-10."Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
. ' actions taken, and reference each violation by date.
.11? If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
12 Tenter "NameWille ofPrincipal Executive ODicer" uith " Signature of Pnncipal Executive 0]Jicer ofAuthorized
. 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.
! J14. More detailed instructions fo'r use of this Discharge Afonitoring Report (DAIR) form may be obtained from Office (s) specified in permit.
~
Legal Notice J'lhis report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day ] of violation, or by imprisonment for not more than one year, or by both. 1
)
a ,
- EPA Form 3320-1 (Rey,08-95) l l
n n_ . PEnht TTEE NAGE/ADOfECS Quee=Mesehrph st-CTW esATIOstAL POLLUTANT DesC84Afteg a mensaTIOes SYSTens (MOE31 Form W. ' .-'
"A" 7 4 X e I p T A K E.y S C s E !M N
(: e4I 9 VALLLY 0CkEO ?7ATiUM t7 ADDRESS r + U = c01 4, D 1 * ? ' " 1 h G6 t ( 3 U f f* O S) ; PERMIT NUMBER DesCHAReE seuMeeR ~* ' AT T b ; ~ O A V i ? DIliGORt'- y . rjg4L Sh1F INCFO17 PA 15 0 ' ggy 'MAJoh - YEAR MO DAY YEAR MO DAY ' LOCATION w FROM gs -u.- TO u ' CSO - N O DISCh1%E 1 COO-kT*%* ^ DkVL& G h % l'O N y (2021) (22-23) (24-2So 126 271 (20-299 (30-311 je NM M &l bW
- PARAMETER (3 cmr onM QUANTITY M LOADING to Cardif OnM NTITY M NM NO. mEcuenscY SAhW'LE tes-sar 154-691 130-46o 146-539 454-691 Or 132-37) AneALYans M AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS saram ,,,,,,j fag.pg f i,U s , ih C C s,0 017 . C } SAMPLE [ g 3) ypoc. m; c c o , e c c:y e 0 657-1
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SAMPLE MEASUREMENT PERMIT ; REQUIREMENT i SAMPLE I i MEASUREMENT I PERMIT REQUIREMENT , SAMPLE MEASUREMENT PERMIT REQUIREMENT T = SAMPLE l MEASUREMENT , i
~
PERMIT REQUtREMENT [ SAMPLE MEASUREMENT
.{
PERMIT REQUIREMENT SAMPLE t MEASUREMENT f PERMtT . t REQUtREMENT E I NAME/ TITLE PRINCIPAL EXECUTIVE OFRCER I CERTIFY UNDER PENALTY OF LAW THAT e HAVE PERSONALLY EKAheissED AND TELEPHONE DATE AM FAMtUAR WITH THE essFORMATION SUBamTTED HEREIN: AseO SASED 088 f j MY INQUIRY OF THOSE tesotVIDUALS tesMEDIATELY RESPOse9IBLE FOR i
/. f / '
DeVid DrDdOr{ OBTAINING THE 18eFORMATIose. I SEUEVE THE SUBMITTED aNFORMATION IS TRUE. ACCURATE AseD COMPLETE. 8 AM AWARt THAT THERE ARE (, [#Qf<J' [ ) ,, fw) , [ i L hOClI H e.1,'f se S8GNsFICANT PENALTtES FOR SU8amTTING FALSE INFOResATDON. INCLUDessG L s1MI/IEC r THE POS$tB4WTY OF Rest AND IMPRISOesesENT. SEE 18 U.S_C. 51001 AseD 33 *Y9 ' 4 0 4. r, y i 1 qq y ,1 97 6 U.S.c. t t sie. amenemme seisser enes eessunse meF sienase Krise se se s repoo 840 NATURE OF PRINCE *AL EM 3,gg l TYPED OR PRINTED w ermeanien- _ - ._.; W aerween s monens W 5 yeeras OFFICER OR AUTHORIZED AtBEIIT CODE NUteER YEAR MO DAY , COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a6 strechments /serof
- I ira e ursu 3320-1 (08-95) Previous editions may be used. IREPLACES EPA FORM T.40 VWWCH MAY NOT BE USED.) PAgE OF !
' O c,. 63. . / ? 9,, D_. 0 - 1 a 3, .9 1 ,
- __ ____ _ - - - _. ._ -. - _ _. .. - - - ~
N Paperwork Reduction Act Notice Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an average per response for some minor facilitics, to 110 hours as an average per response for some major,facihties, with a weighted average for major and minor facilities of 18 hours per respome, including time for reviewing instructions, searching existing data sources, gathering and nuintaining the data needed, and completing and reviewing the colketion of informati,on. Send cornments regarding the burden estimate or any other aspect of this collection of infonnation, including suggestions for reducing this burden, to Chief, Information Policy l Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the J Office ofInformation and Regulatory Affairs, Of6ce of Management and Budget, Washington, DC 20503. General Instructions >
;1. If form has been partially completed by preprinting, disregard instmetions directed at entry of that information ,
?
already preprinted. [2. Enter "Permittec Namedfailing Address (and facility name/iacation, if different)," ." Permit ' Number," and
" Discharge Number" where indicated. (A separate form is required for each discharge.)
'31 Enter dates beginning and ending "A/<mrtoring Period"cos ered by form w here indicated.
> 4. Enter each " Parameter" as specified in monitoring requirements of pennit.
' 5. Enter "Sa ng/c Afeasurement" data for each parameter under "Guantity" and "Guality" in units specified in permit.
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for cach parameter obtained during "Alonitoring Period"; "A/aximum" and "Alinimum" are normally extreme high
. and low measurements obtained during "Afonitoring Period" (Note to municipals with secondary treatment requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average of sample measurements obtained during monitoring period under "Alarimum ")
- 6. Enter " Permit Requirement" for each parameter under "Guantity" and "Guality" as specified in permit.-
- 17. Under "No Ex" enter number of sample measunnents during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "O*.
l 8. Enter " Frequency of Analysis" both 'as " Sample A!:asurment" (actual frequency of sampling and analysis used
. during monitoring period) and as " Permit Requirement" specified in pennit. (e.g., Enter " Cont," for continuous monitoring. "l//" for one day ptr week. "l/30" for one day per month, "l/90" for one day per quarter, etc.)
9.. Enter " Sample 7)pe" both as " Sample A/casurement" (actual sample type used during monitoring period) and as
Permit Requirement " (e.g., Enter " Grab" for individual sample, "2.iHC" for 24-hour composite, "N/A" for continuous monitoring, etc.)
(10. Where violations of pennit requirements are reported, attach a brief explanation to describe cause and corrective
- actions taken, and reference each violation by date, 11; If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
12, Enter "NamerTitle of Principal Executive ODicer" with "Signatu're of Principal Executive Oficer ofAuthori:ed
^ Agent," 7elephone Number," and "Date" at bottom oi 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 Discharge A/onitoring Report (DAIR) fann may be obtained from Ollice(s) specified in permit.
Legal Notice This nport is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
.of violation, or by imprisonment for not more than one year, or by both.
EPA Form 3320-1 (Rev. 08-95) (-
_ _ . = . . . m , , . .g & .
'i, stnameTTEE NA9dE/ADOMESS(m$ane#yAewtereme=cfh>=ws NADOssAL Pontr7 Asst thecMameE n-Does sYsTas (FROES / Form Approved. *-~ o a i, A y [ c. yj *1M pgkp Desc
- NAndE '?4 fig; GE MONITOfWIG REPORT (%$ gy,j;g4y3 3y M No. N Coosass e a C. AX 4 CN^'5 V" P
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P A. 1C077- f,'J A "' "O 'i FCCILITY MITM N !' YEAR MO DAY YEAR MO DAY ~ $ LOCOTION FROM t ;; ,. TO + i 31 704 NQ bl5CMM[f k NOM Reed m W oenapneene M form. D00 .i aTT : vA%in O: 'C3i . (20211 t22-23r t2+259 126-2n 120-291 130-3n (3 On&# QUANTITY OR LOADING /4 h On&J QUANT!TY OR CONCENTRATION NO. mEOutnCy PARAMETER 146-53v 130-46p SA8MLE " 954-6t9 446-539 16 & 6 99 OF : r32-3n EX Analysis TYPE AVERAGE MAXIMUM UNITS MINtMUM AVERAGE MAXIMUM UNITS ' asus, fg#ay, gggya, 9
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. 087AmitNG THE gbsFORadADOR$, 9 SELtEVE THE sumastTTED INFORRAATIOss as il y/ / - '
. - I D O.V I d C EU dO r t- TRUE.
- a dATE AND COndPLETE.
. I AM AWARE THAT THERE ARE ( 'h (f , ( , j f/ / g Chenist ry !!anage r StGN!FAANT THE POssiesuTv 0F PENALTIES FOR SUtamTTiesG FesE AseD insenisONasENT, sEf is u.s.c. FALSE u.s.c. e ist s. aRenames enieur snes, seemos nier hice,me mese a, se s10,000
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s iooi As 0 3: theCLU.DetG 880AAATUplE W NAI. EXECUWE 12 393-5113 % 10 27 , TYPED OR PRWTED min er ai====na : se aseu === 8 enens== =ia a r==ss OFFICER OR AUDaneswn AGE 9ff NutMER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# ettschments heret i .i' - v- ' LO,, E9!' - Alw a i C-[OfI',., 37.i J 7 4 L ;$2_ tan CMLed: 3 %?E F 2 Q 'j I E _' O O .*t h y DU;INC " q(M E
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, f EPA Form 3320-1 (08-95) Previous odetions may be used. IREPLACES EPA FoftM T-40 WeeCN MAY NOT BE USED.) . -. PAGE OF
- JysEr /1 " ,,,7 rvc-13ry i, .
Paperwork Re3uction Act Notice
.; .Publie.. reporting burden for this collection of information is estimated to vary from a range of 10 hours as ui
, iaverage per response for some minor facilities, to i10 hours as an average per response for some major facilities,
~ with a weighted average for major and minor facilities of 18 hours per response, including' time for reviewing
' instructh>ns, searching existing. data sources, gathering and maintaining the data needed, and completing and
. reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
~
> < this collection 6f information, including suggestions for reducing t!ds burden, to Chief, Information Policy
' Branch,'PM 223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the
" Office ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
5
. ' ' General Instructions
- 1. If fann has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted.
- 2. Enter " Permittee Named / ailing Address (and facility name/ location, if different)," " Permit Number," and
, " Discharge Number" w here indicated. (A separate form is required for each discharge.) >
^ 3. Enter dates beginning and ending "Alonitoring Period
- cevered by form where indicated. I r
- 4. Enter each " Parameter" as specified in monitoring requirements of permit.
r 5.' Enter " Sample A/casurement* data for each parameter under " Quantity" and "Guality" in units specified in permit. i
" Average" is nonnally arithmetic average (geometric average for bacterial parameters) of all sample measurements ?
for each parameter obtained during "A/onitoring Period"; "A/arimum" and "Afinimum" are normally extreme high , and low-measurements obtained during "Alonitarmg Period." (Note to municipals with secondary treatment ; requirement.. Enter 30-day average of sample measurements under " Average." and enter maximum 7-day average
; of sample measurements obtained during monitoring period under "A/arimum.") l
- 6. Enter " Permit Requirement" for each parameter under " Quantity" and "Guality" as specified in pennit. ,
i l7 Under "No Er* enter number of sample measunnents during monitoring period that exceed maximum (and/or t minimum or 7-d.sy average as appropriate) permit requirement for each parameter. If none, enter "0" j
- 8. Enter " Frequency of Analysis" both as " Sample Aleasurment" (actual frequency of sampling and analysis used {
l l during monitoring period) and as "Perrait Requirement" specified in pennit. (e.g., Enter " Cont," for continuous j monitoring, "U7" for one day per week. "100" for one day per month, "l/90" for one day per quarter, etc.) i
- 9. Enter " Sample 7)pe" both as " Sample Aleavurement" (actual sample type used during monitoring period) and as
" Permit Requirement," (e.g., Enter " Grab" for individual sample, "2,iHC" for 24-hour composite, "N01" for 3 continuous monitoring, etc.)
- 10. Where violations of nnit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and re crence each violation by date.
I 1. -If "no discharge" occurs during monitoring period, enter "No Discharge" across form in placc of da'a entry. 4
^
l 12. Tenter "Name/ Title of Principal Executive Ofcer" uith " Signature ofPrincipal Executin C#rer ofAuthori:ed 1 Agent " " Telephone Number
- and " Dale at bottom of form.
- 13. Mail signed Report to OfIlce(s) by date(s) specified in permit. Retain copy for your records. )
)
14, More detailed instructions for use of this Discharge A/onitoring Report (DA/R) form may be obtained from Office (s) l specified in permit. j Legal Notice
)
i This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can I result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day h of violation, or by imprisonment for not more than one year, or by both. I EPA Form 3320-1 (Rev. 08-95)
PERMITTEE NAME/ ADORES 3gr.dMent,# dL-m e r Dip-c NanONAL POU.UTAssT DeSCHaAGE EUMINAnON SYSTea (APOES/ Form Approved. -- NAME , :, 7, y4g,gy p g g ; y, f 7 ; 7 7 g 3, [ NN N[,% 3y;7 1 gy1,7 y g ; ^M No. N 7c , AooREss v.0. % 4 -e<o-iit ' s ( SU L :. Og 8P N % -se ' **
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asJ>t 'h3C; FACIUTY YEAR MO DAY YEAR MO DAY LOCATION FROM 9 TO + t + Ocn gC ;;12 3 ; n c;I g AT~J D % 'i O h N;~O : * (2G2ff (22-231 (24-251 (26-271 128-291 (JS3Fj NOTE: Reed inswucalens before - 7 " ; Wils feFm. PARAMETER (3Cer m s QUANTITY M LMG (4 Cent On&s OUANTITY M CONCENTRAN NO. mEm SAlrLE 148-539 154-srs 136-459 146-531 (54-691 oF (32-37/ EX aNays, TYPE AVERAGE MAXIMUM UNITS MINtMUM AVERAGE MAXIMUM UNITS so-s3s imp fas.m SAMPLE . w n_r oc or; n .c c; e
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MEASUREMENT PERMIT - REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERDFY UNDM PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE AM FAMTUAR WITH THE INFORMATION SU8 MATTED HERDN AND SASED ON . DATE i MY INQUIRY OF THOSE INDivtDUALS IMMEDIATELY RESPON98tE FOR / /% 4 06TAANING THE INFORMATION. I SEUEVE THE SUBMITTED INFORMATtCN IS / David VrntiDr[ TRUE, ACCURATE AND COMFtETE. 8 AM AWARE THAT THERE ARE V, ks / <fi- f ,.e y , s/ StGN4FICANT PENALTIES FOR SUBMITTING FALSE ONFORMATION, aNCLUDING ibni et ?
~ M cm a e o r THE POS981uTY OF FtNE AND eMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 ',. t *s 30~1 A?11 oe -
i s; e7 u.S.c cam anos se se s to. coo se0 NATURE O[ PRINCIPAL EXECUTIVE TYPED OR PRINTED awe,. e=: 131s. sRwn ame ammer: eF an e.ew s.eman e n=F AREA NUMBER s monen. et s yearsJ OFFICER OR AUTHORIZED AGENT . CODE YEAR MO DAY , COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# ettechments heret i . PA i um 3320-1 108-95) Prewtous edstrons may be used. tREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) . ,, PAGE OF i esv~. i/s<as7 ,.-13 s i
~
Paperivork Reduction Act Notice Public reporting burden for this collection of information is estinuted to vary from a range of 10 hours as an
- average per response for some minor facilities, to 110 hoars as an average per response for some major, facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
, instructions,'searchiug existing data sources, gathering and' maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
' this collection.of information, includini suggestions for reducing this burden, to Chief, Information Policy
., i
? Branch, PM-223, U.S. Enviromnental Protection Agency,401 M Street, SW Washington, DC 20460; and to the Office of information and Regulatory Affairs, Office of Management and Dudget, Washington, DC 20503.
- General 1nstructions-1.'If form has been partially completed by preprinting, disregard instructions directed at entry of that information '
already preprinted.
- 2. Enter " Permittee Namea/alling Address (and facility name/ location, if ditTerent)," " Permit Number," and
" Discharge Number" where indicated. -(A separate form Is required far each discharge.)
- 3. Enter dates beginning and ending "A/onitormg Permd" covered by form where indicated.
- 4. Enter each " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample 3/caturement" data for each parameter under "Guantity" and "Guahry" in units specified in permit.
"Awrage" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Atonitoring Perimr; "A/arimum" and "3/ininmm" are normally extreme high
-! and low measurements obtained during "A/<mitoring Period." (Note to nmnicipals with' secondary treatment requirement: Enter 30-day average of sample measurements under " Average " ar.d enter maximum 7-day average
-.of sample mea >urements obtained during monitanng period under "Alarimum ")
- 6. Enter " Permit Requirement" for each parameter under " Quantity" and "Guality" as specified in permit.
- 7. Under "No &" enter number of sample measurments during monitoring period that exceed maximum (and'or ininimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0V
- 8. Enter " Frequency of Analysis" both as "Sompte Alcaturment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in pennit. (e.g., Enter " Cont " for continuous monitoring, "l/7" for one day per week, "l/30" for one day per month, "l/90" for one day per quarter, etc.)
;.9. Enter " Sample 7)pe" both as "&mple A/easurement" (actual sample type used during monitoring period) and as
" Permit Requirement " (e.g., Enter ." Grab" for individual sample, "1<t/IC" for 24-hour composite, ."N'A" for
,. lontinuous monitoring, etc.) s 101 Where violations'of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date. i1. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
- 12. Enter *Name'Dtle of Principal &ecutive Officer" uith " Signature of Principal becutive Oficer af Authori:ed 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 Discharge A/onitoring Report (DA/R) form may be obtained from Olrice(s) specified in permit. Legal Notice This report is required by law (33 U.S.C.1318: 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both. l EPA Form 332'0-1 (Rev. 08-95) l we - _ . -_-._-.___._________m_ . _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ . _ _ . _ _ . . _ _ . . _ . _ _ _ . _ _ _ _
s sTnaalTTEE MAnaElt.DOMESS rrWesteM. hem =vapmo scat CosM pot 1UTAssT DISCDeARGE 8-71000 SYSTths (AFDES) ** ~ N M rz.pn N M REPORT O W/ .,,n.,y ,,'Foem ? ~ .-d. NAME - sr*~,-
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NAMElTITLE PRINCIPAL EXECUTIVE OFFICER a CERTtFY UNDER P9 SALTY OF LAW THAT I HAVE PUtSO8 DALLY EFamED Aado . TELEPHONE DATE I Aas FanmOAR WITH THE WsFORhAATIOed SUSAMTTED HUtEue: AND SASED Oed _ / l MY tesOUWtY OF THOSE tesDIVIOUALS gesasEDIATELY RESPoss'.28LE FOR 9 j ~ / ! f f'.N j- / ~~ / , f .h . / j b.
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OBTAINING THE IssFORMATIOst. I BEUEVE THE SUBtAtTTED sNPORRAATIOtt IS t f DitVid OTUdOrf TRUE. ACCURATE AseD ConsFLETE. 4 AAA AWARE THAT THetE ARE b _ StGNEFICANT PUeALTIES FOR SUBastTTING FALSE 188FOftAATIOfi, $NCL12188G k12 ChenI s t rv 'iang er THE POS$4810TY OF FIGGE AND IAAPRISOsetAENT. SEE IS U.S.C. i 1001 A8ID 33 880NATWE OF PRRICW'AL FXEM 1 9.)"O 1 I 3 9b 10 27 U.S.C. s 131s. iFuammee asemer mese sammeses nasy mesesse mies se ao s70.40e , TYPED OR PRedTED aw er ainemie== - .- er Ase a meansneaw s yearmJ OFRCER OR AUTHORGED AGENT $ NURSER YEAR MO DAY ; COMMENTS AND EXPLANATION OF ANY V!OLATIONS (Reference af attachments heref r 4 1 T i: shILY 5 3 (1 "U ' ') ULTE s?-3 #1 ' I' I O C l A
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3C/L. (I3I Ll lt IT 15 3E M ! J/L '. 5 kiLi dEe} Q ( , y , j g, r}pf p y, y J , ; , 5 Form 3320-1 (06-95) Previous editions may be used. IIEPLACES EPA FORM T 40 WeeCH MAY NOT SE USED.I - n . ,g PAGE OF q.7 g ) .,
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__ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ . . _ _ _ _ _ _ _ _ _ . _ _ _ . - _ - _ _ _ - _ - - _ _ _ . _ - . _ - . , , . , - - . , . -r #-, , -# . .r.,.-% . -
Paperwork Reduction Act Notice - i Public rsporting burden for this collection of information is estimated to vary from a range of 10 hours as r.n average per response for some minor facilities; to 110 hours as an average per response for some major facilities, O with a weighted average for nujor and minor facilities of 18 hours per response, including time for reviewing.
. 'instmetioris, searching' existing' data sources, gathering and maintaining the data needed,,and completing and
' ~ reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of .
this collection' of information, including suggestions for reducing this burdeni to Chief. Information Policy I < Branch, PM-223, U.S. Environmental Protection . Agency,401 M Street, SW Washington, DC 20460; and to the . 10ffice ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503m i.o- 4-* General Instructions. ,
~ - +
)1[If form has been partially completed by preprinting, disregard instructions directed at entry;of that information '
already preprinted. '
, 2. Enter " Permittee Named / ailing Address (and facility name/ location, if di!Terent)." " Permit Number," and
" Discharge Number" where indicated. ( A separate form is required for each discharge.)
- 13. Enter dates beginning and ending "Atonitoring Period" covered by form u here indicated.
' 4. Enter each " Parameter" as specified in monitoring requirements of permit.
"5. Enter " Sample 3/easurement" data for each parameter under " Quantity" and "Guality" in units specified in permit,
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Alonitormx Period"; "Afarimum" and "Alinimum". are normally extreme high and . low -measurements obtained during "Ahmilaring Period" (Note to municipals with secondary treatment
- requirement: Enter 30-day average of sample measurements under " Average " and enter maximum 7-day average
' of sample measurements obtained during monitoring period under "Alarimum ")
i 6f Enter " Permit Requirement" for each parameter under " Quantity" and "Guality" as specified in permit.
- 7. Under "No Ex" enter number of sample measurments during rnonitoring period that exceed maximum (and/or
.s l- 1 minimum or 7-day average as apprcpriate) permit requirement for each parameter. If none, enter "0".
l8. Enter " Frequency of Analysis" both as " Sample Aleasurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont," for continuous , monitoring, "In" for one day per weck, "l/3C" for one day per month, "le90" for one day per quarter, etc.)
- 9. Enter " Sample 1)pe" both as "Samrile 3/casurement" (actual sample type used during monitoring period) and as
" Permit Requirement," (e.g., Enter " Grab" for individual sample, "24//C" for 24-hour composue, "N/A" for
' continuous monitoring, etc.)
- 10. Wiiere violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference cach violation by date.
- 11. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
~
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12'." Enter "Name!Dile o Principal Executive ODicer* with " Signature' of Principal Executive Of))cer of Authorized Agent * " Telephone ' umber," and "Date* at bottom of form. l
- 13. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your records. s
- 14. More detailed instructions for use of this Discharge A/onitoring Report (DA/R) form may be obtained from Office (s) specified in permit.
l Legal Notice 4 1 This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully cari result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both.
-. EPA Form 3320-1 (Rev. 08-95) '
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1, PERMITTEE NAME/ADORUSGmkasuyh=/f 4'DM NATIONAL POLLUTANT DSCNARGE fuMsMATION SYSTas (MPDES/ . Form Approved. nnv a:<v I NARME - .,o uua.,a a , i i
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u . ~ e 1 ' y' " FACILITY MONITORING PERIOD YEAR MO DAY YEAR MO DAY ._ LOCATION Mk BO 01 > L L I. i G . FROM ;t <. TO e I_l W NOTE: Read instructions before onenpoeting this form.
!$ 1 ; J J V2 v 0ew Ui* (2&21A (22-231 f24-25# (26-277 (2&291 (3&3,j PARAMETER (3 Ced on&J QUANTITY m LOADM (4 Cad on&/ QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE 146-639 154-679 130-46) 146-53) 154-6fI oF (32-37; EX aN4 Lyss TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS au-s8 164-ses (6S7af F LC , As _ Q :. ii L; ; ; y. SAMPLE ( C 3) oec 3 (. s icn; a? . h;* dQ1 P L A. MEASUREMENT , O Q L/ .COV O g[7 FST 3 .' : : i
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, PERMIT E f.p O M 7pOld scom . c u c c ) .: ya$cyc 4W g 333 sy;Ip t f ~ ;. 5I . ,_ iai REQUIREMENT f fg n g 7; y - ;y %, ., ;.. c.
SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE i MEASUREMENT , PERMIT REQUIREMENT . SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNCER PENALTY OF LAW THAT I MAVE PERSONALLY EXAMtNED AND TELEPHONE DATE AM FAMfUAR WITH THE INFORMATION SUBMITTED HERON: AND BASED ON _ MY INQUIRY OF THOSE INDeVIDtJALS IMMEDIATELY RESPONSISLE FOR 06TAIMNG THE INFORMATION. I BEUEVE THE SUBMf7TED INFCAMATION t$ I uav u u:adori Taut- accuam aNo coMPtrTE- ' ^M ^*
- THAT Thear =
9GN3FtCANT PENALTIES FOR SUBMITTING FALSE tNFORMATION. INCLUD4NO i /w/ o ~I '4 e '.he ry i e t r v
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THE POSSIB4UTY OF FINE w-AND m IMPRISONMENT. mSEE 18 U.S.C.,i 1001 se se AND 33 s70.000 500 NATURE OF PR8BfCIPAL EXECLfrfvE 41' 143 6{}"I 4, !i) ?7' i TYPED OR PRINTED u.S.c. e 13is. ansa w er==.mun!_ r et a.sw s.mausw e n=nesn=rw sicame rearafnn. OFFICER OR AUTHORIZED AGE 9fT m NUMBER YEA) MO DAY COOE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# strachments here) C6*A t .am 3320-1 (08-95) Previous edittOns may be used. (REPLACES EPA FORM T-40 WteCH MAY NOT BE USED.) PAGE OF s,
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, a Paperwork Reduction Act Notice i Public reporting burden for.this collection of infornation is estimated to sar; from a range of 10 hours as an 1
' average per response for some minor facilities, to i10 hours as an average per response for some nujor facilities, J with a weightal average for major and minor facilities of_18 hours per response, incipding time for r'eviewing instn etioris, searching existing data sources, gathering and maintaining the data needed i and completing and reviewing the co!!cction of information. Send comments regarding the burden estimate or any other aspect of
- this collection of information, including suggestions for reducing this burden, to Chief, Information Policy l
- Branch,' PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the !
Office ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. j 1
< General Instructions
- 1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information-already preprinted. .;
2, Enter
- Permittee Name/3/alling Address (and facility namellocation, if ditfcrent),* " Permit Number," and ,
" Discharge Number" where indicated. (A separate form is required for each discharge.)
- 3. Enter dates beginning and ending 3foniformg Period" covered by form where indicated.
4, Enter each " Parameter" as specified in monitoring requirements of permit.
~
- 5. Enter " Sample A/eaturement" data for each parameter under " Quantity" and "Guality" in units specified in permit ;
" Average" is nonnally arithmetic average (geometric average for bactetial parameters) of all sample measurements a for each parameter obtained during "3/onitortng Penod"; "A/aximum" and "Alinimum" are normally extreme high and low measurements obtained during *3/onitoring Period." (Note to municipals with secondary treatment requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day nyerage of sampic measurements obtained during monitoring period under "3/arimum. ") t
- 6. Enter " Permit Requirement" for each parameter under "Guantity" and "guality" as specified in pcrmit.
- 7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
- 8. Enter " Frequency of Analysis" both as " Sample A/easurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont " for continuous monitoring, "l/7" for one day per week, "l/30" for one day per month, "l/90" for one day per quarter, etc.) !
, 9. Enter " Sample 1)pe" both as " Sample A/easurement" (actual sample type used during monitoring period) and as "Pennit Requirement," (e.g., Enter "Grah" for-individual sample, "NIK'" for 24-hour composite, "N'A" for :
; continuous monitoring, etc.)
10.EWhere violations of pennit requirements are reported. attach a briuf explanation to describe cause and corrective 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 entry.
'12. Entet "NameG1tle of Principal Executive ODicer" with " Signature of Principal Executive Officer ofAuthori:ed Agent." " Telephone Number," and "Date" at bottom of fortn.
- 13. Mail signed Report to Omcas) by date(s) specified in permit. Retain copy for your records.
- 14. More detailed instructions for use of this Discharge Atonitoring Report (D3//() form may be obtained from Omce(s) specified in pennit.
Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceal $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) - i
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PEHuaTTLE NAMEJADORESS(JacandefardwyAamn.'Lecaseme((Uq.9wenst NCTIONAL pot 1UT ANT O'SCHARGE ELIMINADON SYSTEM (NPOES/ Form Approved. NOME o1 e DISCHARGE MONITORING REPORT (DMR) .~-, ,..i.- . vc OMS N. o. 2040.OO, O4
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!* : .V , + - (2a2fs (22-231 (24-25/ (26-27s (28-29/ (Jospj NOTE: Reed instructione before'corEplleting this form PARAMETER 13 Cerd on&J QUANTITY OR LOADING I4 Card on&s QUANTITY OR CONCENTRATION NO. mEQUENCY SAMPLE 146-531 15
- 6 91 (38459 146-539 154-699 or (32-37; EX ANALyss TYPE MAXIMUM MINIMUM
/ AVERAGE UNITS AVERAGE MAXIMUM UNITS ,vs.,3; (s.4-6 81 tem SAMPLE
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' " yf MEASUREMENT S,17 8. / 7 O f Fo 6Me s c, ', r , PERMIT necem accen: - 0 :: ..e ' " ? ? :~ 1,0 3 AC E/ GEg REQUIREMENT -
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;q, REQUIREMENT yyq n.7;, ,
nyg q7 SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMEhi PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTNE OFFICER I CERRFY UNDER PENALTY OF LAW THAT t HAVE PERSONALLY EXAMINED AND TELEPHONE DATE AM FAMsuAR WITH THE esFORMATION SUBMITTED HEREIN: AND BASED ON MY INQUIRY OF THOSE INOMDUALS IMMEDIATELY RESPONSIBLE FOR ! /- D.3V 1 G O ! T. d C 1 1 08TAINtNG THE INFORMATION, I SELfEVE THE SUBMfTTED INFORMATION IS TRUE. ACCURATE AND COMPLETE. 6 AM AWARE THAT THERE ARE f f $ .'f f
/
C: Cili:2LTV l{ J [Mge r StGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDeNG k,2 1 393411 -3 9R 10 27 THE POSSIBruTY OF RNE AND SMPRISCNMENT. SEE 18 U.S.C. $ 1001 AND 33 U.S.C. E iais. sm asse.e .niew m s ssGNATURE OF PRINCIPAL EXECUThfE g TYPED OR PRINTED .as or == amn= L. - : er aerw s,esams s maamsmer amt wee. #bwe see se s rom 6 yearms OFF'CER OR AUTHORIZED AGENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS tReference a# stischments here/ EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
< ,,r - , 7 ~. . ; ,,. -, .,.. ,
4
- Paperwork Reduction Act Notice
, ' Pukific reporting burden for this collection of information is estimated to vary from a range of 10' hours as nn
-average per response for some minor facilities, to 110 hours as an average pe; respora for some major facilities, ,
'with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing instructions, searching existing data sources gathering 'and nuintaining' the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or_,any other aspect of >
; Lthis collection 'of information,'. including suggestions for reducing this burden, to Chief, Infornution Policy.
Branch, PM-223, U.S. Environmental Protection Agency,401.M Street, SW Washington, DC 20460; and to the
'Omcc ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
r s:!
. General Instructions :
! 1, If form has been partially completed by preprinting, disregard instructions directed at entry of'that information s i already preprinted
'2. Enter " Permittee Name/Afailing Address (and facility namellocation, if different)," " Permit Number," and
" Discharge Number" w here indicatedc (A separate form as required for each discharge.) ,
- 13. Enter dates beginning and ending "Alonitoring Permd* covered by fonn where indicated.
- 14. Enter cach " Parameter" as specified in monitoring requirements of permit.
~
- 5. Enter " Sample A/casurement" data for each pararneter under " Quantity" and " Quality" in units specified in pernut.
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "3fonitoring Periocf'; "Afaximum" and "Alinimum" are nornully extreme high ;
and low measurements obtained during "Alonitoring Period" (Note to municipals with secondary treatment requirement: Enter 30-day average of sample measurements under "civerage " and enter maximum 7-day average 1 of sample measurements obtained during momtoring period under "Afaximum. ") e
- 6. Enter " Permit Requirement" for each parameter under " Quantity" and "Gualip" as specified in permit.
;7 Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "F' ,
8c Enter " Frequency of Analysis" both as " Sample Areasurment* (actual frequency of sampling and analysis used
; during monitoring period) and as " Permit Requiremen!" specified in permit. (e.g4 Enter " Cont " for continuous monitoring *l/7". for one day per weck, "l/30" for one day per month, "l/99' for one day per quarter, etc.)
- 9. Enter "Samp/c Type" both as " Sample Afeasurement" (actual sample type used during monitoring period) and as !
1" Permit Requirement " (e.g., Enter " Grab" for individual sample, "N/IC" for 24-hour composite, "N/A" for continuous monitoring, etc.)
;10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective ,
actions taken, and reference each violation by date. I1, If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
.12." Enter "Name/ Title of Principal Executive Oficer* with " Signature of Principal Executive OJ]icer of Authorized Agent," " Telephone Number
- and "Date" at bottom of forni.
- 13. Mail signed Report to Office (s) by date(s) specified in permit Retain copy for your records.
t
.14. More detailed instructions for use of this Discharge Afonitoring Report (DA/R) form may be obtained from Office (s) ,
specified in permit. , Legal Notice -
%is report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to repon truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
'of violation, or by imprisonment for not more than one year, or by both.
. EPA Form 3320-1 (Rev. 08-95) .
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PEfemTTEE NAM /ADOfESS(AmeimaleFaeasFName gfDgfbrunrf StATIOstAL POLLUTAse? OBSCHAftGE EUMINA1100s WYSTas NJ .Foevet Apptq>wed .-
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ADDRESS PeCe 904- 4 hi 7 A (503I*- 0 5) n r i. ; . ' r a v I : oas;on PERMIT NUMBER oesCHARGE semasm 7 7 gg W P "~". . S ti l P P i b G iG h l ' P4 1 % 77 MONITORING PE;UOD %tJOR. - pa a YEAR MO DAY YEAR MO DAY .
. LOCATION
. FROM -91 . -l t. TO s> v .,
Oc& MO DISCH A RG E'1) NOE Reed insenseelene W oesupleeing titio forsn. [ 4?O A1Ih3 S1VID Oh! 3G ft f (20 211 (22-23/ (24-2fD (2s-2h (28-29/ (JS3tj PARAMETER 13 M onM QUAN OR LOADING (4 M % QUANW OR NTION NO. PnEOUSMCY SAhWLE 146-55 150-sto 1304V 146 164-619 or (32-3n EX mys,s -TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM - UNITS ,sr.em ,,,,,,, ge SAMPLE c r# c o o: ocw:c.
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MEASUREMENT qK Q 79L d I/ 7 QM coagy 1 Q- 9 . PERMIT . -. u s c owc C C ep c O - r6w g;g- " -cogpco .- 9 , g - , q ;Q gyg '
" F . ;j . c , -- ; 3 V;;f REQUIREMENT '
,n g . g 7 y g y, Qgp g -ty PLJAg g cg3pg{7 jy SAMPLE g _jj) cc-of. c o c 2.tc - o ns e:
T w 'l I I c. 4 ! W ? t LA; MEASUREMENT . nob . 015 O 1/7 F 5T.
; '; L ., G 1 0 . PERMIT 2 . E i p pj ? g y p O *-J *OS00e OcotM. ; cc.* c c c Oc$o egpg m yy 2 / r .' W : +T . , ;o. '
> V i i. ] REQUIREMENT gg gg r q y y1 w ; 3 , ggQ SAMPLE c e r- c :,. c G L i t: t ?i E , M AL & cncP 9 4- r.a ,-
(-13 1jpg MUD u ;p04L MEASUREMENT p , f G, p;]1 ..h t O ?, @ l y e PERMtT cocrea ; :g rP 0 0 98 xt occ qw ;pgppgp gtgpg p 7g;c g, c4;t7
- F?.ddb1 >ThiT V A l. J REQUIREMENT 4cen jg g -g ggspy . .. g g pg SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT -
REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT - REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER e CERTWY UNDER PENALTY OF LAW THAT I HAVE PERSONAuY EXAsmesED AssO TELEPHONE AM FAMlUAR WITH THE seFORMATices SUOMITTED HEREIN: AseO SASED 006 , ~_ DATE D3V [d Ut'lldO! { MY INQUIRY OF THOSE leeDIVIOUALS tasMEDIATELY RESPONSISLE FOR OSTAINtNG THE INFORMATION, I BEUEVE THE suess TTED tesFORMATIOes is TRUE. ACCURATE AsdO COMPLETE. I AM AWARE THAT THERE ARE [' [ /c19 {! M
/p
.js SaGNaRCANT PENALTIES FOR SUEANTTING FALSE INFOfudAT10N. seeCLUDeNG ch.S } { <a t rv M ;m n -* r r
'-' THE POSSISIUTY OF FIBfE AND IMPftSONMENT. SEE 10 U.S.C. i 1001 AssO 33 -, ,.;y ,. ,, 9 S80NATUIE OF Pf5118CIPAL EXECUTIVE U.S.C. t isse. smwenames wear en se asseusse mer heedde owe se se r70.000 TYPED OR PRINTED aas er mennese i- - ee see=eer s means eis s peeras OFFICER OR AUTHOnt2ED AGElfT CODE NUMIIER' YEAR MO DAY CCMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af strechments here/
t r. ' ' d A I. i .. $J G ble .. ; CT TLvATI' '#CLI O f; V ;3 I c a ; FN> I! UTHid T h A s 1 H A C 1., 3 %U=,7$. Ca*A 6 uam 3320-1108-95) Previous ed: Dons mey be used. IREPLACES EPA FORM T-40 W99CH MAY NOT GE USED.) 0Ce%/9h07.L;* 1 ; 5_ _ _ _ - - -PAGE OF
3 3 Paperwork Reduction Act Notice .
'Public re' porting burden for this collection of infornution is estimated to vary from a range of 10 hours a.s an
- average per response for some minor facilities, to 110 hours as an average per response for some nujor facilities, N (with a weighted average for nujor and minor fagilities of 18 hours per response, including time for /eviewing
' instructions; searching existing data sources, gaihering and maintaining the data needed, and corupleting and
, reviewing the collection of information. Send comments regarding the burden estirnate or any other aspect of i I
Lthi collection of information, including suggestions for' reducing this burden l to Chief, Information Policy . Branch, PM7223, U.S. Environmental Protection Arency,l401 M Street, SW Washington, DC 20460; and to the ( ^ 0ffice ofInformation and Regulatory Affairs, Office of Management and Budget,, Washington, DC 20503. s . . 4
~
General Instructions .
- 1. If form has been panially. completed by preprinting, disregard instructions directed at eiitry Lof that information already preprinted.. '
- 22. Enter " Permittee Namea/ ailing Address (and facility _ name/ location, if different)," " Permit Number," and
" Discharge Number" where indicated. ( A separate form is required for each discharge.)
, 3. Enter dates beginning and ending "A/onitoring Period" covered by form w here indicated.
4 Enter each " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample A/easurement" data for each parameter under " Quantity" and "Guahty" in units specified in permit. [
" Average" is normally arithmetic average (geometric aserage for bacterial parameters) of all sampic measurements for cach parameter obtained during "A/onitormy Period"; "3/aximuin" and "3/inimum" are normally e.streme high
. .and low measurements obtained during "Atonitormy Period." (Note to municipals with secondary treatment
- requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average of sample measurements obtained during monitoring period under "3/arimum. ") ,
~
- 6. Enter "Penn/t Requirement" for each parameter under " Quantity" and "Quahty" as specified in permit.
- 7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter, if none, enter "0",
- 8. Enter " Frequency of Analysis" both as "Smnple A/casurment" (actual frequency of sampling and analysis used
- during monitoring period) and as " Permit Requirement" specified in pennit. (e.g , Enter " Cont," for continuous monitoring, "#7" for one day per week, "l/30" for one day per month, "//90" for one day per quarter, etc.)
- 9. Enter " Sample Ape" both as "Samp/c A/casurement" (actual sample type used during monitoring period) and as
" Permit Requirement " (e g., Enter " Grab" for indisidual sample, "N/IC" for 24-hour composite, "Nd" for continuous monitoring, etc.)
- 10.JWhere violations of pennit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference cach violation by date.
- 11. If"no discharge" occurs during monitoring period. enter "No Discharge" across form in place of data entry.
' 12. Enter *Name/Dtte of Principal Executive 0])icer" uith " Signature of Prmcipal Executive Oficer of Authorired l
- Agent * " Telephone Number," and "Date" at bottom of fann.
13s 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 Discharge A/onitoring Report (DA/R) form may be obtained from Oflice(s) specified in pennit.
~
Legal Notice t 'Ihis report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both.
- EPA Form 3320-l'(Rev,08-95)
_._ . . - - ..._4 u- .~ . -, . .s 2
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ITRMITTEE MAndE/ADOHESS(A==We fasee A*=*'Laramadb=he ==as NAfiOIeAL PonUTAseT DeoCHAAGE B.msesAftOse sv3Tes S1 L Form Approved. NAasE ygn f ygg;gy'pggp[ 37477gg GEM M M N t,7.,, t g 77 ,L 01y OMB No. 2OOOOO4 cocnss 17 0, 301 PtM?;ri9 '7
, 4
'(SU2P C5) **PNW "'"-* I [
AI!N: 'DAiIF O > 5 t, o 3 i' PERMIT NUMBER DescHAmeE esuMeeR p . p;3L j O j l f it I h G F % ? FA ISC77 ggg y M?d O3 4 I ~ '
. FACILITY .I t YEAR MO DAY YEAR i MO DAY 4 _
i LOCA N FROM yt r u TO 3, < a COC NO D I ",C N A h G j [ j l c % . }
- 2. Y % : 1Ay13 Os%DDhr 120 211 122-231 124-25) 426-27) (20-291 130"3tb NOM Reed inemmenene & comptedag % %. :i PARAMETER 13 cent on&s OUANTITY OR t.OADING (4 cent on&) QUANTITY OR CONCENTRAM NO. mEcuseCY SAWLE
- 146-539 -154-691 130 465 446-6.1F 164-691 09 ,
132-37) EX ,,,ALysis TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS nar sa fu las.m CIA %1bi, aWK ACID, SAMPLE :nncm n.^eque ec oc v. { 19 ; a u ., m., r. L A :L
. MEASUREMENT <, >OlO 2,01 0 .O 9l92 G, PAS ,
cm3 1 o e PERuiT. .m eae v.e c o reon ;o cco c e- n n.m 3 epg; , 7yrcs na , < > F . J : .. n y A L1 REQUIREMENT g g, e q g p..g ~ g g:f $ yyg : .g { c t.2. . " _- SAWLE came ne m o co - ( 5 g, , a ( 7c. s.~3 + .). .*. L MEASUREMENT 4,o#O / 010 O -2 Q @ 46 ; ! oc7 u 1 n a t eERuir c o c o c c+-- faccoo- mec . ococco ngro g .ggog rurcg . cay .; ! s y r _ ., *+ ,t 53 y ; Li REQUIREMENT gy g . .,7 3 g 9 7.
. ;g g ;-g p.j { g, I AMl?.uYi, 70'i A L SAMPLE ocecc' o cc c ra c. opcoc cO
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REQUIREMENT ! i SAMPLE MEASUREMENT f PERMIT , 4 s REQUIREMENT y 6 SAMPLE ; MEASUREMENT , I PERMIT - 5 REQUIREMENT r SAMPLE i
.t MEASUREMENT PERMIT , !
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REQUIREMENT , f NAME/ TITLE PRNeCFR EXECUTIVE OFFICS 8 CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERS00 SALLY EXAMIh0ED AfdD TELEPHONE DATE l AM FAMIUAM tMTH THE INFolh8ATIOst SUotAITTED MEREles: Ase oASED Oer p r MY INOUIRY OF TMOSE lidOtVIDUALS samasEDsATELY 8tESPOesSleLE FOR ' E/ ' i OoTAINtNG THE esFORMATIOss. I oEUEVE THE SuSestTTED leeFORRAATIOed IS i {}avtg Ornjor{ [I-[+4-/ ('2 Xf / $> TRuf. ACCURATE AssD consplETE. : Ana AWAnE THAT TwERE AnE i CheMetry .'Ianager
~
SNCANT PENALMS FOR SUnteUING FALSE tesFORMATIOei. ImeCLU0esG - I TwE PossisiuTv oF FiesE AssD inarRisOssesENT. SEE is u.S.c. 800pIAM OF PRIBICe*AL EXEM 412 393-$113 9A 10 97 u.s.c.
.w or e is.te. s%a.m.e as se sro, coup TYPED OR PRNWTED --
va senseur r s a.n.e.
- n. ass.eem.ese.may y r ) heenameorreCER me ,sOR t,oot AseD sa AUTHORIZED AGENT @ YEAR MO DAY j COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af strechments heref i l
1 EPA Form 3320-1 (08-951 Previous editions may be used. (REPLACES EPA FORM T-40 WDECH MAY NOT SE USED.) ,i,. PAGE OF
..r./qe,2,$
s .2 g _ <t 3 ra-A . . _ _ . . - _ _ . .
- m '
Paperwork Reduction Act Notice .' o yc I Public reporting burden for this' collection of information is estimated to vary from a range of 10 hours as an average per response for some minor facilities,'to 1l'0hours as an average per response for some major facilities, cwith a weighted average for' major _ and minor facilities of IR hours per response, including time for r"eviewing indructionsl sdaichi'ng existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.. Send comments regarding the burden estimate or any other aspect of
, Et his collection 'of informat' ion,' including r,uggestions for reducing ht' is burden, 'to Chief, Information Policy
~
l Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW hhington, DC 20%0; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, hhington, DC 20503. Su - - y L . General Instructions I, If form has been partially compte Ed by preprinting, disregard instructions directed at entry'of that infonnation : l already preprinted [ 2. Enter " Permittee Name/ Mailing Address (and facility name/ location, if different)," " Permit Number," and
- " Discharge Number" where indicated. ' (A separate form is required for each discharge.)
- 13. Enter dates beginning and ending " Monitoring Period" covered by form w here indicated.
7 4. Enter each " Parameter" as specified in monitoring requirements of permit. t
' 5. Enter " Sample Measurement" data for each parameter under "Guantity" and "Gualitt in units specified in permit.
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
;for each parameter obtained during " Monitoring Period"; " Maximum" and " Minimum" are normally extreme high and low measurements obtained during " Monitoring Period." 1 Note to municipals with secondary treatment requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average
; of sample measurements obtained during monitoring period under "Marimmn ")
61 Enter : Permit Requirement" for each pararneter under " Quantity" and " Quality" as specified in pennit.
? 7. Nnder "No Ex" emer number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter, if none, enter "0".
; 8. Enter "Frequeny of Analysis" both as " Sample Measurment" (actual frequency of sampling and analysis used
. du ing monitoring period) and as " Permit Requirement" specified in pennit. (e.g., Enter " Cont," for continuous
' monitoring, "l/7' for one day per week, "100" for one day per month, "l/90" for one day per quarter, etc.)
- 9. Enter " Sample Type" both as " Sample Measurement" (actual sample type used during monitoring period) and as
'" Permit Requirement.",(c.g., Enter " Grab" for individual sample, "24/IC" for 24-hour composite, "N/A" for ., contmuous momtoring, etc.)
l'10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each siolation by date. _11. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
~
12'." Enter "Namenitie of Principal Executive 0))icer" with " Signature of Principal Executive Of]icer ofAuthorized Agent," " Telephone Number," and "Date" at bottom of form. LD 13. Mail signed Report to Office (s) by date(s) specified in permit Retain copy for your records. l - -14. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Office (s) P specified in permit. 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 result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
~of violation, or by imprisonment for not more than one year, or by both.
,e '
EPA Form 3320-1 (Itev. 08-95)
PER6MTTEE NAMEIADORESS('wderaryh vt.een qrD.p e NAnONAL PORUTANT CPSCNAnef tuh4NADON SYSTEM (MPDES) t Form Approved. ** - NAME ,, ,, g y ; yt y 31, L[ y pn,gg ,3g;;37 . N%[ NN N ',% f ' 1g1 ' cy y 3; g7,; y OMB No. NNO
.ADDREt$
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( J. b, u, h U a) Approval empires. A . ,r > 05d1-98 e-e a .eJ ., ea*"eAv~n a ram n o. k.> p. .i PERMIT NUMBER DesCHAnoE NUMeeR g_ .m .t 3 u
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y
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;3-- . s u x t. 3v. r* r :*c. x' si 4 M } myg y - 4, u+ Tun S" -
YcAR MO DAY O.AR MO DAY l OCATION FROM < w- - TO s- u 2 M4 .' D I S C H L J. ~._ j 200 NOM Reed ineemcelone betono _ T) 2- ; due form.'
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D5Y kT %: D L '.' i O Li : v20'211 I?2-231 124-251 126-271 128-2s1 (30-311 _ PARAMETER t3 w @ANM OR LOAM (4 M W WANW M CMCENTRAM NO. MEMNCY SAMPLE v46-531 164-671 (30-461 '46-539 154-619 or 132-371 - EX ANays,s TYPE AVERAGE MAXIMUM UNITS MINIMUM A*dRAGE
. MAXIMUM UNITS estas, fe m faga pd SAMPLE c acr2 c.c.c e ; u vaer -
3 ^, : - MEASUREMENT
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fi_u' d , RI AL SAMPLE - e :: r neten oc6t : gg l ( t9
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gCb3v 1 0 0 .. PERMIT . vacc % CM?e? :M 9 povcen 30 I Cf- W12 n CM P ' '! REQUIREMENT
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PERMIT a :; : ene r$ece na70 ; 15 20- W y3, g; g . j gy;gg z- , , - j gg REQUIREMENT w e g Agg g n y'. y y j; ,
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n 13 ; j 1, ; PERMIT McC9 "<No : M =- CW5 GOO M L NdT -RMOG khEKL GMAJ _t _ , 7, , j 2, g REQUIREMENT , :c g3 i y ;., D Agy' v. yOfL SAMPLE MEASUREMENT r PERMIT ' l REQUIREMENT , NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER CERnFY UNCER PENALTY OF LAW THAT 4 HAVE PERSONALLY EXAMtNED AND TELEPHONE DATE L L AM FAMittAR MY INQUIRY WITHOF THOSETHE INF,OMATION NDIVIOUALS SUOMTTED EMMEDIATELY HERON: AND SASEDFOR MESPONStBLE ON / r g D:tvid 01 ndori osmMWG NE WFOWADON, I BEUEVE WE SUBMTTED WFOMADON IS TRUE. ACCT % ATE AND COMPLETE. 8 AM AWARE THAT THERE ARE -4 3
~ + '- O 'L '/ ~
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i Chenistr/u Manager SGNmCANT PENALDES FOR SUBMTTING FALSE INFORMATION. INCLUDWG THE POSSIStuTY OF F8NE ANO IMPRISONMEN It 3 3934113 q 8 W ,7 4
.swu T.m.,
SEE 18 =U.S.C. 91001 AND 33 a s1o.000 s00 NATURE OF PRINCIPAL EXECUTNE TYPED OR PRINTED u S.C. 9 ist e. % w.r m ama er m wwe n- - er a.r e css s maams w a y raJ mi OmCER OR AUTHORIZED AGENT m NUMBER YEAR MO DAY ; CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refererree er artschmerrts herej -/* . , *-
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. 6*A B sen 3320-1 108-95) Previous editions may be used. (REPLACES EPA FORM T-40 WieCH MAY NOT BE USED.I , g 3_ c <a c f ; ; p> 7 .~3 ,g , ,1 .. PAGE OF ;
r
y>sv- - Paperwork Reduction AsttNotice s 7 ml Public reporting f, .
~
_ = burden for this collection of information is estimated to vary from a range of 10.bours as an
- f average per response for r,ome minor facilities, to 110 hours as an average per response for some major facilities,
> > ' with a weight'cd average for major and minor facilities 'of 18 hours per response, including; time for r'eviewing 9
initmetions,'. searching . existing'~ data sources, gathering and maintaining the data needed, and completing and p reviewing the collection of,information. ' Send comments regarding the burden estimate or any other aspect of Jt his collection of information, including suggestions for reducing this burden, to Chief, Information Policy j , ; Branch, PM-223 U.S. Environmental Protection Agency. 401 M Street, SW Washington, DC 20460; and to the
' Office ofinformation and Regulatory Affairs, Office of Management and Budget, Washbyton, DC 20503. 4 y
4 General Instructions
, 1 If form has been partially completed by preprinting, disregard instructions directed at entry' of'that information 3"..
; already preprinted.
,: 2, Enter "Permitter Name/ Mailing Address (and facility- name/ location, if different)," " Permit Number," and
, " Discharge Number" where indicated. (A separate form is required for each discharge.)
s 3, Enter dates t.eginning and ending " Monitoring Period" covered by form w here indicated.
'~
f .4 Enter each " Parameter" as specified in monitoring requirements of permit: , y
- 5. Enter " Sample Measurement" data for each parameter under " Quantity" and "Guahty" in units specified in permit.
, " Average" ss nonnally arithmetic average (geometric average for bacterial parameters) of all sample measurements '
. for each parameter obtained during " Monitoring Period"; " Maximum" and "Minimmn" are normally extreme high
. and -low measurements obtained during " Monitoring Period." (Note to municipals with secondary treatment j
' requirement: Enter 10-day average of sample measurements under " Average," and enter maximum 7-day average %'
iof sample measurements obrined during monitoring period under "Marimum ")
- 6. Enter ." Permit Requirement" for each parameter under " Quantity" and "Guality" as specified in permit.
17.' Under "No Ex" enter number of sample measurments during monitoring period that exceed maxirnum (and/or minimum or 7-(.Sy average as appropriate) permit requirement for each parameter. If none, enter "0".
' 8J Enter " Frequency of Analysis" both as ." Sample Measurment" (actual frequency of sampling and analysis used
,. during monitoring period) and as "Pennit Requirement" specified in permit. (e.g., Enter " Cont," for continuous monitoring, "l/7" for one day per week, "//30" for one day per month, "hW)" for one day per quarter, etc.)
- 9. Enter "Samp/c Type" both as " Sample Measurement" (actual sample type used during monitoring period) and as
'" Permit Requirement," (e g., Enter " Grab" for individual sample, "24HC" for 24-hour composite, "N/A" for
; continuous monitoring, etc.)
10.- Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
' 11 lf"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
;12. Enter "Name/ Title of Principal Executive OJ]icer" with " Signature of Principal Executive Officer ofAuthorized V Agent," " Telephone Number," and "Date" at bottom of form.
rr 13, Mail signed Report to Oflice(s) by date(s) specified in permiti etain copy for your records. L 14. More detailed instructions for use of this Dis-hargeMonitoring Report (DMR) form may be obtained from Ollice(s)
.specified in permit.
Leaal Notice, Thif 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 resun in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment fer iot more than one year, or by both.
. EPA Form 3320-1 (Rev. 08-95)
_ . _ _ _ _ _ _ _ _ _m. _ __ m ..._,----w , --
PERMITTEE NAMEJADDRESStr-a. der reeyD vtar.nm.grtser is+ NADONal POLLUTANT DISCHAftOE EUMIf6ADOst SYSTEM (NADES) Form Approved. . NAE 2 %s
- s n 's _. s. "v o> omr
- i. y o 0 4 s. n. e. *4 5= *..-
t .T v DtSCPJCGE MONITORING REPORT (DMR/ fy. r si fr A rs; 3nh t -+ Ao3
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$ $ 15 ^EE **
CDORESS /. O. b O IL 4 -tt 1- ' a (CUB 8 05) ~'
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;!i!FP UGPP T iA 1bG77 ^
MONITORING PERIOD YEAR MO DAY YEAR MO DAY - LocArm pgou ,
. TO << . 3; 9<v b0 U hMa43L l _t . Mo NOTE: Reed instructions before completm8 this form.
A~Ts: O4Vfi OdLi.OsI (20'271 (22-23) (24-25J (26-27; (28-291 (30 371 PARAMETER '3 C*'d m &s QUANTITY OR LOADING /4 Card & &f OUANTITY OR CONCENTRATION NO. 'REQUENCY SAMPLE 146-65 v54-671 (36-451 146-531 (54-679 OF (32-371 EX analysis TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,n.43, gg4 6,f fgg7af
- SAMPLE MEASUREMENT VM nv e'es W 7sy
' L NGC 793 (.+' O 2Mo 666
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.. & fc u PERMIT von N - McW ceu u,0 .rz u w t 3,G - ItICf. GE; Att .
q AgyQy . g gp t Fi LU ? iT a, s 7. L M REQUIREMENT # ., 3 g q ; a. g g , eq? r V 1 i t SAMPLE 'GMm seerc0 . :: c o s + m ( ^7' a . .s r .. . b. .- w MEASUREMENT 5. '7. 5 O e so GMB - c0 ;; ; G ,. . PERMIT C%cu c c.c e t u . - 9c099W ), ,10U: 4 TkICL GRAW
+y*- , ,N3; y3j, REQU:REMENT em n ;+. zga g j g' gi pyL gg r: r: 3 r*< SAMPLE $Or900 N o c :w . -
( 1*' [([
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4 Ws 9 4 c 1S. 2L T W IC E, GpAg
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yo jg gpg ggy@ h) M;j[ fy g
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s ' I t ^T MEASUREMENT 6 A ~$4 / .001 <, 00 O 4 50 F57
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7 ,3, gay . REQUIREMENT e ty G p;7Ly r1 , c r. 7 e SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT 1 REQUIREMENT SAMPLE MEASUREMENT PERMIT i REQUIREMENT , NAME/HTLE PRINCIPAL EXECUTIVE OFFICER I CEPDFY UNDER PENALTY OF LAW THATI HAVE PERSONALLY EXAMINED AfsD TELEPHONE DATE AM FAMIUAR WITH THE INFORMATION SUBMITTED HERE)N: AND SASED ON - p ,/
., , MY INQUIRY OF T'4CSE INDIVIDUALS IMMEDIATELY RESPON98LE FOR /f. .
j d,, aV ! t1 UtUdOr1 08TAlpetNG THE INFORMADON, I BEUEVE THE SUBMfTTED INFORMATIO*d tS i;t ' fy-TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE E f j' ,u.,'" '
>'t ~-t 4s'# -
C h Cl21AfIf [$aD U $t*C SIGNfFICANT PENALTIES FOR SUBMITTING FALSE INFORMADON, INCLUDING
~
o 393-5113 i , THE POSSIBEUTV OFoms.r FINE AND
'* 169 93 10 e u.s.C s i3is. em an IMPRISONMENT.
- m. me, meAm SEEsh. 18 U.S.C.,$a, se s;om 1001 AND 33 S4GNATURE OF PRINCIPAL EXE AREA TYPED OR PRINTED .as .,. man == n _ : ta.r. s m.asne as s r rms OFFICER OR AUTHORIZEO AGENT M)MBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# ettschmen s heref EPA Form 3320-1 (08-95) Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ., n PAGE OF NULt/', < : 7,.,/ M 1..J
i-
,a F Paperwork Reduction'Act Notice ,
Public. reporting burden for this collection of information'is estirnated to vary from a range of 10 hours as t.n ' t average per response for some minor facilities, to 110 hours as an average per response for some major facilities,,
- with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
~
instructions, searching existing ' data sources, gathering and maintaining the[ data needed, and completing and reviewing the collection of information. ' Send comments regarding the burden estimate or any other aspect of this collection of infonnation, including suggestions for reducing this burden, to Chief, information Policy Branch, PM-223, U.S. Environmental Protection Agency,401 M Stuet, SW Washington, DC 20460; and to the
, 'LOffice ofInformation and Regulatory Affairs, Office of Management and Budget, Washington,1 General Instructions:
- 1. If form has been partially completed by preprinting, disregard instructions directed at entry of'. hat information already preprinted. -
- 2. Enter " Permittee Name/Alalling Address (and facility name/ location, if different)," " Permit ' Number," and
' " Discharge Number" where indicated. (A separate form is required for each discharge.)
1 4
. 3. Enter dates beginning and ending "Alonitoring Period" covered by form where indicated.
; 4 Enter each " Parameter" as specified in monitoring requirements of pennit.
- 5. Enter " Sample Afeasurement" data for each parameter under " Quantity" and " Quality" in units specified in permit.
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Afamtoring Period"; "Afarimum" and "Afinimum" are nonna!!y extreme high
, , _ and low measurements obtained during "Alonitoring Period" (Note to municipals with secondary treatment requirementn Enter 30-day average of sample measurements under " Average " and enter maximum 7-day average i of sample measurements obtained during monitoring period under "A/arimum,")
' 6. Enter " Permit Requirement" for each parameter under " Quantity" and " Quality" as specified in permit.
L7Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0". t
- 8. Enter ." Frequency of Analysis" both as " Sample Aleasurment" (actual frequency of sampling and analysis used
..during monitoring period) and as " Permit Requirement" specified in pennit. (e g., Enter " Cont " for continuous monitoring, "1/7" for one day per weck, "l/30" for one day per month. "1/90" for one day per quarter, etc.)
- 9. Enter " Sample Type" both as " Sample A/easurement" (actual sample type used during monitoring period) and as
" Permit Requirement," (e.g., Enter " Grab" for individual samp!c, "24HC" for 24-hour composite, "N/A" for continuous monitoring, etc.)
- 10. Where violations of permit requirements are reported. attach a brief explanation to describe cause and corrective actions taken, and reference cach violation by date.
11.= If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. j 12'.~ Enter "Name?Dtle of Principal Executive OJJIcer" with " Signature of Principal Executive OJJicer of Authori:ed
. Agent," " Telephone Number," and "Dat;* at bottom of form.
l 113. 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 Discharge Afonitoring Report (DAIR) fonn may be obtained from Omce(s) !
specified in permit. I Legal Notice , l This repe. is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both. j l EPA Form 3320-1 (Rev. 08-95) l
_ ~_ _ %-. -- = t. PERMITTEE NAME/ADORESS(FasweForetv#aas't.e.es erDJipwar) 98ATIONAL POLLUTANT Ot9CHAACE EUMINATtOes SYSTEM (NFDESJ orm Approved. - NAME DISCHARGE MONITORING REPORT (DMR/
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PERMIT NUMBER DISCHARGE 98 UMBER ; , . - + nv
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cn1 .- 2 a31 .. 4 3 2 .. . ,y 7 MONITORING PERIOD
,#J' YEAR MO DAY YEAR MO DAY __
LOCATION FROM : ' ' c
#s TO 1 , , ;; ;cls7 ,1 {~j 4 ii ; ', n' *
% v (20'271 (22-23/ (24-25J (26-271 (28-291 (30L37) NOTE: Read instructions before compieting this form.
(3 c ,cr On&i QUANW OR LOADING (4 carif on&s QUANTITY OR CONCENTRAMN NO. mEQUENCY SAMPLE PARAMETER 146 531 (54-61I 136-451 146-53) 154-6 ff 09 (32-J71 EX analysis TYPE AVERAGE MAXIMUM UNITS MINIMUM ' AVERAGE MAXlMUM UNITS ,s2. ass ig4.ssj ra m SAMPLE ,r '^
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g, REQUIREMENT - j- Sa,e;y ;y . , - yy4 SAMPLE MEASUREMENT FERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERM 3T REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERT 18Y UNDER PEN ALTY OF LAW THAT 4 HAVE PERSONALLY EXAMfNED AND TELEPHONE DATE AM FAM!1.lAR WITH THE INFORMATION SUBMfTTED HEREIN; ANO BASED ON , MY INQUeRY OF THOSE INDIVIDUALS IMMEDSATELY RESPONSrEL E FOR f Nygd Ogndgy{ OBTAINING THE INFORMATION, a BELtEVE THE SUBMITTED INFOP.MATION IS j j* ,
"jj; -
TRUE. ACCURATE AND COMPLETE. 8 AM AWARE THAT THERE ARE e8 / , LiaOMi3i f V 21d P a p,C I SIGNIFICANT PENALTIES FOR SUBMITTING FALSE fMFORMATION, INCLUDING ThE POSSIBIUTV OF FINE AND IMMUSONMENT. SEE 18 U.S.C 91001 AND 33 i 1' 10 7 A 1 1 3 % Ii ): u_S.C. s 131o. sp nemes en=ser riese sonnes may kickan naes se m no, coo SiONATURE OF PRINCIPAL EXEClmVE g TYPED OR PRINTED .as er man =,= 1 - : er aerwe.a s mamne mas 5 yearms OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# stfachments here/ 1 j
.t. > .- , .
t e*A e wm 3320-1 408-95) Previous editions rnay be used. (REPLACES EPA FORM T-40 WHICH MAY NCT BE USED.) PAGE u_ zur- ' . e
- ~ :. -
OF
t y
= -
Paperwork Reduction Act Notice-
~
?Public reporting burden for 'this collection of.information is estimated to vary from a range of 10 hers as an
- average per response for some minor facilities, to 110 hours as an average per response for some major facilities.,
E .with a weighted average for major and minor facilities of la hours per response, including time for reviewing ' instructions, searching existing' data ources, gathering and maintaining the data needed, and completing and reviewing the collection of information/ Send comments' regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden : to Chief, Information Policy i Branch, P_M-223, U.S. Environmental Protection Agency, 401 M Street,' SW Washington, DC 2N60; and to the
' Office of Jaformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
,C 41.
,2, m r l General Instructions .
[1, if form bas been partially; completed by preprint'ing, disregard instructions directed at entry of that information .
, , already preprinted. ,
i
- 2. Enter "Permitter Named / ailing Address (and facility name/ location, if different)," " Permit . Number " and 4
" Discharge Number" where indicated. (A separate form is required for each discharge.)
- d. Enter dates beginning and endinj; "Afonitoring Period" cos cred by form w here indicated.
m 4', Enter each " Parameter" as specified in monitoring requirements of permit.
+ .
J 5. Enter " Sample A/casurement" data for each parameter tinGr " Quantity" and "Guality" in units specified in permit.
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for cach parameter obtained during "Alonitoring Penod"; "Alaximum" and "A/inimum" are normally extreme high 1 . and Jow measurements obtained during "A/onitoring Period" (Note to municipals with secondary treatment requirement: Enter 30-day average of sample measurements under " Average," and enter maxistum 7-day average of sample measurements obtained during monitoring period under "Afarimum.")
- 6. Enter " Permit Reqmrement" for each parameter under "Guantyy" and "Guality" as specified in permit.
7/ Under "No Ex" enter number of sample measurments during monitoring period that exceed ma.v imum (anNor
; minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0". {
Sc Enter " Frequency of Analysis" both as " Sample A/easurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in permit. (e g., Enter " Cont," for continuous (monitoring, "l/7" for one day per week, "//30" for one day per month, "l/90" for one day per quarter, etc.) -
'9s Enter "
" ample T pe" 3 both as " Sample Afeasurement" (actual sample type used during monitoring period) and as
' Permit Requirement," (e.g., Enter " Grab" for individual sample, "NHC" for 24-hour composite, "N/A" for continuous monitoring, etc.)
10.;Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
- 11. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
~
.'12. Enter "Name/ Title of Principal Executive OJJ1cer" with " Signature of Principal Executive Officer ofAuthori:ed
- 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 Discharge A/onitoring Report (DA/R) form may be obtained from OfTice(s)
L specified in permit. Legal Notice Tnis report is required by law (33 U.S.C.1318; 40 C.F.R.125 27). Failure to report or failure to rtoort truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceel $25,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95)
PERMITTI.E NAMEJCDOREES ta=AadeF.caawyA= Larmes=ecf4p., f. NAT 0,eAL POLLUTANT oisenARet EuMiseAh04 SYSTEM (NPDfSJ . Form As.l%ved. - NAME M. n y y n. e
? t, U y .- cy y .i >-.a e n -g r 4 9. *s 0 +s y. DISCHARGE MONfTORWG ftEPORT IDMRf y o , ,, . s a F.,L.V I &,- :4 M No. M, x. .
u 3 %
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($ULh O$) k PERMIT NUMBER DesCHARot NuMeER '* 417 %; ;AYlO CJ M 00 Rf y __ yy3g {.- ager.s.,s.,.y
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ar .A a 7 ,- 7*. ; y' # FACPUTY MONITORNG PERIOD l' LOCA N YEAR MO IDAY YEAR MO DAY .. -p FROM , > d _.
, TO 4t u; Oc NO P1;;CI! AEGn j j 84 0 h 77i : 'l4: u O i:
i ?<Qn* 12O219 122-231 124-25) 426-271 (26-29) (30u319 NON b*d W** L -l I- -: N f*V* PARAMETER (J Card on4J QUANTITY OR LOADING I4 Card On&A- QUANTITY OR CONCENTRAM NO. mEmer SAhrLE ' I46-539 (54-691 (30459 446-539 f54-619 OF
#32-37; EX 3,gy,S TYPE
/ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,82-8 2 (64-6s1 (69 70F TLOW, j; C O ' 0 01 ~. W. SAMPLE ( c j) ovacee s omu w;: v n.
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SAMPLE MEASUREMENT PERMIT REQUIR2 MENT SAMPLE MEASUREMENT PERMIT ' ; REQUIREMENT t SAMPLE MEASUREMENT
. PERMIT nEOUIREMENT SAMPLE MEASUREMENT PERMIT .
REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT-REOutREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER e CERTWY UNDER PENALTY OF LAW THATI HAVE PERSONALLY EXAMINED Afe0 TELEPHONE DATE AM FAMluAR WITH WE INFORMATION SUSMITTED HEREth: Aped BASED Ost , >r MY INQUERY OF THOSE INDIVIOUALS IMMEDIATELY RESPO8898LE FOR ./ Dayid erndorf Oeramma mE e FORMAnON. : SEUEVE WE SUBMITTED InfFORMATION IS // C [1t'n i E ( iV Mi10 in g 0 t-TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE 9GNIRCANT PENALT!ES FOR SUBMITTING FALSE INFORMATION. leeCLtKletvG I h' # (1 -[' h l f, , / 2 -. 44
/
98 THE POSSIBtUTY OF FINE.AND SMPRISONMENT. SEE 18 U.S.C 51001 41 7 393-5113 ,0 i 27 u.s.C. e i3 e. e%n m. =M., nn - mer 6. cans. m . s. sAped 33 roooo sooNATURE OF PRINCIPAL EXECUTWE AREA TYPED OR PRP8TED w or man === : .Fe.rw n a m.mns and a yaerd OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReference s# sttschments here) EPA Form 3320-1 (08-95) Previous editions may be used. UtEPLACES EPA FORM T-40 WieCH MAY NOT BE USED.) . . ., PAGE 0 15 U1c= t, ,, ,g .3 b b 7 m, y., 71J5,* l, , .
~
Papenvork Reduction Act Notice l T Public reporting burden for this collection of information is estimated to vary from a range of 10' hours as at average per response for some minor facilities, to 110 hours as an average per resp < nse for sdme major facihties, , Nith a weighted ahrage for major and minor facilities of 18 hours per reponse, including time for reviewing
~
" instr'uctions; searching ~ exiMing data ' sources,' gathering and maintaining the' data needed, and ' completing and reviewing the collection of infonnation. Send comments regarding the bmd- :timate or any .other aspect of y i his t collection" oflnformation, including suggestions for reducing this burdu., to Chief, Information Policy ,
i : Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the LOffice ofInformation'and Regulatory Affairs, Office of Management and Budget, )hhington, DC 20503. , j 4
, j - 't
. General Instructions
- f L 1. If form has been partially ~ completed by preprinting, disregard instructions directed at entry 'of that information already preprinted. 3
- 2. Enter "Pennittee NameAfailing .4ddress (and facility namellocation, if different)." " Permit Number," and i ." Discharge Number" where indicated. (A separate fonn is required for each discharge.)
' 3. Enter dates beginning and ending "Alonitoring Period" covered by form where indicated, 4' Enter each " Parameter" as specified in monitoring requirements of permit.
' - 5. Enter "Samp/c Afeasurement" data for each parameter under " Quantity" and " Quality" in units speciaJ in permit.
"<t rerage" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtain d during "Alonitoring Penott'; "A/aximum" and "Alinimum" are normally extreme high
- and low measurements obtained during "Afomtormy Period" (Note to municipals with secondary treatment ,
. requirement: Enter 30-day average of sample measurements under "stverage," and enter maximum 7-<!ay average of sample measurements obtained during monitonng period under "Alarimum. ")
- 6. Entdr " Permit Requirement" for each parameter under " Quantity" and "Guahty" as specified in permit. .
- 7. Under "No Ex" enter number of sample ir.casurments during monitoring period that exceed maximum (and/or i~
rninimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
- 18. Enter
- Frequency of.4nalysis" both as " Sample Leasurment" (actual frequency of sampling and analysis used during monitoring period) and as "Perunt Requirement" specified in pennit. (e.g., Enter " Cont," f- mtinuous ,
monitoring, "UP' for one day per week, "uJ0" for one day per month, "u90" for one day per quarter, L ,
- 9. Enter " Sample 7)pe" both as " Sample Aleasurement" (actual sample type used during monitoring period) and as
" Permit Requirement " (e.g., Enter " Grab" for individual sample, "NHC" for 24-hour composite, "N41" for continuous monitoring, etc.)
;10. Where violations of pennit requirements are reported attach a brief explanation to describe cause and corrective actions taken, and reference cach violation by date.
I1. 'If"no discharge" occurs during monnoring period enter "No Discharge" across form in place of data entry. li.' Enter "Name/ Title of Principal Executive ODicer" with " Signature of Principal Executise OHicer ofiluthorized
- Agent," " Telephone Number,"'and "Date" at bottom of fornt
- 13. Mail signed Report to Office (s) by date(s) specilled in permit. Retain copy for your records.
- 14. More detailed instmetions for use of this Discharge Afonitoring Report (D3/R) form may be obtained from Office (s) specified in permit.
L Legal Notice i ! This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
- of violation, or by imprisonment for not more than one year, or by both.
i EPA Form 33204 (Rev. 08-95)
m PERealTTEE NAME/ADORESS(A=hdeFarerpName'LeresseCIN$breep NATIONAL POLLUTANT ONARGE EUMINADON SYSTEM (NPDES) Form Approved. " ' DISC NAME , gy g; ya;;g7 g ;j g, 3777;g3 MONITORING REPORT (Og , - r N No. N
,c
.ADORESS . edo aA. 4 .. . * - ,3 < . ( b ,u, ; *
.) 3)
- Approval e.xpiree 2*s 05-31-98 ,
AiiSi JAV!O CihhUC97 PERMIT NUMBER oeSCHARot NuMsER y _ py3zg u+.,,., , , . we s .r. aatt t. .v. - rn .y <a v'# 3 ,3 ' FACluTY MONITORING PERIOD YEAR MO DAY YEAR MO DAY _ LOCA h . FROM ~1 u :2 TO w rec n j ,15 C a t h ; j UOc s .' T . : G! i: L 2nL s' Y (20 211 (22-231 124-25) 126-27) 128-291 130 31) NOTE: Reed inetrucebene before _Tl a thin PARAMETER (3 w my QUANTITY M LOADM (4 Carst mM QUANTITY OR CMCmTRAN NO. NN SAMPLE (4 & S 39 454-611 (30-459 (465m (66619 or (32-371 EX ANAty m TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 88288 (6&sel 16Ms SAMPLE :r+ r e e :; c e c :; 7
; 3
( " MEASUREMENT 7.26 733 d /[}d 6U8
, +, ,. g i j PERMIT n;acc, ecc ,t. t,0 _ rj c 1y e 9 i;. f,g. Q g gg gg
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REQUIREMENT , cc 11 h ' A? p hAd y06 .* _t SAMPLE 3 r. , e v " ? t. e 30nc / ,; [ ^ }[ ,]#
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MEASUREMENT d dh ' '" h I 6Q
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'3 SAMPLE s :nc en- (
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o I/7 6M6 PERMIT M e i M:% OJ 1 , , 4< . lb- .M . ,3 g ;;{ g t Q A1 e , ,3 ,, , REQUIREMENT m, q 3, y g - 4 7 gg ;) '7 gg yy; .yL
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REQUIREMENT ., 1 m r1- > ,.t. y , t .- , , .a n _ SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT , REQUIREMENT SAMPLE MEASUREMENT PERMIT. REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTtFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE- s AM FAMILIAR WITH THE INFORMATION SUBMITTED HERON: AND BASED ON _ MY INQUIRY OF THOSE INDIVIDUALS IMMEDsATELY RESPONSIBLE FOR {./- / OSTAINING THE INFORMATION, t BEUEVE THE SUButTTED INFORMATION IS d Y/ f UOVI d UT Ldt l' E TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING FALSE tNFORMATION, INCLUDING N /s L/ - / .i'"..*-!
. ,' ~ '. THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE IS U.S.C. 91001 AND 33 EIJ lOl=%!]7 m) W lp * *r U.S,C.t 1319. fPeneese saneler snese senasnes mesy ancheelp Ares 44p 3D IIOM SIGNATURE OF PMAL EXECUTfvE g, TYPED OR PRINTED aaa er m==sman ! :er 6erween s niemns ana s years.s OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLAN ATION OF ANY VIOLATIONS (Reference a# errschments here/
4 s ?!c o n 1. (ly , 4pg [& ]y pj , g 7(&Q + a 6% i ane 3320-1108-95) Previous editions may be used. (REPLACES EPA FORM T-40 WteCH MAY NOT BE USED.) PAGE OF
;',,s..
u s h / f c c I O t , ..aj:
e Papenvork Reduction Act: Notice l "Public reporting burden for this collection of information is estimatJd to vary from a range of 10 hours as an j average per response for some minor facilities, to 110 hours as an average per response for some nuijor facilities s
. rwith a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
' instructions, searching existing data sources, gathering and maintaining the' data needed,' and completing and.
, reviewing.the collection of information. Send comments regarding the burden estimate or any other aspect of i
this collection of information, including suggestions for reducing this burden, to Chief, Information Policy .; TBranch; PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460iand to the p Office of Information and Regulatory Affairs, Office of Management and Budget, Washington DC 20503,
. m
O'
, General Instructions -
. , ~
i t, if form has been partially completed'by preprinting, disregard instructions directed at e try of that information
~
already preprinted. , (2. Enter " Permittee Name/3failing Address (and facility name/ location, if discrent)," " Permit ' Number," and
' ." Discharge Number.".uhere indicated. (A separate form is required for cach discharge.)
- 3. Enter dates beginning and ending "Afonitoring Period" covered by form where indicated.
N.~ Enter each " Parameter" as specified in monitoring requirements of permit.
. : Sc Enter " Sample Areasurement" data for each parameter under " Quantity" and "Guality" in units specified in permit.-
. " Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements '
for each parameter obtained during "Afonitoring Period"; "Afarimum" and "Afmimum" are normally extreme high tand low measurements obtained during "Afonitoring Period." (Note to municipals with: secondary treatment
= requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average of sample measurements obtained during monitoring period under "Afarimum ")
- l. - 6. Enter " Permit Requirement" for each parameter under "Guantity" and "Guality" as specified in permit.
l '7. Under ."No Ex" enter number of sample measurments during monitonng period that exceed maximum (and/or minimum or 74tay average as appropriate) permit requirement for each parameter. If none, enter "0".
;8. Enter " Frequency of Analysis" both as " Sample A/casurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in penuit. (e g., Enter " Cont," for continuous monitoring, "u7" for one day per week, "#30" for one day per month. "#90" for one day per quarter, etc.)
(9. Enter " Sample ' Type" both as " Sample A/enturement" (actual sample type used during monitoring period) and as
" Permit Requirement,* (c.g., Enter " Grab" for individual sample, "24HC" for 24-hour composite, "N/A" for continuous monitoring, etc.)
- 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
. I1. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. l12. Enter "Name/ Title ofPrincipal Executive OJJicer" with "Signatu're of Principal Executive Officer of Authorired
; Agent,*
- Telephone Number," and *Date" at bottom of form.
- 13. Mail signed Report to Oflice(s) by date(s) specified in permit. Retain copy for your records.
114. More detailed instructions for use of this Discharge Afonitoring Report (DAIR) form may be obtained from OIIIce(s)
- specified in permit.
Legal Notice , This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
. of violation, or by imprisonment for not more than one year, or by both.
- EPA Form 332'0-1 (Rev. 08-95) a:
_ - __ _ -_ _ _ _ . __ . _ .m_ . , - - - - . , - _ _ -..m ..s. , .-__.-
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. PERMITTEE NAME./ ADDRESS ossurernhey A=w4 rame= vtWeari esAfiONAL POLLUTANT DeSCMARet eueme%nOss sysTau (MPDES1 Form Approved. -* I NARE NN M M % !
e 3 h ~t ;. .;.. un +a .r.L t,. v. +
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-. r ADOGSS i dGX 4 7' O= ' ' ' ' * ' E (sObR O S) *t An s; :;avIo dseudF PERMIT NUMBER l oescwARGE NuumeR y .,, ygg ;
n 3 ,
., e'i A h }'. , Ah .s'a 3e. U E 4
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q1 4 3 V- gg gg $Ayi. D .% e -) FACluTY g . < YEAR MO DAY YEAR MO DAY ,_. l LOCA N FROM +
- t. TO n m ;6 M $ DISC 5AhF!( j ecc- l k T T % *, .ALTD C..i :P ' (20k211 122-23) (24-251 126-279 128-291 (30 319 MN N -
/k PARAMETER is card onM OUANTITY OR LOADING I4 Car N / QUANTITY OR CONCENTRAMN NO. mEaumcv SAMPLE I 146-53s est-sts (30-461 146-539 154-01) or ;
132-37; EX Amavses TYPE i AVERAGE MAXIMUM UNITS - MINIMUM AVERAGE MAXIMUM UNITS w.ess f,,.gg fgg.yg e a SAMPLE u o n Mt eC$ H c C %" ? ? ' ' (1?. h b MEASUREMENT 1$ 3 hh ! 604l, i O . PERMIT enc?o: ce?ch ros 6,0 10 3 0% Q '9 ;O _ pidC4 4343 i-
+ff3d}9T 5 E L ;, REQUIREMENT occc '9ryt m 3 A gggy w %g? ;
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7 It Ly (Cjg . { k gt,jJ l O O - PERMIT coccoe nocce@ . c 'ecc McC?901 - .R - 5 Gy T GCL' QO M- 1 5 4 lFF t.J ! , T ,nM . A L t.i REOtHREMENT vwe @ pj p - rig y 1,p ph) 3c/L %dy; ELu,, 1, ) N i, u i I 9 .. SAMPLE c. p, 9 ( s
- 3) cGow OO CM - CUCO' ^
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- t r;,;c4 i ,, _; ; Ag REQUIREMENT nuce . $- QQ; 100y T hC M : ,
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Lr LO *- ;l a VaLu REQUIREMENT -ce :06 ;yg- pMyp g/L ig; t SAMPLE e MEASUREMENT j PERMIT - ! REQUIREMENT i NAME/ TITLE PRINCWsAL EXECUTIVE OFFICER e CERTIFY uNoER PEN ALTv of LAW THATI HAVE PERSOceALLY EXAMiseED AND / TELEPHONE DATE AM FAMtuAR WITH THE sesFOsosATION mama'TTED HEREfBf; ANO SAsEO Ost . f f j BAY letOUIRY OF THOSE leIDIVIDUALs IMMEDIATELY RE N SELE FOR /
'Q I d.dV l u, Of fid O1' ,A ORTAINING THE 19eFORMATIOst, 6 SEUEVE THE sueMITTED tesFORMAT10es as
/--
f / .N /j/-l ' , .f ' s 4 . 7,gg. ', _ ) [,., _ l TRUE. ACCURATE AssD COMPLETE. 4 AM AWARE THAT THERE ARE f j (;3 - Chenistry Manager SIGNIFtCANT THE POssreiuTv PENALTIES OF FierEFOR ANDSUsemTT.I.N,G iurRisO ENT. FALSE SMFORMATION, sEE is u. IBfCLUDING 412 39341 0 10 9
~7 :
U.s.c. e 1:10. s%siones asimir mese seamos nier hacean,s.c. mise a4P s sooi ANo as sp $70,00, 54GIGATUIIE OF PHNIt2AL EXECME y TYPED OR PRINTED mad ar mass =sa : - er aerwesa a mmime sis s yearts OFRCER OR AUTH0HIZED AGENT $ NUMilER YEAR MO DAY l COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference at attachtnents here) k y st ( ,+ % C"'C f-s sGEx,
?
EPA Form 3320-1 106-95) Previous editione may be used. GREPLACES EPA FORM T-40 WIGCH MAY NOT BE USED.) PAGE . OF
- g, ., >, /,h, ,a lc f ,: :
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- _ . ___.m- . , . _ _ . . _*
. 'y-+ Paperwork Reduction Act Notice
! Public reporting burden for this collection of information is estimated to vary fmm a range of 10 hours as r.n li Javerage per' response for some minor facilities, to 110 hours as an average per response for some major facilities,
' 0 with a weighted average for major and minor facilities of 18 hours per response, including' time for ts. viewing' "insthietioris, searchin'g l existing datai souices, gathering and ;naintaining the data needed, and completing and j reviewing the collection of information? Send comments regarding the burden estimate or any 'other aspect of
, 1 Jthis co'lection of information, including suggestions for reducing this burden,- to Chief, Information Policy
-] Branch, PM-223, U.S. Environmental Protection Agency 401 M Street, SW Washington, DC 20460; and to the
' l Office of information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
, , ~ ~ . .
f a. J.t> , General Instructions h b :1. If form has been partially completed by preprinting, ' disregard instructions directed 'at entry of that information
'already preprinted.
12f Enter " Permittee Name/Afailing Address ~(and facility name/ location, if different)," " Permit Number," and
" Discharge Number" where indicated. (A separate form is required for each discharge.)
- 3. Enter dates beginning ar.d ending "Alonitoring Period" covered by form where indicated.
'[4. Enter each " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample Afeasurement" data for each parameter under " Quantity" and "Guality" in units specified in permit
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Alonitanng Period"; "Afarimum" and "Ahnimum" are normally extreme high and low measurements obtained during "Alonitoring Period" (Note to municipals with secondary treatment requirement: Enter 30-day average of sampic measurements under " Average," and enter maximum 7-day average
,. :of sample measurements obtained during monitoring period under "Afaximum ") ) n 6 Enter " Permit Requirement" for each parameter under " Quantity" and "Guably" as specified in permit. 7e Under "No Er" enter number of sample measurmenjs during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "O*.- l 8 Enter ' Frequency of Analysis" both as " Sample A/easunnent" (actual frequency of sampling and analysis used l during monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont," for continuous monitoring, "b7" for one day per week, "160" for one day per month, "1/90" for one day per quarter, etc.)
' 9. Enter _" Sample 1)pe" both as " Sample 3/casurement" (actual sample type used during monitoring period) and as
" Permit Requirement,"-(e.g., Enter " Grab" for individual sample, "2MC" for 24-hour composite. "N/A" for continuous monitoring, etc.)
i l10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
.' actions taken, and reference each violation by date.
- 11. 'If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
\
.12 Enter "Name! Title of Principal Executive OBicer" with " Signature of Principal Executive Officer ofAuthorized Agent,* " Telephone Number," and "Date* at bottom of form.
- 13. Mail signed Report to Oflice(s) by date(s) specified in permit. Retain copy for your records.
- 14. More detailed instructions for use of this Discharge A/onitoring Report (DAIR) form may be obtained from Oflice(s)
(l~ ' ( specified in permit. L Legal Notice l' This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
, of violation, or by imprisonment for not more than one year, or by both, b"- - EPA Form 3320-1 (Rev 08 95)
)
4. I, ~ PERMITTEE NAME/ ADDRESS (I=dieF cenyN.=./ Zee man (D#mme NAhossAL PouLUTANT DeSCHARGE n -710sf SYSTEM (MPDfSJ ~ Form Approved. ** NAME ggy n ygg;gy pg g y , p;7;g [NN Nl,0 g7 jgy. gy g3 ggM No. y 6 ,
'se pproval expNes O5-3N ADDRESS c+C, LU% 4 %' * *1 4
( $ U !)I 05)
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iTTa; O A 4 i:e U%4 5 0 ft? PERMfT NUMBER DISCHARGE NUMBER y , 7 g L r 3 7 x r> cv. ei i r.4 . <> t. ,n 3eg77 .' MONITORNG PERIOD
- 7. y g y' FAC18TY LOCATION FROM ; TO - 'M NOM had NO Ici$ChAbGT- k l M & & M form; M*
A";i v 1. g 1 D Oi%L3n? 120'211 122-231 124-259 - t26-271 128-29) (30-311 13 card on&p QUANTITY OR LOADING I4 Cwd On&# QUANTITY OR CONCENTRATION NO. NowNcv PARAMETER SAMPLE (46-53) (54-691 130-469 446-55 (64-691 OF i 132-37; EX mys,s TYPE - AVERAGE MAXIMUM UNITS MINIMUM AVERAGE. MAXIMUM UNITS #ss-em (64-ass is>7ap _j SAMPLE , , , . - - c e r+ c- _ n-; o r ,g g7 MEASUREMENT - Cut?~ 1 C , PERMIT ccQte + et e% c Wc i; , y -p on.p p- 3,g . 7gygg gy;gg rElU: * . FX i A Li REQUIREMENT g, gygxp - p g . g g- ,. ; gg
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+c<Q;4* ; m r .n ' V A Lt REQUIREMENT goc gg7 g y. .y7 OJg Aio un A 3 SAMPLE cve - Ovcu ( g asv
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_t-Lu;a? .1 1_ # 4 A Lt REQUIREMENT sm c u .g (y;7 . M y g-f : 4 A/L NoyT (Lov, [i J U; W [ ! @ SAMPLE ( .J) cocce ;c h w 9m atn L4
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SAMPLE MEASUREMENT PERMIT , REQUIREMENT NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I CERDFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE DATE AM FAMauAR WITH THE INFORMATION SUBMITTED HEREIN; AND SASED ON i MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR f -4 1)attJ Urndorf OBTAINING THE INFORMATION. 4 BEUEVE THE SUBMtTTED $NFORMATION IS ,, [j kj/// TRUE. ACCURATE AND COMPL ET E. I AM AWARE THAT THERE ARE .p p ' Jp g "'/- Chenistry Manager SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING ' 3 9,3 =$ l l 3 M , THE POSSIBillTY OF FfME AND IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 S40 NATURE OF PRNGCIPAL EXECUTIVE
<= l 2 [O . 7 .
u.S.c. i 13ie. an a.nws wer owse . mer hen
- Am se se s70.000 g !
TYPED OR PRtNTED ew or mamnen _ er ww.se s means aw s yearms OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference att ertechments bere) f J.s-A e .a s.. 3320-1108-951 Previous edit:Ons may be used. (REPLACES EPA FORM T-40 WieCH MAY NOT BE USED.) ..s .
,, PAGE OF I m .1 3 2. / #._-.7g!-12:
.s v ,; Paperwork Reduction Act Notice '
4
~; r --
l
,,, _ 3 .
' TPublic.rdpo'r ting burden for this collection of information is estimated to. vary from a range of to bours as an faverage per response for some minor facilities, to I10 hours as an average per response for some major facilities,,
iwith a weighted average for major and minor facilities of 18 hours per response, including time for riviewmg
~
' instr'uc'tiony rearching~ exisiing daia sources, gathering and maintaining the data needed, and completing and reviewing the_ collection of informat_ ion. ' Send comments regarding the burden estimate or ar y other aspect of -
0 i "this collection of information, including. suggestions for reducing this burden, to Chief, fruormation Policy 5 t l Branch, PM-223 U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the ,
. ! Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503,
,; _ . , . < ,. . ~ .- - ,
' ' " 4 '
-General Instructions
- DI. If form has been partially' completed by preprinting, dirregard instructions directed at entry of that information
~ already preprinted.
~2. Enter
- Permittee Name/A/ ailing Address (and facility namellocation, if different),*
- Permit Number," and
" Discharge Number" where indinted. (A separate form is required for each discharge.)
9 . _. . . ,
? 3. Enter dates beginning and ending "Ahuritoring Perio(" covered by form w here indicated.
[4 Enter each " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample A/easurement" data for each parameter under " Quantity"Tand "Guality" ir units specified in permit.
" Average" is normally arithmetic average (geometric aserage for bacterial parameters) of all sample measurements for cach parameter obtained during "Alonitormg Period"; "Afarimum" and "A/inimum" are normally extreme high
. and low measurements obtained during "A/onitoring Period." (Note to municipalc with secondary treatment
. requirement: Enter 30-day average of sampic measurements under " Average," and ente maximum 7-day average ;
ersample measurements obtained during monitonng period under "A/aximum ") t
- 6. Enter " Permit Requirement" fer each parameter under "Guantity" and "Guality" as specified in permit.
(7 Under "No Er" cnter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) pennit requirement for each parameter. If none, enter "0" 8, Enter -* Frequency of Analysis" both as " Sample A/easurment" (ac I frequency of sampling and analysis used
.during monitoring period) and as " Permit Requirement" speedied in crmit. (e.g , Enter " Cont," for continuous monitoring, "#7" for one day per week, "l/30" for one day per month. N90" for one day per quarter, etc.)
. 19. Enter " Sample 7)pe" both as " Sample Areasurement" (actual sample type used during monitoring period) and as
" Permit Requirement," (e.g., Enter " Grab" for individual sample, "R//C" for 24-hour composite, "N/A" for 4
' continuous monitoring etc.)
- 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
11,' If"no discharge" occurs during monitoring period, enter "No Discharge" across fonn in place of data entry.
- 12. Enter "Name0ltle of Principal Erecutive OBicer" with " Signature of Principal Executive Officer ofAuthori:ed 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 Discharge A/onitoring Report (DA/RJ form may be obtained from OfIice(s) specified in permit.
Legal Notice This report is required by law (33 U.S.C,1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can
]
result in civil penahies riot to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both. ;
. EPA Form 3320-1 (Rev,08-95)
_ . _ . . g,. - _ , , . . . _ , . ~ , . _ , . _ , . , _ _ . _ . _ . , _ _ _ . - _ , _ _ . _
v PEnteITTEE NAMEJADunES$ f7=hs Faceky Aame'Larsmes trucereerJ 96CTIOosAL POLLLN4N7 0eSCHARGE R ehAW ATIOes SYSTas thPOFS/ . Form L _-d. ' NonsE _a cei Y * "t a#' u' ,/. vs - ,5: na d ~P.. ."12 ** A s*T-r Q Mu DISNGE 12-161 MNORM REPORT9 9NJ 7-G4 _ c3g,v c ~s <- -, ; ,; -s-i e r. +"-
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. .OMB No. 2040-0004 cooncss ir . G. - im f.: .-
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( 5_v .,M . 0 5). Approval gxpwes 05-31-98
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- " 'A ' %77 M '** J C"' '-
FQC1 TTY 4 .? MRORM PERIOD i YEAR MO DAY YEAR MO DAY ., LOCATION FROM ye . 9, TO 90 -
- ( Ced LO a l "C ?i A R G; *' j [ j j , n W
.e. T 'T h : L- t V ~ D 0Hb*OhV 12O 21) 422 231 (24-25) 126-271 128-299 130"31) W ***
- N $*M-PARAMETER 132-37)
\ (3 Csid Oniys QUANTITY OR LOADEG 146-531 154-611 I4 Carut OMyl QUANTITY OR CONCENTRATM 130-465 146-52 154-611 NO.
EX-FREQUENCY or. Analysis SAMPLE TYPE MAXIMUM
/ AVERAGE UNITS MINIMUM AVERAGE MAXIMUM UNITS - agra gj ggg.yg -
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. REQUtREMENT e .~ m . q y h p gg g p jg g :p g
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SAMPLE a .m y , e-e c 3 c coccor - ( 49 - g rtA 3 gg MEASUREMENT o. 7 (L 7 O s;; /jo cyg
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yy,g.o; ,, .. - y 3 i, y REQUIREMENT sq% Ng jpj f g { g-Q. gjn . g.y iLO4, ;* vaeul! Of SAMPLE ( :3) "J e c n t u c c .) c c c r,- @ o s y'pgg e7n o s. .p o n :. o. . .* 1o ft > ,, MEASUREMENT e 1.005 0.oo /o O J/7
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39GDC 1 C U PERMIT g , tm 'q g pC p p D C4 43 n yCC090, c occcyg oc4o gmL ggy ,j
. < F uj c ., r e t .: c eAiU REQUIREMENT .g ;p '931ty.yy my once MEASUREMENT h* b! I' h bMb
, . , , t 0 PERMIT sc Gwe cennoe zou m S M O RT! . .' M Oh ! i W M" OM '
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. I .~v ett o , REQUIREMENT i
00 4 - Nb A V ii ' "II3 T }i A I C I I' ( NONI w U ; l f C 1 1, } Chi SAMPLE c ? c o f. c '- r: n o n cocom conny ( lj 7 g bMb uj , s , , MEASUREMENT f h 74 . .. PERMIT. mmoct 9dem :O n 2 M e cy W Jg3 . c o r; w ;f ry g g , que -
~ ,- g d g Q
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PERMIT . cW0nn . c c Wa % 2 *
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m t' r L e ; N " oeM, i 't i H REQUIREMENT cecc g gpg ' c gp.j ! vg/t ; goy 7, SAMPLE MEASUREMENT PERMIT ' REQUIREMENT NAME/ TITLE PRINCNDAL EXECUTIVE OFFICER CERTIFY LADDER PENALTY OF LAW THAT I HAVIE PER;O8 SALLY EXAMIpeED Afe0 AM FAMIUAR WITH THE IIeFOsmeAT?Oel SUOMETTED HEREtsd; AfsD SASED 000 /,- TELEPHONE DATE - MY INQUIRY OF THOSE INOMDUALS sasR4EDIATELY RESPOtsSIBLE FOR ' / - p /, , d.!!V l u: k !!'Ud O t~ f OSTArNING THE NeFORRAATtOes 4 SEUEVE THE SUBMITTED susFORMATIOes IS TRUE. ACCURATE AND COMPLETE. 8 AM AWARE THAT THERE ARE StGNIFICANT PENALTIES FOR bugmelTTl98G FALSE IpeFORMATIC98. IldCLUDusG
/
I
? [7G, /// / s , f7 / / " ' /,/ ? r d C.11SCry UOHAget' THE POSSIBIUTY OF FNsE AND thePRISOpeMENT. SEE 10 U.S.C. t 1001 Afe0 33 412 393-5113 93 10 2 'I ,
U.S.C. I 1319 JPommmuos wisser stese seseuses may bread = Russe asp se # F0,000 StGNATUIE OF PIMAL EXECUTIVE gg TYPED OR PRINTED ew er men ===.' - c ereerwoma s manne.w s pa rs.s OFFICER OR AUTHOR 8 ZED AGENT NUtdBER YEAR MO DAY CODE , COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af strechments here/ f f EPA Form 3320-1108-95) Previous editions may be used. IREPLACES EPA FORM T-40 We#CN MAY NOT BE USED.) PAGE M 7 9 / h. ,7 v ,e r, .1_, ,; ,; ,. . OF g i _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ _ ______ . . _ . _ _ _ _ - _ . . _ . _ . . _ _ _ _ _ _ _ _ _ _ _ _ _ . _ ~ _ _ _ _ _ . . _ _ __ _ _ . .
y v +- s
> I Paperwork Reduction Act Notic~e '
o_ - -- , 3 , . Public reporting burden for this collection .of information is estinuted to vary from a' range of 10 hours as an Daverage per response for some minor facilities, to 110 hours as an average per response for rome major facilities,, 4 with a weighted' average for maior and minor facilities of 18 hours per response, including time for reviewing
' instructions l'scirching existing data ' sources, gathering and maintaining the data needed, and completing and
; ; reviewing the collection of information.: Send comments regarding the burdyn estinute or any;other' aspect of-E this collection of information, including suggestions for reducing tMs burden, to Chief, Jafornution Policy
~ Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the
, ' Office of Information and Reguh tory Affairs, Office of Management and Budget, Washington, DC 20503.
General instructions JL If form has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted.
- 2. Enter " Permittee Namedlailing Address '(and facility name/ location' if different)," " Permit Number," and
" Discharge Number" where indicated. (A separate form is required for each discharge.)
- 3. Enter dates beginning and ending "Alonitoring Period" covered by form where indicated.
- 4. Enter each " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample Alcasurement" data for each parameter under " Quantity" and "Gt ahty" in units specified in permit.
" Average" is normally arithmetic average (geometric average for bacterial paranc . >f all sample measurements for each parameter obtained during "Alonitoring Period"; "Afarimum" and "Afinimum" are normally extreme high and low measurements obtained during "Afonitoring Period" - (Note to municipals with~ secondary treatment
- requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average
.of sample measurements obtained during monitoring period under "Alaximum. *)
- 6. Enter " Permit Requirement" for each parameter under " Quantity" and " Quality" as specified in permit.
e
; 7, Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0",
- 8. Enter " Frequency of Analysis" both as " Sample A/easurment" (actual frequency of sampling and analysis used
. during monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont," for continuous monitoring, "l/7" for one day per week, "160" for one day per month, "1/90" for one day per quarter, etc.)
- 9. Enter " Sample 7)pe" both as " Sample Alcarurement" (actual sample type used during monitoring period) and as
" Permit Requirement," (e F., Enter " Grab" for individual sample, "24/IC" for 24-hour composite, "N?!" for continuous monitoring, etc.)
110I Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference cach violation by date. Ili If"no discharge" occurs during monitoring period enter "No Discharge" across form in place of data entry. 12." Enter "Name/ Title of Principal Executive Oficer" with
- Signature of Principal Erecutive Officer ofAuthorized 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 Discharge Afonitoring Report (DAIR) form may he obtained from Office (s) l specified in permit. I 1
Legal Notice This report is. required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report tmthfully can ) result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day j of violation, or by imprisonment for not more than one year, or by both, j l EPA Form 3320-1 (Rev. 08-95) (
Fosvn Approved.
- PERMtTTEE NAME/ ADDRESS (F=WeForespNe=s24mers C7DWI.ewf NAT10stAL POLLUTANT D9 CHANGE R maTION SYSTes (NPDESJ NAME- y j, 7 j y;;;cg pgg 3 g 5737yy [NN Nl,0 g7 jij 7 y p ., y y g 3ggg OW No. 2040-0004
"'
- AppmW e 05-3 bSS ADDRESS : .U. . A d '? = - 'b pQMh df}
1- f I h ; OA/1J O !! L L U I. y PERMIT NUMBER DsCHAAGE NUMSER T F1;iL sa.. , u --u
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MONITORING PERIOD YEAR MO DAY YEAR MO DAY _ LOCA M FROM , L TO 4: # j. v@ n aj Lci ;W;, g e ^. c n[? 1 ak\iu G.1 3Lf (20211 122-23J (24-25I (26-27) 128-29) 13& 31) NOTE: M ineemcelone Mfore Cll % % _fo PARWETER (3 Card OrWs OUANTITY OR LOADING I4 Cerd OrWJ QUANTITY OR CONCENTRATM NO. N SAW1.E 14 6-S 39 (54-691 (30-451 146-531 (64-671 OP (32-37; EX ANests TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS com -16Aars ras-7ar
;; 2 SAMPLE s. u o n ( cocev e, cacc. .
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once SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT . REQUIREMENT . SAMPLE MEASUREMENT PERMIT + REQU:REMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF t.AW THAT t HAVE PERSONALLY EXAMINED ANo TELEPHONE DATE AM FAMlUAM WTH THE INFORMATION SUSMITTED 04ERDN: AND SASED ON , MY INQUIRY OF THOSE INDIVIOUALS meMEDATELY RESPONSIBLE FOR OBTAINING THE tNFORMATION. t BEUEVE THE SUBMtTTED INFORMATION IS f g 'iA d41Viua L TTk50f i 3 TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE arf 1/ [ f/ f 'f7 , 4 Gcrn s t r Y *%nrO a SIGMRCANT PENALMS FOR SUBMm3 FALSE INFCWAN. INMOING THE POSSIStuTV OF AN h12 393*)[13 1Q 2f u.s C. t i sie. sPm.m.E.AND SiONATURE OF PRNeCIPAL EXECUTWE TYPED OR PRINTED .w or m.mm = ' -Mer awIMPRISONMENT.
- ermer se.euwe mer,aexam s momne SEE sm g18seU.S.C.
w s , ras s ro.oop 51001 AND 33 OFFICER OR AUTHORIZE 3 AGENT g NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# strechments heref 4 wa e arm 3320-1 108-951 Previous editions may be used. ! REPLACES EPA FORM T-40 WieCH MAY NOT BE USED.) PAGE ju t / y_ o,.c,_,, J i - 1 J..- ,: OF
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Paperwork Reduction .Act Notice __ U ' Public-_ reporting burden for this collection of information is estinuted to vary froni a range of 10 hours as an average per response for some mirior facilities, to 110 hours as an' average per response for some major facilities,,
. ;with a Weighted average for major and ' minor facilities of 18 hours per response, including time for reviewing
' ~
instmetsms, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Chief, Information Policy LBranch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the 0 l Office ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. General Instructions
,A l1, If form has been partially' completed by preprinting, disregard instructions' directed at entry 'of that information 3-1 already preprinted, 2, Enter " Permittee Name/Afailing Address (and facility namellocation, if diffcrent),*
- Permit: Number," and
" Discharge Number" where indicated. (A separate fonn is required for cach discharge.)
- 3. Enter dates beginning and ending "Afonitoring Period" covered by form where indicated.
- 4. Enter each " Parameter" as specified in monitoring requirements of perniit.
- 5. Enter " Sample A/easurement" data for each parameter under *Guantity" and "Guality" in units specified in pennit.
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Alonitoring Period' "Alaximum" and "Alinimum" are normally extreme high and low measurements obtained during "Afonitoring Period.". (Note to municipals with secondary treatment 9 requirement: Enter 30-day average of sample measurements under " Average." and enter maximum 7-day average
' of sample measurements obtained during monitoring period under "Afatimum. ")
- 6. Enter " Permit Requirement" for each parameter under " Quantity" and "Guality" as specified in permitc L7. 'Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
L
- 8. Enter " Frequency ofAnalysis" both as " Sample Aleasurment" (actual ^cquency of sampling and analysis used
[ .during monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont," for continuous monitoring, "//7" for one day per week, "//30" for one day per month, "I/90" for one day per quarter, etc.) ,, 9. Enter " Sample 7)pe" both as " Sample A/easurement" (actual sample type used during monitoring period) and as
" Permit Requirement," (e.g., Enter " Grab" for individual sample, "R//C" for 24-hour compostle, "N'A" for continuous monitving, etc.)
- 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
l 11, if"no discharge" occurs during monitoring period, enter "No Discharge" across fonn in place of data entry. i { ' 12. Enter "Namenttle of Principal Executive Oj]icer" with " Signature of Principal Executive 0))icer of Authori:ed l Agent " " Telephone Number," and "Date" at bottom of fann. l j- 13, Mail signed Report to Office (s) by date(s) specified in pennit. Retain copy for your records. p l
- 14. More detailed instructions for use of this Discharge Afonitoring Report (DAIR) form may be obtained from Oflice(s)
I specified in permit. u 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 l' result in civil penalties not to exceed $10,000 per day of violatiom or in criminal penalties not to exceed $25,000 per day
- l. of violation, or by impriso'nment for not more than one year, or by both.
t ' ( EPA Form 3320-1 (Rev. 08-95) l L 1+-________-.-_______________. - _ _ _ _ - _ . - _ _ - - - . - - - _ , . , .
/
Form Approwesi. "* PERMITTEE NAMEJADCaESSth*Meraurba==L*eac=#eprew NAVIONAL POLLUTAssT " m ammaanoes sYsTea (AFOES/ NQME i n A if f T N k Li.f Y p O W r 3 '. 5 ? ATIOh MC p MNM N ( OhiT 2 DOG L T O W E OW No. 204H004
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- PARAMETER r3 Carct OnM QUANTITY OR LOADING (4 Cant Oi&f OUANTITY OR CONCENTRATION NO. MEMENCY SAMPLE 146-531 154-6 r1 430-49 146-539 t$4-619 cF (32-371 EX mys,$ TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS - sys.am iss. ass (ep.?ar p, SAMPLE O r:. c c t cc- 700 cusgo ( '] y MEASUREMENT 0043 1 Q 3 . PERMIT t e o rc e ec^coe :a. c ((G, uncoco* 74 T U C_L cp,ga
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- PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMD4T NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I CERDFY UNDEM PEteALTY OF LAW THAT I HAVE PERSONALLY Ey ma*ED AffD AM FAMtuAR WITH THE INFORMATION SUeMITTED HEREIN- AND SASED Oed TELEPHONE DATE
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MY INQUERY OF THOSE IIsDIVIDUALS eMMEDIATELY RESPoesSIBLE FOR -
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8 biavid OrTidorf' OSTAINING THE 4NFORMATIOes, 8 SEUEVE THE SUBMITTED INFORMATIOes IS TRUE, ACCURATE AND COMPLETE. 8 AM AWARE THAT THERE ARE SIGN 4RCANT PENALTTES FOR SUBMITT196G FALSE INFORMATIO8d. IIeCLUDeleG
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Ulf'Ili 8 f. r*f UllIL.I J'C r 98 THE .* I 2 393-SIi3 1ti 2I U.SA POSSeduTY OF FtBIE ANO IMPRISOesMENT. sSEE stese 18 U.S.C. t 1001 AfsD 33, . SIGNA'TURE OF PRIINFAL EXECtfTRFE TYPED OR PRINTED t 131s. s%imase sw er maarenien ' asemier snese aseawee aier iews
- eraerween a unsaane aw a vooras se so sto,otig OfMCER OR AUTHOREFFn AGENT m NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference at artschmstres hers/
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EPA Form 3320-1 (08-95) Previous editions may be used. IREPLACES EPA FORM T-40 WIGCH MA. sT BE USED.) PAGE OF
, , .i '.Y nu . ?su J 10 b,~ ,a :., ,b 2
.___ _ _ _ _ _ _ _ _ _ _ _ _ - . - - ._....m._._.__ _. ___
Paperwork Reduction Act Notice
- 1 l
lPubhc reportmg burden for this collection of information is estimated to varj from a range or 10 hours as nn !
' 1 average per re.sponse for some minor facilities, to i10 hours as an average per response for some major facilities, ;
E '
;with a weighted average for major and minor facilities of 18 hours per response, including time for reviewmg
,! ~ {
instructions, ' searchinge' xisting data sources, gathering and maintaining the data needed and completing and . reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of 1 (this collection'of information, including suggestions for reducing this burden, to Chief, Information Policy
~
Branch, PMy223. U.S. Environmental Protection Agency,401 M Street, SW Washington', DC 20460; and to the
' Office ofInformation and Regulatory Affairs Office of Management and Budget Washington DC 20503.
,m,
- General Instructions I1 If form has been partially completed by preprinting, disregard instructions directed at entry of that information
~
; already preprinted.
u2. Enter "Permitter Name/3/alling Ac/ dress (and . facility namer.ocation, if different)," " Permit ' Number," and
.? "I)ischarge Number" where indicated. (A separate form is required for each discharge.)
{
- 3'.- Enter dates beginning and ending "Alonitoring Period" covered by form where indicated.
- 4. Enter cach " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample A/easurement" data for each parameter under " Quantity" and " Quality" in units specified in permit.
. " Average" is norma!!y arithmetic average (geometric average for bacterial parameters) of all sample measurements for each param:ter obtained during "Alonitoring PeriocP; "Alaximum" and "A/mimum" are nonnally Ltreme high
.and low measurements obtained during "Afonitonng Period." (Note to municipals with. secondary treatment ;
requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average j of sample measurements obtained during monitoring period under "A/arimum. ") J
- 6,' Enter "Pennit Requirement" for each arameter under "Guantity" and "Guality" as specified in permit.
t
- 7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0",
- 8. Enter " Frequency of Analysis" both as " Sample A/cosurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in pennit (e.g., Enter " Cont " for continuous monitoring "//7" for one day per week, "//30" for ene day per month, "//90" for one day per quarter, etc.)
9.' Enter " Sample 7)pe" both as " Sample Aleavurement" (actual sample type used during monitoring period) and as
" Permit Requirement " (e.g . Enter " Grab" for individual sample, "24//C" for 24. hour composite, "N/A" for continuous monitoring, etc.) i l10 yWhere violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
II, If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. l
'12 Enter "Name/ Title of Principal Executive ODicer" with " Signature of Principal Executive ORicer ofAuthori:ed
. Agent," " Telephone Number," and "Date" at bottom oiform. !
- 13. Mail signed Report to OfTice(s) by date(s) specified in permit Retain copy for your records.
- 14. Marc detailed instructions for use of this Discharge A/onitoring Report (DA/R) form may be obtained from OJTice(s) specified in permit Legal Notice This' report is' required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
~ of violation, or by imprisonment for not more than one year, or by both.
EPA Form 3320-1 (Rev. 08-95) i
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Form Approved. *~ PEF.MITTEE NAME/ADOfESS A3 deFerdifEs==s/1 cmeas afEAA =e# NATIONAL POLLUTANT OtSCHAd4GE EUMINADON SYSTEM (NPDESJ . < E NMG NT (D f NAME . yqy1 7 3 i,;, g y p g j y ., ; _;;y , t? U IT 2 tJ i C I L E W P,,
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' AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXtMUM UNITS ns.es, f,4.,,; f,, 7, 2 , L 2 U ., , To!AL SAMPLE , u e;,.qu< mog ; ;,
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SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT I PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THATI HAVE PERSONALLY EKAMINED AMO TELEPHONE DATE AM FAMIUAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MY INQUIRf OF THOSE INOtVIDUALS EMMEDIATELY RESPON9SLE FOR . .A 06TAINING THE INFORMATION, 8 SEl.lEVE THE SUBMITTED INFORMATION IS / / . f David Urndert TRuf. ACCURATE M COMPLETE. 4 AA4 AWARE THAT THERE ARE '. h j fry ,%, *
$4GNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING
( ' } m e, e c-evv 2, - '-;o. . . . - TME POS9BILITY OF FIN e s.C. e 1 sis sPumm E AND IMPRIS.ONMENT. SEE 18 U.S.C. 6100,1 AND 33 f 1 'P 'IO1- % I } 3 4 ft )( )"/ SsONA 1JRE OF PRIOGCIPAL EXECUTIVE
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- a. Mar an as ames nur awnM. sk a a s70.0o0 TYPED OR PRINTED l aM ermen m en. - a#6erwoma s ainams amer s remras OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO gOAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# ettschments heref i sw a urs.e 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) , . . , PAGE OF Ju,05/..-: 3 my - V c ;. 2 , .
w ;- a , 1 ;
-1 Paperwork Reduction Act Notice
' Public rqv,rting bunien for this collection of information is estimated to ' vary from a range of 10 hours as an l average per . response for some minor facihties, to 110 hours as an average per response for some major facilities,
.with a weighted average fo~r aujor and minor facilities of 18 hours per response, including time for reviewing'
< .instnictions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
> 1this collection of information, including suggestions for reducing ,this burden, to Chief, Information Policy i Branch, FM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the
' Office ofInforoution and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. t t .;
i~ General Instructions
~
l !' "1. If form has been partially; completed by preprinting, disregard instructions directed at entry of 'that information
, already preprinted. , t V ;2. Enter *Permitter Name/A/ ailing Address (and facility namellocation, it different).* " Permit Number," and
" Discharge Number" where indicated (A separate form is required for each discharge.)
L3. Enter dates beginning and ending "A/onitoring Period
- covered by form w here indicatedc
- 4. Enter each " Parameter" as specified in monitoring requirements of permit.
5; Enter " Sample Alcarurement* data for each parameter under " Quantity" and "Guality" in units specified in permit.
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
^
for each parameter obtained during "Alonitoring Period"; "A/aximum" and "A/mimum" are normally' extreme high and low measurements obtained during "A/onitoring Period" (Note to municipals with secondary treatment requirement: Enter 30-day average of sampic mensurements under " Average," and enter maximum 7-day average of sampic measurements obtained during monitoring period under "A/arimmn. ") - 3 l' 6. Enter " Permit Requirement" for each paran eter under "Guantity" and "Guality" as specified in permit.
- 7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or
; minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0" IS. Enter " Frequency of Analysis" both as " Sample A/easurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont " for continuous l monitoring, "1/7" for one day per week "l/30" for one day per month, "l/90" for one day per quarter, etc.)
- 9. Enter " Sample Type" both as " Sample A/easurement" (actual sample type used during monitoring period) and as
" Permit Requirement "- (e.g., Enter " Grab" for individual sample, "2#IC" for 24-hour composite, "N41" for b = continuous monitoring, etc.)
-10. 'Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
i1. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. l ' 12.' Enter "Name/Dtle of Principal Executive ODicer* with " Signature of Principal Executive Oficer of Authori:ed
' 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 Discharge A/onitoring Report (DA/R) form may be obtained from OfTice(s) specified in permit.
L Legal Notice , j' 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 ' l result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day ! of violation, or by imprisonment for not more than one year, or by both.. L 1 l EPA Form 3320-1 (Rey,08-95) l-l
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- NO. mecumcv SAnrLE 14 6-S 31 154-619 (30-461 I46-539 ' 0%6H 132-J7/ EX ,,,or -
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- i l NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PedALTY OF LAW THAT I HAVE PERSOseARY EpaeanaED AND Aa4 FAMIUAR WITH THE WIFOft4ATIOst SUBestTTED MfREIN: AIO SAMD 000 p TELEPHONE DATE- I
/ i 1 ' MY INQUlftY OF THOSE WIDMDUALS leARSEDSATELY RESPO8898LE FOR , r OSTAFNatsG THE INFOftaAAT100s. I SEUEVE THE suena!TTED esFOftneATtoes IS 'y- * /f f -- =
*JAVid O t'ngOf 'i TRUE, ACCURATE AfeD COesPLETE.
SIGNIFICANT PE9sALTTES FOR SugesITTING FALSE INFoltAATIO88. IIeCLLCIIsG 8 AM AlarARE THAT THERE ARE -
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Rteniatry tanager. d THE POssissuTv OF mee a .aar. sEE is u.S.c. e i00 ANo sa '12
. 393-5113 93 10 27 i
u.s.c. t isie, spwisamme esiser anese summiese meer m esne shoe se me sio.com 800fdAWIIE OF NAL EXEWWE AREA TYPED OR PRINTED and er mm-enn ' et asewe== s meme and a yearm.1 0FFICER on AUnanmaysn AGEIET CODE NUteER YEAR MO DAY _ COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af attechments herof g (. 434 g.; . lpy G o cg p ggg , i f --- ge h m /
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EPA Form 3320-1 (OS-J5) Previous editions may be usef. IREPLACES EPA FORM T-40 INteCH MAY NOT BE USEDJ -- PAGE OF f O G U Y 1 / J c o 1 D R ~s. - 3, * <- 4 . +
. _ _ _ _ . _ _ _ _ . _ _ _ _ _ _ _ _ _ . _ _ . _ _ . _ _ _ . _ _ _ _ . _ _ . _ _ _ _ . _ _ _ _ . _ . _ _ _ . . _ - _ _._.______________._._.___....____._____f
Paperwork Reduction Act Notice
- s.
; Public reporting burden for this collection of information is estimated to vary froni a range of 10 hours as r.n
; average per response for some minor facilities / to 110 hours as an average pei response for mme majoffacilities, twith a' weighted average for major and minor facilities of 18 hours per response, including time for r0 viewing
' instructions ( searching jxisting data sources, gathering and ' maintaining the data needed, and completing and reviewing the 'c ollection of information Send ' comments regarding the burden eptimate or any. other bpect of
? this collection of information, including suggestions for reducing this burden,~ to Chief, Information Policy
". Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the
' ! Office ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
y-General Instructions
~
, .1. If form has been partially completed by preprinting, diuegard instructions directed at entry'of that information
- ~ already preprinted. ' ,
N. Enter " Permittee Name/Afailmg Address (and facility name/ location, if different)," " Permit Number " and -
" Discharge Number" where indicated. (A separate form is required for each discharge.)
- p.
, 3. Enter dates beginning and ending "Alonitoring Period
- covered by form w here indicated.
- 4. Enter each " Parameter" as specified in monitoring requirements of permit.
[
'$. Enter " Sample A/easurement" data for each parameter under " Quantity" and "Guality" in units speciDed 'in pe:mit.
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measureme.nts for cach parameter obtained during "A/onitoring Perior/'; "Afarimum" and "Alinimum" are normally extreme high and low measurements obtained during "Alonitoring Period"- (Note to municipals with secondary trea' ment requirement: Enter 30-day average of sample measurements under " Average " and enter maximum 7-day average of sample measurements obtained during rnonitoring period under "Alarimum ")
- 6. Enter " Permit Requirement" for each parameter under " Quantity" and "Guality" as specified in permit.
' 7.' Under "No &" enter number of sample rneasurments during monitoring period that exceed maximum (and/or
. minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
- 8. Enter " Frequency of Analysis" both as " Sample A/easurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in permit. (e g., Enter " Cont," for continuous
, . monitoring. "#7" for one day per week, "u30" for one day per month, "#90" for one day per quarter, etc.)
;9; Enter " Sample 7)pe" both as " Sample Afrasurement" (actual sample type used during monitoring period) and as
~ " Permit Requirement," (e g., Enter " Grab" for individual sample, "N#C" for 24-hour composite, "N/A" for continuous monitoring, etc.)
, '10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date. 11, if "no discharge" occurs during monitoring period, enter "No Dircharge" across form in place of data entry. 12 Enter "Namenitte of Principal Executive OJJicer" with " Signature of Principal Executive Officer ofAuthorized
- Agent," " Telephone Number," and "Date" at bottom of form.
cl3. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your ecords.
- 14. More detailed instructions for use of this Discharge Afonitoring Report (DA/R) form may be obtained from OUice(s) specified in permit.
Legal Notice This report is required by law (33 0.S.C.1318; 40 C.F.R.125.27). Failure to report or failurc to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
- . of violation, or by imprisonment for not more than one year, or by both.
EPA Form 3320-1 (Rev. 08-95) l i
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.. . - . . . . . - ,- a a . . . . . - , pef %4TTEE NA&ME/ADORESS frar.,guyy ,<r i.,4ro.j6, ,) NATION AL POLtutAs:T otSCs4 roe "jMusAnoes sYsTse (tWPDES) . Form Approved.. '. NAME DISCHARGE MONITORWG REPORT (OMRt -
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FACluTY MONITORWG PERIOD YEAR MO DAY YEAR MO DAY _ LOCATION pgog c , 7g y. , 99n 3 g;3yq3 g l g.gn ii. . Dni u u , o i l'. r (2O2tl (22-231 (24-251 (26-27) (28-29143t>31) NO N R**8 W*'* l W N 50'*- PARAMETER /3 Carst On4# QUANTITY OR LOADING (4 Card On/rf QUANTITY OR CONCENTRATION yo, PREQuENCY
' SAhrLE 146-539 154-619 (30 251 446-531 154-619 EX or (32-371 mYars - TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ss2 am f6mp inya p; SAMPLE 1. r c c: , 3 g e; ;,
MEASUREMENT f, R7 7 J g,, Q / ,/ } y ,$ ['M S c ., ; ; PERMIT c o v e% e reub wcn 3,0- o v y.c g , 9, y. g ig g g gg
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REQUIREMENT gc x . ,., y ; 3 j377 3gf _ 3 :i;, , ., 7ii;L SAMPLE - r aer- oe4m ( ;q-gg h If~/y Qg
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, ,L43 MEASUREMENT p ; p:{ -
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.t 1 o (: PERMIT ,y ; - c p ry ; v;4 m.. c: n ow qqoe ee1 g g g 1, ggyy s t ,1 ,
; , ; gj REQUIREMENT ;, 7 .y e p. 7 v y , m. ec-g SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT j NAME/ TITLE PRINCIPAL EXECUTNE OFFICER a CERTIFY uNoER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE AM FAMiUAR WITH THE INFORMATION SUSMITTED HERDN; AND BASED ON DATE MY INQUIRY OF THOSE INDMDUALS IMMEDIATELY RESPONSISLE FOR ,'
s b 511j U E Eg UI. (
- OBTAINING THE #NFORMATION, I BEUEVE THE SUBMITTED aNFORMATION tS TRUE, ACCURATE AND COMPLETE. 8 AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING FA'.SE INFORMATION, INCLUDING b hj '/ ' ,
a s n
- CMCPIiEL G.,Ilil!M $C1 *-
Tete POSSieluTY OF FINE AND eMPfDSONMENT. SEE 18 U.S.C. e 1001 AND 33 l1 *
%3-$1[3 u; 1g 27 U.S.C. e 1 seemes n=y sicam shes w so s 70,000 SiONATURE OF PRINCIPAL EXECUTIVE TYPED OR PRINTED maar er m 31o. m.n ap a.m.s samer sn n s ,=wans ns s v.ars; NUMBER c eta.rw OFFICER OR AUTH0ftlZED AGENT CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refersace att strechments here) e f __ 6 ,
.; r, ,; ' '
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..i.cy.
<3 5 n A 6 m.i 3320-1108-95) Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE 7 3 ., f % > s ,. v e - L s. .; ,-
O, F
.j\ .g ,
, Papenvork Reduction Act Notice' -
iPublic re' porting burden for this collection of information is estindted to vary from a range of 10 hours as an caverage per response for some minor facilities, to 110 hours as an average per response for some major facilitics ,. C with a weighted average for major and minor' facilities of 18 hours per response, including time for reviewing
.. instructions, searehing' existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of mformation. Send comments =regarding the burden estimate or any other aspect of
.; ; this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
~
I ' Branch,'PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the Office ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503, 1 GeneralInstructions
~
,"1. If form has been partially ' completed by' preprinting, disregard instructions directed at entry 'of that information already preprinted. I
$ 2, Enter " Permittee Named / ailing Addrest (and facility name/ location, if different)," " Permit Number," and
" Discharge Number" where indicated < (A separate form as required for cach discharge.)
i Enter dates beginning and ending "Alonitoring Period" covered by form where indicated.
~
l 4. Enter each " Parameter" as specified in' monitoring requirements of permit.
- 5. Enter " Sample Aleasurement" data for each parameter under " Quantity" and "Guality" in units specified in permit.
. " Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements j - for each parameter obtained during "Alonitoring Period"; "Alawmum" and "Alinimum" are normally extreme high 1- and low measurements obtained during "A/onitoring Period." (Note to municipals with secondary treatment 7tcquirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average of sample measurements obtained during monitoring period under "Alaximum. ") l ~'
- 6. Enter " Permit Requirement" for each parameter under " Quantity" and Guality" as specified in permit.
- 7. Under "No Ex" enter number of sampic measurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0" l .8: Enter " Frequency of Analysis" both as " Sample Afeasurment" (actual frequency of sampling and analysis used i daring monitoring period) and as "Icemit Requirement" specified in permit. (e.g, Enter " Cont " for continuous
. monnoring, "//7" for one day per week, "160" for one day per month, "//90" for one day per quarter, etc.)
9.- Enter " Sample 1)pe" both as " Sample A/easurement" (actual san:ple type used during monitoring period) and as l 1" Permit Requirement," (e g., Enter " Grab" for individual sample, "J///C" for 24 hour composite, "N/A" for j continuous monitoring, etc.)
- 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
' actions taken, and reference each violation by date.
11, if"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
~
' 12 Enter "Name/ Title of Principal Executive ODicer" with " Signature of Principal Executive ODicer ofAuthori:ed
~ 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 Discharge Afonitoring Report (DAIR) form may be obtained from Office (s)
, specified in permit.
L . Legal Notice L This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can
- result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day i of violation, or by imprisonment for not more than one year, or by both.
l
' EPA Form 332tkl (Rev. 08 95)
A
MRAMTTEE NAMEJCDOMSS e7miersher A 'I r.s.m. v f>q#.r=.rt NATIOosAL POLLUTANT OsSCHARGE EUMBIAMON SYSTths (MPDES1 Form Approved.
- DtS NAME 9 7 f.J ; j y p LLgy pggg t SIM [,)y GE MONITORING REPORT IDM Cik ( x; ; D 3 g ; OM8 h ?O W og CDCUSS f.O. 61 4 *"0?761' il 2 (5CE? 03)
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. .j a r PERMIT NUMBER OiSCHARoE NuMsER i- . *
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w h.a + r ,. y m qu a ' FAQlITY-M M M PER M YEAR MO DAY YEAR MO DAY LOCATION FROM TO _n CQ4 +O D I S c a i p ; i. m NOTL Reed ineennesione inetore[~,j : r_ ~ ting shie fem.
. . 4 <
AT'%: ,, t. y I D ., ;LURf 126211 122-23) 124 25) 126-271 (2s-29) 136 319 v3 cam OnlyJ QUANTITY OR LOADING (4 Card Onlyt OUANTITY OR CONCENTRATION NO. mEomCY PARAMETER (A&539 454-619 (30-45) 154-691 oF . SAMPLE 146 531 (32-3n EX ,,,ty,,s TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS w.43, f,4,,, tas.m 4 SAMPLE MEASUREMENT
; co e^" er.oc. O s. s a c t. {:12 A ,;U i :) C ' PERMIT - *: o c nc o eccco 4:a 5,g_ . ego:gy MPOUT TV .lC E1 Gil d -
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-l i ! L G , mi ,R ., 2 i A LU REQUIREMENT .3eg g;37q6- qq 'gg, 4
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1 3 ? PERMIT 00nc0h CWW + r s ': 000000 A 1QQs I g gy , GRAg-77 3 , *
, g; 7zg REQUIREMENT og je qm g gQQ. gf L pg7 ij i g '
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; * .. A 1 : - L. k A V ,e; MEASUREMENT
, ~, ' % c ; L PERMIT cecoco. acnCCC c .;a C O c o O,c -ly :20 TWICL%E A b
. ! r' : d ? -4 7 VALU REQUIREMENT c a.. e. n yn g3 p.g y g y g. pgjL pg g
< L .j a , 1. ; ,,cul; j SAMPLE ( ?]) auc- , 00cnm WM o' s
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in. !; MEASUREMENT 3' 1 ', G PERMIT q iMF a - ; pMI C$ wo7 Govcac _ ccygeo 3ch ;g g gL gny
. La !. ! u :2 s '. i L :j REQUIREMENT ;,3 gg ' e,3 7 g y gy -
- cc o SAMPLE MEASUREMENT PERMIT .
REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCW'AL EXECUTIVE OFFICER I CERDFY UNDER PENALTY OF LAW THAT t HAVE PERSO88 ALLY EKAMINED AND - TELEPHONE DATE AM FAMlUAR wtTH THE INFORMATION SUBMITTED HERE3N; AND SASED Des e~ / Dayid erndetf MY INQU6RY OF THOSE IfeDIViOUALS tMMEDIATELY RESPON9 ISLE FOR [ i fl;r- -, "[
/
OSTAINmG THE MFORMADON. 8 SEUEVE THE SUBMITTED WFORMATION IS / / /y{' f ,/ J-* TRUE, ACCURATE AseD COMPLETE. I AM AWARE THAT THERE ARE e '
., G' f, G Onift L L'V lla t'a P.t; r SIGNsFICANT PENALTIES FOR SUBMITTING FALSE 8MFORMAMON. lesCLUDeteG c.
3 r l- 1r
' ' 4 l *q 3q -
y0
- ^ 97 THE POS$aB!UTY u.S.c. n 13:e. amma.m.OF FueE.AND sw steseMPRISONMENT.
meews mer hacos. SEE a IS U.S.C. 9,1001 AND 33 s s70,000 SiONATURE OF PRINCIPAL EXECU1WE g I TYPED OR PRINTED .ad er m.m m n - : erase. nsn nme a s m) OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY ' COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# ettschments heraf EPA Form 3320-1 (08-95) Presous editsons may be used. IREPLACES EPA FORM T-40 WteCH MAY NOT BE USED.) PAGE OF K L J l / % L:] U % 3 ; :
~ . - .- 4 -, x a
~
Paperwork Reduction Act Notice , Public reporting burden for this collection of information is estimated to vary from a range of 10 h$urs as an
' average per response for some minor facilities, to 110 hours as an average pes response for some major facilities,
- 1 :with a weighted average for nujor and minor facilities of 18 hours per resp <mse, including time for rdviewing
~
4 > instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of l ~ this collection of information, including suggestions for reducing this burden, to Chief, Information Policy ( Branch, PM-223, U.S. Environmental Protection Agency, 401 M Staet, SW Washington, DC 20460; and to the
' 10ffice ofInformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
s= t s w L
- -e L General Instructions ,
, 1. If form has been partially completed by preprinting, disregard instructions directed at entry of tha't information already preprinted.
l l , 2. Enter " Permittee Name/Alatling Addren (and facility name/ location, if different)," " Permit Number," and l: " Discharge Number" where indicated. (A separate form is required for each discharge.) 3, Enter dates beginning and ending "Alonitoring Period
- covered by form w here indicated.
- 4. Enter each " Parameter" as specified in monitoring requirements c' permit.
- 5. Enter " Sample A/easurement" data for each parameter under " Quantity" and " Quality" in units speciDed in permit.
" Average
- is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Alonitoring Period"; "A/aximum* and "A/inimum" are normally extreme high and low-measurements obtained during "A/onitarmy Period." (Note to municipais with secondary treatment requirement: Enter 30-day average of sample measurements under " Average." and enter maximum 7-day average of sample measurements obtained during monitoring period under "Afaximum ")
- 6. Enter " Permit Requirement" for each parameter under " Quantity" and "Guality" as specified in permit.
.7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or miniumm or 7-day average as appropriate) permit requirement for each parameter, if none. enter "0".
- 18. Enter " Frequency of Analysis" both as " Sample A/easurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont " for continuous monitoring. "//7" for one day per week, "l/30" for one day per month. "//90" for one day per quarter, etc.)
- 9. Enter " Sample Type" both as " Sample A/easurement" (actual sampic type used during monitoring period) and as
" Permit Requirement," (e.g., Enter " Grab" for individual sample, "NUC" for 24-hour composite. "N/A" for
. conti nuous monit onng. etc.)
- 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
-actions taken. and reference each violation by date.
I1. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12 Enter "Name/ Title of Principal Executive Of]icer" with " Signature of Principal Executive Officer ofAuthort:ed 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 Discharge A/onitoring Report (DA/R) 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 failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
, of violation, or by imprisonment for not more than one year, or by both.
EPA Form 3320-1 (Rey,08 95) l
M PERMITTEE NAME/ADORESS (Jed.de F.eenpName.Tecease tfD&=ed
" NATIONAL POLLtffANT DSCHARGE R.IM*WATIOtt SY?Tru (NPDESJ . Form Approved. '*
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- 1 , r. Y ~ P04: 1 'i f .. J ! J ! It 7 2 0 h 0 t $ ^ 1.1, .2 L C ;-OMB No. 2040-0004 ; ; -:-
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, g; ,, { ; ,y 7 W gr A1I e: c- , b- 4 v D' r (20-211 (22-231 (24-25/ NOTE: 8tead instruedons before comptehng this f(rm.
(28-27J (28-29/ (3&311 PARAMETER (3 CsM On41 QUANTITY OR LOADING I4 Cmd on&J QUANTITY Oft CONCENTRATIEN 14 & 5 31 (54-699 (38-aSI NO. meow ggyptg (32-37/ 14 & 6 31 164-691 OF AVERAGE EX TYPE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS mYsis m.sm ggg. ,,, fg7,
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.. 'l REQUIREMENT t g 4, y - 13a; n ,t; ; 3/ L j NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER e CERTIFY UNDER PENALTY OF LAW THAT 4 HAVE PfRSONAL1Y EXAMINED AND AM FAMILIAR WITH THE INFORMATION SUEMITTED HEREIN: AND BASED ON TELEPHONE DATE MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR 7 7
i OBTAINING THE 9NFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS
*b v i d. U r ri d e l- f TRUE. ACCURATE AND COMPLETE.
- g. -7ep, ?<n, ', I AM AWARE THAT THERE ARE SIGN 4F4 CANT PENALTIES FOR SusutTTING FALSE WFORMATION. INCLUDING THE POSSIBluTV OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 51001 AND 33 y/ ((// / f- 4 ,* , wJ.
in u.S.C. t 1sie. sReammee uneNr ei.e. en.ams mer m ien,s an s se se nom 9167ts i17 ni 1, y7 StGNATURE OF PRINCIPAL EXECUTIVE TYPED OR PRINTED =as er me==mna :eraer a,a.ame sas s yearsJ OFFICER OR AUTHORIZED AGENT m NUMBER YEAR CODE MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence a# ertschments herof
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- 6.1 ; ~ 4.)
. PA e um 33201108-95) Previous editions may be used.
(REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
, /. - - -, r L :~ 8
s 4 Paperwork Reduction Act Notice ' q - Public reportihg burden for this collection of inforuution is estimated to vary from a range of to hours as an
~
1 # average per response for so'ne minor facilities, to 110 hours as an average per response for some major facilities, (with a weighted average for nujor and minor facilities of 18 hours per response, including time for reviewing
. { instructions, seaichmg existing data sources, gathering and' maintaining the data needed, and completing and
- /eviewing the callection of information. Send comments regarding the bu.rden estimate or any other' aspect of
' this collection of information, including suggestions for r-ducing this burden, to Chief, Information Policy
. Branch, PM-223, U.S. Environmental Protection Agency,401 M Street,-SW Washington, DC 20460; and to the
' Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. -
N e GeneralInstructions - - J1. If form has been partially completed by preprinting, disregard instructions directed at ent.y.of that information
*~ '
;;__ already preprinted. ,-
- 12. Enter
- Permittee Name4failing Address (and facility name/ location, if different)," " Permit Number," and ll
. " Discharge Number" where ind.cated. (A separate form is required for each discharge.)
- 3. Enter dates beginning and ending "Alonitoring Period" covered by form where indicated.
- 4. Enter each " Parameter" as specified in monitoritig requirements of permit.
- 5. "nter " Sample Afeasurement" data for each parameter under "Guantity" and "Guality" in units specified in pemut
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each pammeter obtained during "Alonitoring Period"; "Afarimum" and "Afinimum" are normally extreme high and low measurements obtained during "Afomtoring Period." (Note to municipals with secondary treatment requirement: Er'er 30<!ay average of sample measurements under " Average " and enter maximum 7-day average
- of sample measurements obtained during monitoring period imder "Afarimu,m ") )
6, Enter " Permit Requirement" for each parameter under " Quantity" and "Guality" as specified in permit.-
- 7. Under "No Ex" enter number of sampic measurments during monitoring period that exceed maximum (and/or ;
minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0". !
- 8. Enter "Frequenc' of Analysis" both as " Sample Afearurment" (actual frequency of sampling and analysis used k during monitorirg period) and as " Permit requiremem" specified in permit. (e.g, Enter " Cont," for continuous j
. monitoring, "l/7" for one day per week, "1/30" for one day per month, "l/90" for one day per quarter, etc.) >
- 9. Enter " Sample 1)pe" both as " Sample Afeasuremenr (actual sample type used during monitoring period) and as ;
" Permit Requiremeni," (e g., Enter " Grab". for indwidual sample, "N/fC" for 24-hour composite, "MA" for <
continuous monitoring, etc.) ! (
- 10. Where viblations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
I1. If"no discharge" occms during monitoring period, enter "No Discharge" across form in place of clata entry. l Il2. Enter "Name/Dtle of Principal Executive Officer" uith " Signature of Principal Executive 0]licer ofAuthori:ed
- l. Agent " " Telephone Number," and "Date" at bottom oiform.
- 13. Mail signed Report to Office (s) bj date(s) specified in permit. Retain copy for your records.
l: - 14. More detailed instmetions for use of this Discharge Afonitoring Report (DAIR) form may be obtained from Office (s) L specified in permit. .< L Legal Notice I-l This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can l, result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
' of violation, or by imprisonment for not more than one year, or by both, i'
l I
. EPA Form 3320-1 (Rev. 08-95)
._ . . ~
#TRMTTLE NAME]ADORESS vadadeforesy Ama== Jeesuaa 6 swest NATIONAL pot.LUTANT DISCHAAGE EL%NADON SYSTEM (NPDES / I Form Approved. *
'AY'< 'l A b b ?, Y [OhiL 7YkTIU$ - 7 177 . 33d[2 i[O E D . No, ,47
- m + r:r. . oy: e i ,e, Approval expiree 05-31-98 fgss r e ' .. s . .: s. ., s
=
u sp u,ss ,
,11 ; saeiD UA+Dy ;y PERMIT NUMBER DtSCHARGE NUMSDL l ,ygp ,
2' -*. g n*' . 4 - .. u ,. . :J.<.- %, t 3 4 .> "a 7 7 FAC:LsTY MONITORING PERIOD 1 YEAR MO DAY YEAR MO DAY LOCATION FROM v- v; TO . CW $O L;I S C , s , o h h co? ATi : DAV:. O ? S *c ? 12G271 (22-231 (24-25s (26-271 (28-231 (30-31; NOTE: Reed instructions heefore completme this form. (3 card On&p QUANTITY OR t.OADING (4 Card on&f OUANTITY OR CONCENTRATION NO. FREQUNCY PARAMETER SAMPLE 146 53) 15+619 130-45) 146-531 156611 or (32-377 EX ann Y9s TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS N (64-ses tas-7m 3g[ , , 1NL SAMPLE 920600 f .? n n e a (c o *: <v. ( '13 MEASUREMENT
,;1; ; 1 J g PERMIT cc?cac W ooc '
w Mcocc C O. lig gn G R A L4
.8' r i,01 jr ;g- 1A i , *. H . REQUIREMENT nc eq .g yg. pgj[y p gt SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE .
MEASUREMENT PERMIT REQUIREMENT S AMPLE MEASUREMENT ; PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REOutREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAt. EXECUTIVE OFFICER CERnFY UNDER PENALTY OF LAW THAT i HAVE PERSONALLY EXAMtNED AND , / TELEPHONE DATE AM FAMBUAM WITH THE INFORMADON SUSMITTED HEREJN; ANL BASED ON W ~/
'e MY INQUIRY OF THOSE INOfVIOUALS SMMEDIATELY RESPON98LE FOR . /
, ,, O8TAINING THE INFORMADON. I BEUEVE THE SUBMITTED INFCRMATION IS / ' ~,/-
i)itV ( d U r:1d e r t.. TRUE. ACCURATE AND COMPLETE. AM AWARE THAT THERE ARE - f . M' '. ( , er 9GNIFICANT PENALTIES FOR SUBMITTING FALSE 8NFORMADON, INCLUDING $ .. ChO!'s i G L r i Mit U Cl dt! r THE POSSIBluTY OF RNE AND IMPRIS b = 39)~bI1), h D, li 9.*.y d U.S.C. s 131e. rwimmen wiser ow.ONMENT. sseems mer a SEEsbies wam It U.S.C. I 1001 a, as AND 33 S4GNATURE OF PRtNCtPAL EX'ECUTIVE s70,000 AREA TVN OR PRINTED aw er ======= : : era.e- a a ==ame aw s y rs; OFFICER OR AtJTHORIZED AGE 8ET COOE NUMBER YEAR MO DAY COMMENTS AND EXPLAN ATION OF ANY VIOLATIONS (Reference af ettectunents heref , i . ,m i: > ; Jt ir -1NJ.' . t
~LY f ' 'J - ! . .10 ; .f .P
- L '. ) . ; p . . _ " o c . , , . D fs 1 L ; p q ( I ;'j 7 r', . 'Z 3
<-; .. ; t: 2N_ (;; t. f. c . ) : 13/L. (; - g,4 T I" i, N/; 43 t v>1Ly : A. < . }
EPA Form 3320-1 (08-35l Previous edttions may be used. (REPt. ACES EPA FORM T-40 WHICH MAY NOT BE USED.) ,, . . - , PAGE OF
- 2 ;3 J / 'i t _.- I C 2. ~ L y a
3 Paperwork Reduction Act Notice t
' Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as im
~
3verage per response for some minor facilities, to 110 hours es an average per response for some major facilities,
;with a weighted average for. major and minor facilities of 18 hours per response, induding time for reviewing'
, ' instructions, ' searching existing ~ data ' sources, gathering and maintaining the data needed, and cornpleting and reviewing the collection of information. - Send comments regarding the burdeo estimate or any other aspect of
. this collection of information; including suggestions for reducing this burden, to Chief, Information Policy
. Branch, PM-223, U.S. Environmental Protection Agency,401 M Strat, SW Washington, DC 20460; and to the j ; Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
~
- General Instructions k
i t. If form has been partially completed by preprinting, disregard instructions directed at entry of.that information already preprinted. ' i.
;2. Enter
- Permittee NameSlailing Address -(and facility name/ location, if differect)," " Permit Number," and
" Discharge Number" where indicated. (A separate form as required for each discharge.)
' 3. Enter dates bedinning and ending "Alonitoring Period
- covered by form where indicated
- 4. Enter each " Parameter" as specified in monitoring reqwrements of permit.
- 5. Enter " Sample Aleasurement" data for each parameter under " Quantity" and "Guahty" in units specified in pennP.
" Average" is normally arithmetic average (geometric aserage for bacterial parameters) of all sample measurements for each parameter obtained during "Alonitoring Period"; "Ataximum" and "A/inimum" are normally extreme high
- and low -measurements obtained during "Alonitoring Period" (Note to municipals with secondary treatment
' requirement: Enter 30-day average of sample measurements under " Average " and enter maxiruum 7-day average
'of sample measurements obtained during monitoring period under "Afaximum ")
6.' Enter " Permit Requirement" for each parameter under " Quantity" and "Gi.ality" as specified in permit.
- 7. Under "No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or minimum or 7-day aserage as appropriate) permit requirement for each parameter. If none, enter "0".
J 8. Enter " Frequency of Analysis" both as " Sample Aleasurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in penuit. (e.g.. Enter " Cont " for continuous monitoring "//7" for one day per week, "//30" for one day per month, "l/90" for one day per quarter, etc.)
- 9. Enter
" Sample Ape" both as " Sample A/casurement" (actual sample type used during monitoring period) and as
. Permit ' Requirement." (e.g., Enter " Grab" for individual sample, "N/K'" for 24-hour composite, "N/A" for continuous monitoring, etc.)
10..Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date. I15 If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
^
12." Enter "Name r ntle of Principal Executive ODicer" uith " Signature of Principal Executive Ofcer ofAuthorized 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 Discharge Afonitoring Report (DA/R) form may be obtained from Office (s) specified in permit.
Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or.by imprisonment for not more than one year, or by both. EPA Form 33201 (Rey,08-95) .
v _ PERMITTEE NAME/ADORESS #adahFerdwyhavr.aren r e W . seATeOseAL pot.LUTAfdT De9CNAAGE EUMWsATION SYSTS8 /AS'OfSJ . " Form Approwest. .-
~ "# "
UL&VFs h A L L t. Y PdMEM STAT 10h 1 -OULK PQcL JTOEAGM No. _ ADORESS'i . ). ,,01 li g *
- W %S'5 ui7
- APP I -
(30bH C S)
- AY7 NI' bAV1U O$liLQRP g PERC41T NUMBER DISCHAAGE NUMSER p. p g* '
FA MQ77 9 /, J U R FACIUTY '3dC E IEF OET ' e YEAR MO DAY YEAR MO DAY _,,, LOCATION .
. FROM y.
- g. TO .y- * ;- Oct N O ;;I O C 3 A %q F - } _ L c M h i's % : i l 'l 1 ;> ': ? % i 12O 21) (22-239 424-25) 126-27) (20-29) 13W311 NON M IR*'nscelone W oeenpleelne 1No term.
PARAMETER (3 w w QUANTITY M LOADM I4 w % / QUANTITY M CONCENTRATM3N NO. mecueNCY SAMPLE 146-53I 154-691 (304El 146-539 (54-691 09
#32-37f EX an,tys,s TYPE, AVERAGE MAXIMWA UNITS MINIMUM AVERAGE MAXIMUM UNITS sEs.am ga fu n
*" SAMPLE c w W;- c%cnc O n e- ( ; '9 A f k%
hlO(h .'! 2 . MEASUREMENT O o [$ b O g :, ' . ; O C _ PERMIT gopon A em;m e 1000 g,g. -a c ocq ;gy. gg; gyg
- } y ,o 7 ; r yqg REQUIREMENT 4( m- 47yya p - gggg4 ,
.q . ,v 6 n,,
t-
*ws 4 .. .,e.n SAMPLE u,m- c e r. $ - com (
t r x'
,; j g g ; j y, e , MEASUREMENT {47 4 44y Q } [~/ .p 6 f 4, (';
i c ;, ; ; ; ; , PERMIT #cccoc rr mcc ef r. :oc cocce ,39 3 (+ g ; gggyg gg g -
' c ; a i G T- ; L: s 7 y40 REQUIREMENT ne - jn 3qq -j g g f. y ,
,j r u 1: ,150 ,., ; t, es; SAMPLE n Mo ecque an & .
(' ;a-F' '; ,i19- :AY M 17 MEASUREMENT 4h d3 h ~/ +'6f AD
;; g i g a 1 0 0 PERMIT - - u"s e W ?. *&6004 ..a cc000c 3 ;. cjg, g g y, L gg g
- F F L L, ; *1 & "Dji V? LU REQUIREMENT g in .gg g yg .gg gp p p;ft ,
TL ?x , is ; ONDL;. vi SAMPLE ( j) c00 n n.9/ W : u n S c: m
,- j b M, O c
"- , . M
. A ! 'I aT Pitt , . EASUREMENT [.[)hf [t hh,f h #
f l duJ ;u i C O PERMIT h 5 ~P O R ? r*PCF; c004% voccov 9 00:00 q ccte g g ,q g L ggr*
- j;;; REQUIREM. 4 gyptg, ,
; s u .g zy; 'ngdy p., g .;5 cue SAMPLE t MEASUREMENT i
PERMIT. - - REQUIREMEtsT SAMPLE I MaASUREMENT ; PERMIT .r r REQUIREMENT i SAMPLE MEASUREMENT PERMIT. [ REQUIREMENT , NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTtFY UNDER PENALTY OF LAW THAT e HAVE PERSONALLY EXAMINED AND AM FAMiUAR WITH THE peFORMATtON SUBMITTED HERON: AND SASED Oss p-TELEPHONE DATE MY INQUIRY OF THOSE *NDIVIOUALS IMMEDIATELY RESPONSISLE FOR ^- 08TAINfMG Tete INFORMATIOes, I BEUEVE THE SUBMtTTED INFORMATION IS
; f /
J / e'l ,
/
TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE f * , j. .-. / ,J' ' J M/-- d, i.t V k d VI ITtiO t 1 SIGNtRCANT PENALftES FOR Susa(TTING FALSE ONFORMATION, INCLUDtNG
, .n, ,, .
THE POSSIBAUTY u.s.C. e lais. m .=N, m.= . ANO OF FfME Man .eMPRISONMENT SEE 18 U.S.C. t 1001r mANO sso. m. an coo 33 w s SIONATURE OF PRINCsPAL EXE'CUTNE ,,, TYPED OR PRINTED ." . .w or =====ie : _ : .F a.rw a e ni.nas aw s y.oras omCER OR AUTHOR 8ZEO AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY Vu flONS (Reference a# ettechments here/ f l c'
; 4 - t. nWC
- p. ., - ! .r i s; H r ; .9 p tg i
c rA 6 osm 3320-1108-958 Previous editions may be used. IREPLACES EPA FORM T-40 Wt#CH MAY NOT SE USED.) PAGE OF J ,g x , i w L / 9 :: (s ;eU, , L A,fL. , i t
Paperwork Reduction Act Notice - Public repeting burden for this collection of information is estimated to vary from a tange of 10 hours as an
-average per response for some minor facilities, to I10 hours as an average per response for some major facilities, Lwith a weighted average for major'and minor facilities of 18 hours pet response, including time for reviewing' imtructions,-searching existing data sources, gathering and maintaining the ' data needed, and complet'i ng and
~
reviewing the collection of information. Send comments rrgarding .the burden estimate or any other aspect of [this collection of information, including suggestions for redu@g this burde 1 Chief, Information Policy
;. Branch, PM-223, U.S. Environmental Protection Ageng,401 M Street, SW W . . . ; ton, DC 20460; and to the
< Office ofinformation and Regulatory Affairs, Office of Management and Budget L ashington, DC 20503.
- -n.
, 1_ .
General Instructions L1; If form has been partially completed by preprinting, disregard instructions directed at entry of that infonnation already preprinted.
- 2. Enter
- Permittee Name/Afailing Address (and ' facility namellocation, if different)," " Permit Number," and
" Discharge Number" v here indicated. (A separate form is required for each discharge.)
' 3. Enter dates beginning and ending "Afonitoring Period" covered by form w here indicated.
~
- 4. Enter cacii Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample Afersurement" data for each parameter under " Quantity" and "Guality" in units specified in permit.
" Average" is normally anthmetic average (geometric average for bacterial parameters) of all sample measurements fcr each parameter obtained during "Alonitoring Periocf'; "Afarimum* and "3/inimum" are normally extreme high and low measurements obtained during "Alonitoring Period" (Note to municipals with secondary treatment requirement: Enter 30-day nerage of sample measurements under "Arcrage," and enter maximum 7-day average .
- of sample measurements obtamed during moni1oring period under "Afarimum ") <
- 6. Enter " Permit Requirement" for each parametec under " Quantity" and "Guality" as specified in permit.
- 7. Under "No Ex" enter number of sample meaurments during monitoring period that exceed maximum (and/or minimum or 7-day average as appropriate) permu requirement for each parameter. If none, enter "0"(
l
- 8. Enter " Frequency ofAnalysis" both as "Samp/c A/easurment" (actual frequency of sampling and analysis used during monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont." for continuous monitoring, "le7" for one day per w eek, "l/30" for one day per month, "!/90" for or,a day per quarter, etc.)
- 9. Enter " Sample npe" both as " Sample Alcasurement" (actual s:unple type used during monitoring period)'and as
" Permit Requirement," (e.g. Enter " Grab" for individual sample, "AiHC" for 24-hour composite, "A%1" for continuous monitoring, etc.) -
- 10. Where violations of permit requirements are reported, attach a bricf explanation to describe cause and corrective actions taken, and reference each violation by date;
-11. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
- 12. Enter "Name?ntle of Principal Executive Oficer" with "Signatu're of Principal Executive Officer ofAuthorized Agent * " Telephone Number," and "Daie" at bottom of form.
- 13. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your records.
- 14. More detai!cd instructions for use of this Discharge Afonitoring Report (DAIR) form may be obtained from OHice(s) specified in permit.
7 Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125,27). Failure to report or failure to report truthfully can result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 g
- day
-of violation, or by imprisonment for not more than one year, or by both.
EPA Form 3320-1 (Rev. 08-95) d . ,, . . _ _ _ - , , . . - , e - -
3
- PEMnelTTEE NAtaE/ADOftESS Wrenehey A nt.ew arb@ews esAricesAL POLLUTAssT De9 CHARGE EUAdutATICAB ). .~ P0ffn Appf9Wed '#'
r
= c a m npa e smna == S. F = '='aa',,,.,,, w n t c & s a oM = >eo 4 s A.Do*2ss P.O. 5OL 4 3'*> '2%!' i 1' *
( % EiR 0 5) ** D _ ""# .. ! 'A U h;.TiAYID CEhOO$7 PERMIT NUMBER DescHAnet es'=am*H y; - p13A(; umimmt FA 15077- . m ot YEAR MO DAY YEAR MO DA/ - LOCA M
~
FROM 9c vr v. TO n u ai tM NG b UCM RG E<[ , CC f. hiTh: DAV: O it O 3 3 ? (2021b (22-239124-259 126-271 (20-2,9130k311 NOTE.- M ine& W & % %.' (3 cent Odys QUANTITY OR LOADING ' (4 Cent Os&f OUANTITY OR CONCENTRATION NO. imEOveseCY PAR AMETER . 146-53r 164-s 19 446-55 SADMLE 130-464 954-019 OP f32-37; EX my,,, TYPE ~ h-AVERAGE. . MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS mum ,e f ,yg, SOLIOd, fuTAL SAMPLE MC7Cr COGNO 40m '( iW l m
'a'sJv 1.. 1 m <-
sJLD MEASUREMENT ._ O Q 510 1 v 0 PERMIT ' OAccco . O :;onse :m vp4009 .31 . 100f. . KEEF4 QFM l EfFLUrNr. a a VAIU RE2VIREMENT , p.c q gyg. M gy. W ,q ;
' ~
FLU;, I 's - DiDUi. OG SAMPLE ( N} oc we cescos vo ;c ci
+- -~
,~t c A . a mu-A. 4
,, a.4ASUREMENT
- +x.a. ?s e- , c. .
~
SO C ' - 0 0 PERMIT - R tT O M" .!iD QJiT - cr/0300 ,0 9 p N .7M.9&% M 03 if LL EL E MlJ, {* 1 Y
" ~
;F ! !""i 5
50SS / A LC REQUtREMENT g.py; .py3y pg
- g ;; ogg ;v SAMPLE MEASUREMENT
, , . PERMIT ' REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT : I. SAMPLE MEASUREMENT l PERMIT .. REQUIREMENT SAMPLE MEASUREMENT
, PERMIT -
REQUIREMENT SAMPLE MEASUREMENT a
. , PERMIT : +- ,
i REQUIREMENT
- NAME/ TITLE PR#dCW'AL EXECUTIVE OFFICER s CERTIFY UNDER PEpsALTY OF LAW THAT I HAVE PERSDISALLY EXAAdWED ABIO /
4 AAA FAheUAR WITH THE WFORasATIOes SUBRAITTED MEREIIt:ABID SASED Oss /_' a ,- TELEPHONE DATE
/
MY GNOUIRY OF THOSE INDIVIDUALS IhAAAEDIATELY RESPossSIBLE FOR / OSTAdessesG THE 88eFOnaAAT10N, 4 SEUEVE THE SUDIAITTED lesFOnhAATIOP' IS rM4 V i d O.!'lldO T A./N '
- s /s f44 /' ^~
a a. TRUE. ACCURATE AssD CORAPLETE. I AAA AWARC THAT THERE ARE _f i i, StGaseFICANT PEDsALTIES FOR SuthMTTING FALSE IseFOftaATIOes, ageCLUDeeG diOYli8 L T y DandEC r THE POSSs81UTY OF FWE AfeD lasPRrSOseasENT. SEE 18 ES.C. 91001 AND M
*12 3gNb 4
U.S.C. e isie. sP>isamme esimir anese susnmes misy mucswal, mise eas a, d 70,000 SIGIIATWE OF NAL Edm 't 3,gg a2 , s - TYPED OR PRWITED mad er ======== : _ ermeri ema sassanns mes 5 yearaf OFRCER OR AUTHOIIEED AGEIrr CODE 88UtWER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Referertce etstrechments heref EPA Form 3320-1 108-95) Previous editions may be used. (REPLACES EPA FORM T-40 WteCH MAY NOT BE USED.) s. .r .. PAGE OF
.s192/}LatOb
. ,t 3 39- - a t
. _ _ _ _ _ _ . _ - . - . ._. . . _ , - . - _ - _ . _ . - - -- _ .__---.l'
.. - - ,-- .-- , _ . - -. .J
y Paperwork Reduction Act Notice '
'Public reportieg burden for this collection of information is estimated to vary from a range of 10 hours as a ,
average per response for some minor facilities, to 110 hours as an average per response for some major facilitics, with a weighted average for major and minor facilities of 18 hours per ruponse, including time for reviewing *
) !
instnictions, searching existing data sources,' gathering and maintaining the data needed, and completing and reviewing the co!!ection of infonnation. Send comments regarding the burden estimate or any,other aspect of j
- this collection of infonnation, including suggestions for reducing this burden, to Chief, Information Pohey (
Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the ! LOffice ofInformation and Regulatory Affairs, Office of Management ad Budget, Washington, DC 20503. 1 a., General Instructions 1 1.' If form has been partially completed by preprinting, diuegard instructions directed at entry of that information
'alreyly preprinted.
Enter " Permittee- Name/A/ ailing Address (and facility reune/ location, if different)," " Permit Number," and
" Discharge Number" where indicated. (A separate form is required for each discharge )
' 3. Enter dates beginning and ending "A/cmitoring Period" covered by form where indicated.
s I
~ d. Enter each " Parameter" as specified in monitoring requirements of permit. I
)
5 Enter " Sample A/eaturement" data for each parameter under " Quantity" and "Guality" in units specified in permit.
" Average" is normally arillunctic average (geometric average for bacterial parameters) of all sample measurements for each parameter obtained during "Alonitoring Period"; "A/aximum" and "A/inimum" are nonnally extreme high and low nensurements obtained during "A/<mitoring Period" (Note to municipais with secondary treatment )
requirement: Enter 30-day average of sample measurements under " Average," and enter maximum 7-day average of sample measurements obtained during monitoring period under "Afarimum ") { l 1
, ' 6. Enter " Permit Requirement" for each parameter under "Guantity" and "Guatio" as specilled in permit. )
i
- 7. Under'."No Ex" enter number of sample measurments during monitoring pedcd that exceed madmum (and/or '
minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
- 8. Enter " Frequency of Analysis" both as " Sample Alcasurment" (actual frequency of sampling and analysis used l
. dunng monitoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont," for continuous i monitoring, "u7" for one day per week, "l/30" for one day per month, "l/90" for une day per quarter, etc )
1'
- 9. Enter " Sample Type" both'as " Sample A/easurement" (actual sample type used during monitoring period) and as
' " Permit Requirement " (e g., Enter " Grab" for . individual sample, "24//C" for 24-hour composite, "N/A". for !
continuous monitoring, etc.)
- 10. Where violations of pennit requirements are reported, attach a brief explanation to describe cause and corrective
! actions taken, and reference each violation by date. 1
- 11. If"no diseharge" occurs during monitoring period. enter "h Discharge" across form in place of data entry. '
[ .1[Snter "NameTitle of Principal Executive Oficer" sith " Signature of Principal Executive Oficer ofAuthori:ed !; Agent," " Telephone Number," and "Date" at bottom of form. l ( 13. Mail signed Report to Office (s) by date(s) specified m permit. Retain copy for your records. l _'14. More detailed instructions for use of this Discharge Afonitoring Report fDA/R) form may be obtained from OfIice(s) specified in perrnit. i Legal Notice i f This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can { result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both. i EPA Form 3320-1 (Rev. 08-95) { b i C_ ___. .. ., . _ . . - -
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