ML20138J016
| ML20138J016 | |
| Person / Time | |
|---|---|
| Site: | Beaver Valley |
| Issue date: | 12/31/1996 |
| From: | Legrand R, Orndorf D DUQUESNE LIGHT CO. |
| To: | NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM) |
| References | |
| NPD3VPO:0588, NPD3VPO:588, NUDOCS 9702040046 | |
| Download: ML20138J016 (63) | |
Text
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., Telephone (412) 393-6000 P!'s;??","
Shippingport PA 15077-0004 January 27, 1997 NPD3VPO: 0588 Document Control Desk U.S. Nuclear Regulatory Commission Washington, DC 20555 '
NPDES Monthly Report. EPA Permit No. PA0025615 j
SUBJECT:
Beaver Valley Power Station, Unit No. 1 and No. 2 BV-1 Docket No. 50-334, License No. DPR-66 BV-2 Docket No. 50-412, License No. NPF-73
Dear Sir:
I Enclosed is a copy of the NPDES Monthly Report as submitted 1 to the Pennsylvania Department of Environmental Protection.
Sincerely, coa ( .t >
Ronald LeGrand Division Vice President Nuclear Operations SLV/tra cc: D. A. Orndorf-J. A. Cool R. K. Brosi Central File 9702040046 961231 ?' I DR ADOCK 0500 4 (9] The Nuclear Professionals
'Af Te:ephone (412) 393 6000 Nuclear Group P O. Son 4 Shippingport, PA 15077-0004 January 27, 1997 NPD3VPO: 0589 United States Environmental Protection Agency ,,
Region III, Pennsylvania (3WM53)
Water Permits Branch Water Management Division 841 Chestnut Street Philadelphia, PA 19107 NPDES Monthly ReDort. EPA Permit No. PA0025615
Dear Sir:
This letter forwards a copy cf our NPDES Monthly Report as submitted to the Pennsylvania Department of Environmental Resources, Bureau of Water Quality Managenent Sincerely,
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Ronald LeGrand Division Vice President Nuclear Operations SLV/trs Attachment cc: D. A. Orndorf J. A. Cool R. K. Brosi Central File The Nuclear Professionals
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Telephone 1412) 393-6000 0 bom 4
$n ppmgport. PA 15077-0004 January 27, 1997 NPD3VPO: 0590 United States Environmental Protection Agency Region III, Pennsylvania (3WM52)
Water Permits Branch Water Management Division 841 Chestnut Street Philadelphia, PA 19107 EPA Permit No. PA0025625 Reoortable Occurrences
Dear Sir:
As required by the EPA Permit No. PA0025625, the following information is provided in regard to reportable occurrences at Betver Valley Power Station.
NPDES Discharge Monitoring Point 203, the Unit 1 Sewage Treatment Facility, exceeded the monthly average total suspended solids specification and the pH minimum specification during the month of December.
Two total suspended solids samples were obtained on the 3rd and 17th of the month measuring 38.9 mg per liter and 56.4 mg per j liter. Although neither of these values exceeds the daily maximum specification of 100 mg per liter, they' result in a monthly average of 47.7 mg per liter, which exceeds the maximum i allowable monthly average of 30 mg per liter. This upset l
condition was the result of increased loading on the facility due to the outage of the Unit 2 Sewage Treatment Facility for extensive maintenance activities. The Unit 2 facility was l returned to service in early January and the loading on the Unit i
1 facility has returned to normal.
p, The Nuclear Professionals a
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January 27, 1997 i NPD3VPO: 0590 l Page 2
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I On Monday, December 2, the pH of .the plant affluent was l measured at 5.92, exceeding the minimum specification of 6.00.
An addition of sodium bicarbonate was made to the system and the J pH. returned to acceptable levels. In addition, Duquesne Light.
i has retained the services of a technical. consultant to assist in ;
evaluating the cause of the upset condition. Their investigation determined that the presence of nitrifying bacteria was causing the normal alkalinity to be stripped from the plant. <
Accordingly, the use of sodium bicarbonate is the appropriate I action to correct the situation. Sodium Bicarbonate additions have corrected the problem and will continue to be used to control system pH.
J If- you' have any questions concerning this report, please do l not hesitate to contact David A. Orndorf. l J
Sincerely, i a
c, .s , , y, Ronald LeGrand 1 Division Vice President !
Nuclear Operations l
SLV/tra cc: D. A. Orndorf J. K. Cool ,
R. K. Brosi Central File - Keywords: NPDES Reportable Occurrence
, ,_ _ - _ _ , _ . _ _ _ __..__ _ _ -1
'Af Telephone (412) 393-6000 Nuclear Group P O Bon 4 Shippingport, PA 15077-0004 January 27, 1997 NPD3VPO: 0587 Attention: "DMR Clerk" Department of Environmental Protection Bureau of Water Quality Management 400 Waterfront Drive Pittsburgh, PA 15222 NPDES Monthly Report, EPA Permit Number PA0025615 Gentlemen:
NPDES Monthly Report for Duquesne Light Company, Beaver Valley Power Station for December 1996 is submitted for your consideration.
Sincerely,
,/ ,
- f. if ,.[f r]!, , a Ronald LeGrand Division Vice President Nuclear Operations SLV/trs Enclosure cc: D. A. Orndorf J. A. Cool R. K. Brosi Central File The Nuclear Professionals
PEntAITTEE NAtAE/ ADORERS (NaMarst,Nmw1.r m trDdband '
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NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERDFY UNDER PENALTY OF LAW THAT e MAVE PERSONARY EMAGApeED MD AM FAMIUAR WITH THE fMFORMATION SUBMITTED MERE 18e: AND BASED ON e
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- MY INQUIRY OF THOSE INDfVIDUALS fMMEDIATELY RESPON98LE FOR i
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drWid OTildGT p-OSTAINING THE IstFORMATION. I SELIEVE THE SUBMITTED INFORMADO80 IS TRUE, ACCURATE AND COMPLETE.
I" p J L I AM AWARE THAT THERE ARE Tt'_D.-p # f ,, 9 M.3,W 3 Qunintry L,saager soNmCmr PENALnES FOR sueMiTTiNo FALSE iNFORMATiON. iNCtuDesea *
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- 1 THE PossessuTY u.s.c. 1 sis. #Rmen. OF FineE.AseDw.r si.e. . anus iMrsusOseMENT. 6si SEE 18 v S.C. I 1001sloNATURE MD 33 OF PRINCIPAL EXECUTfVE g TYPED OR PRIS.TED .ast er ms.* aim n - . rser o n s m aene mer.*=s s w y # hee ms se so
- 70,000 OFFICER OM AUTHORIZED AGENT NUMBER YEAR MO DAY ;
CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference of strechments herof ,
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EPA Form 3320-1 (08-953 Previove edetions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE OF
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' Paperwork ' Reduction A.ct Notice
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i t Pubbe reportmg turde D r this colhxtion of infonnation is estimated to vary from a range of 10 hours1.157407e-4 days <br />0.00278 hours <br />1.653439e-5 weeks <br />3.805e-6 months <br /> as an ;
l avens per response in seme minor' fadlities, to 110 hours0.00127 days <br />0.0306 hours <br />1.818783e-4 weeks <br />4.1855e-5 months <br /> as an average per response for some major facilities,
! mth a wrightcJ ascra " ter major and minor facilities of 18 hours2.083333e-4 days <br />0.005 hours <br />2.97619e-5 weeks <br />6.849e-6 months <br /> per response, including time for reviewing l instructions, uarching cai< ting data sources, gathering and maintaining the data needed, and completing and !
- n. viewing the coi!ccti,n ci information. Send conunent:s regarding the burden estimate or any other aspect of 'l
-this collection of infonnat on, including suggestions for reducirig this burden, to Chief, Inforrnatsa Policy Branch, pW223, U.S Envnonmet tal Protection Agency 401 M Street, SW Washington, DC_20460; and to the ,
Office of Information v d Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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1 General Instructions .
' J. If form has been putiidly completed by preprinting, disregard instructions directed at entry of that information l already preprinted. i 2.. Enter " Permittee WmAfailing Address (and facility namc/ location, if different)," " Permit Number," and "Diu harge Nwnte ' where indicated ( A separate form is required for each discharge.)
- 3. Enter dates begou.ing and ending "Ahwrtonng Period" covered by form where indicated. s
'4, Enter cach "Parm : <er" as speufied in monitoring requirements of permit. I I
6 Enter "Nample At t arment' data for each parameter under "(hont ty" and "Guality" in units specFied in pernut.
"A u rap is ocnMy nthmrtic average (geometric aserage for bacterial parameters) of all samp!c measurements for each paramet cbtained during "Alonaanny renw/"; "Afarsmum" and "Almimum" are norma!!y extreme high and Imv measurants obtained during "3t6rntonn g: Penod " (Note to municipals with secondary treatment reqmrement: EnN r % Jay ascrage of emip!c measmements under " Average," and enter maximum 7-day average of sample meamraat uts obtained during mcnitoring period under "Atarimum.")
- 6. Enter "Pernut Re parwant" fer ench parameter under "Guantity" and "Guality" as specified in permit. ;
- 7. Under "No Er* cer number of sampic rucasurments during monitoring period that exceed maximum (and/or muumum cr%d.e acege as appropriate) permit requirement for each parameter. If none, enter *0".-
- 3. Enter "Frnjuency Cralpu" both as " Sam;>le Atc.nurmert" (actual frequency of sampling and analysis used 1dcring monitoring period) and as "Pernut Rcquirement" cpecified in permit. (c g., Enter "ront," for continuous momtaring, "h7 for ere day per week, "l/30" for one day per month, "b'90" for one day per quarter, etc.)
- 9. En:er " Sample 7rit ' both as "Sumple Alcawrement" (actual sample type used during monitoring period) and as "Permu Requircunwt * (e g., Enter "Grah" for indi5idual r. ample, "At/IC" for 24-hour composite, "N/A" for continuous monitwing, 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.
- 11. If"no discharge" eccurs danng monitoring period, enter "No Discharge" across form in place of data entry.
- 12. Enter "Name?Dile of Principal Execunvc OJpccr" uith *Signan.re of Principal Erecutive Ofcer ofAuthortred Agent," 'Teirphone Number
- and "Date" at bottom _of form i 13. Mail signed Report to OfTice(s) by date(s) specified in permit. Retain copy for your records.
- 14. More detiiled instructions for use of this Discharge Afrmitoring Report (D3fR) form may be obtained from Office (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 l , result in civil penalties not to exceed $10,000 per day of violation; or m criminal penalties not to exceed $25,000 per day I of violation, or by impnsonment for not more than one year, or by both.
1 1
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l EPA Form 33201 (Rev,08-95) l
reRearTTEE NAME/ADEMSS W Fer&y#s==vi.oresen $$mW Mt.DONAL PORUTANT DISCHARGE RasmADoof WWEM (NPDES) Fomi Approved.
NAME ,7 4 y ; . O Li, r y m ?A q
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- LOCAMW FROM as 1. l c1 TO o . !3 11 'r M "3 J I S C i! % b"i' l l $c0 2 + , . naev, aras,,e traits (22-237 (24-25s (26-2n (26-2s/ (30-371 NOTE: Reed instructions before~ completing tNo forin.
PARAMETER (3 Cod On41 QUANTITY OR LOADRG I4 Ced W QUANTITY M CMCENTRAM NO. meow (46-539 (54-611 (30-459 146-539 154-611 OF SAMPLE (32-371 EX AN m TYPE \
AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,Es.es, tod-est (6 m SA LlJ, Tt !3ND1[T 3a
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REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT S AMPLE -
MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTNE OmCER I CERDFY UNDER PENALTY OF TAW THAT I HAVE PERSONARY ERAMWED AND ~. TELEPHONE DATE AM FAMtUAR iMTH THE IIIFORMATIO90 SUOMITTED HEREIN; AND BASED Oss t MY INQUPRY OF THOSE INDIVIDUALS fMMEDIATELY RESPOst98tE FOR '4/" /.;
p l-08TAfNf4G THE INFORMATION. I BELIEVE THE SUBMITTED fMFORMADON IS UdVi d b.fildDr ag .o Chetti n L ry Matia ge i TMUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE StGNIFICANT PENALTTES FOR SUBMITTING FALSE fMFOfeAATION, INCLUDING
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- 01 6' 7 THE C.
u.s POSSMBfLITY OF FINE t 1310. m newer AND eenuse, an.se IMPRISONMENT.
me, h*ste SEE 10ao nae U.S.C.,91001 so a10,000AND 33 SIONATts*M OF PRileCIPAL EkCUTIVE TYPED OR PRWTED g erw er == ==== w - _ : er ser- a e morisas ow a resral OFFIC AUTHORIZED AGEIET COOE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference et artschments / tere /
EPA Form 3320-1106-95) Preinous edttions mey be used. tREPLACES EPA FORM T-40 WHICH MAY NOT BE USED l PAGE OF 7 ,n, l -.
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7- + . N O - -- e,- ~+
.-----.-m-Paperwork Reduction Act Notice l
- 1 .
- , j
. Puldie rep < sting i md- f( r this cc4kstion of inh >nnation is estimated to vary from a range of 10 hours1.157407e-4 days <br />0.00278 hours <br />1.653439e-5 weeks <br />3.805e-6 months <br /> as an i
! : n erge pd repnse U seme minor facihhes to 110 hoars as an aserage per response for some major facilities,
- with a weightd aven ' fu major and tuinor facilitis of.18 hours2.083333e-4 days <br />0.005 hours <br />2.97619e-5 weeks <br />6.849e-6 months <br /> per response, including ilme for reviewing l
{ -indructibns, i.can.hiny eskting dati morers, gathering and maintaining the data needed, and completing and ,
j nviev,mg thJ ud!wtix of infonction Scad comments regarding the burden estimate or any other aspect of f
' thi! collutiba of inf won, uchtding suggestions for reducing this burden, to Chief, Information Policy ;
Branch, PM-223, U.5 Environnvntal Protec<. ion Agency,401 M Stnet, SW Washington, DC 20460; and to the 1
'Ofthe of Information ud Regulatory Affairs, Office of Management und Budget, Washington, DC 20503,
, _ _ . _ _ _ . _ . _ - _ _ _ _ _ _ _ _ l i
General Instructions .
(
l't . Jf. form has been pitially completed by preprinting, disregard instructions directed at entry of that information
- already preprinted [
- 2. Enter "Perrm uce Vamed/m/mg !deirrss (and facility name/kration, if different)," " Permit Number," and ,
" Discharge Number
- where indicated. (A separate form is required for cach discharge ) -
- 3. Etiter dates beginmng :md endmg "Afomformy Period" covered by form where indicated
/
- 4. Eiger cach " Perm ..A r :ts specdied m monitonng requirements of pennit. ,
- 5. Enitt hp!< Af, necmcnt data for each parameter under "(?uantity" and *Guality" in imits specified in permit. !
"ch cryc" is nenu Uy mthmetic average (geometric merage for bacterial parameters) of all sample measurements i i for each piramet r aumed dunng "A!cwtonrrg Permd"; "Afaximum" and "Alinimum" are normally extreme high ;
and low measunu :nh obtamed during "Alomroring Period? (Note to municipals with secondary treatment reqmremem: Enc Wday aurage of sample measurements under " Average," and enter maximum 7-day average of sampic measats ents obtained during monitosing period under " Alarm:um.")
- 6. Enter "Pcenut Re !wrement" fer cach parameter under *guantity" and "Guality" as speci6cd in permit.
7 Und:r "Nu Er" euer numb:r er unple measurments <!uring monitoring period that exceed maximum (and/or minimum or 7-dm werage as ::p;ropnate) permit requirement for each parameter. If none, enter "0".- l S. Enter "Frequero tf Analysi3" both as "Sairyde Afeaturment" (actual frequency of sampling tmd analysis used dcring mcnitonnn period) and as " Permit Rcqwrement" specified in pennit. (c g , Enter "Ctmt " for continuous i monitoting "1/7" for one day per weck. "1/30" for one day per month, "//90" for one day per quarter lcte.) 1
- 9. Enter "Sm+iple 7)pe" both as " Sample 3/casurement" (actual sample type used during monitoring period) and as ,
" Permit. Requirr mert " (e g., Enter "Grah" for individual samplc "NHC" for 24-hour compostic, "N/A" for ;
COnlirulous momloring, cic.) l l
l 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective !
I actions taken, and reference each violation by date. l l l l 11. If "no discharge" acms during monitoring period, enter "No Discharge" across form in place of data entry.
l l
l 12'. Enter "Namemtle of Principal Executive Officer" with
- Signature of Principal Executive OJJicer ofAuthors:ed ,
Agent," " Telephone Number," and "Date" at bottom of fann.
l
- 13. Mail signed Report to Omce(s) by date(s) specined in permit. Retain copy for your records _
l,
- 14. More detailed instructions for use of this Discharge Alumformg Report (DAIR) form may be obtained from Omcc(s) I specified in pennit. i
~
1 Legal Notice
%is 15 port 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 imprimnment for not more than one year, or by both.
1 EPA form 3320-1 (Rev. 0&95)
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PERWTTEE NAME/ ADDRESS (5.ra deFerduyN.=.LoreN.= gfD#www) hATIO8e AL POLLUTANT Ot9 CHARGE ELfMissATION SYSTEM (NPOES/ Form Approved.
NAW . F *?ra f3LL9Y O Pa 4!4 [lt N j6 (F 7 3477 ^%5
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PERMIT NUMBER DISCHARGE NUMBER -
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J l I N' r t W 3 ; '" - 2 1 ' ' T' MONITORING PERIOD "AD" t?%#7 1 7ALL i t3aP4 ;rA*I3 YEAR MO DAY YEAR MO DAY ' +
LOCA N FROM -
TO ), :: e * ? > p;n' tt jh ocr i s 1 > t 51 3r
' * * * . ** r rT 7 -,9 (2G271 (22-23/ (24-251 (26-271 (26-29/ (JG371 NOTE: Reed instructions before completing this fann.
PARAMETER (3 Cerd onNJ OUANTITY OR LOADING I4 Cerd on4J QUANTITY OR CONCENTRATION NO. FREQUENC" SAMPLE to6-53) 154-671 136-45I res-53) (54-619 oF (32-371 EX ANAtysis TYPE %
AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS cas, fgg,j gm SAMPLE e e, 3 +- o^3e> % ^ 3 ,, e
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ty(Ly ut s 3 ,.1 7,, REQUIREMENT ,.-s 3 3 f ,. z ,,, p 33y7,nf y fL SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER a CtRTIFY UNDER PEN ALTY OF LAW THAT t HAVE PERSONALLY EXAMtNED AND / TELEPHONE DATE AM FAMfUAF. WITN THE INFORM ATION SUBMITTED MERUN; AND BASED ON MY TNQUsRY OF THOSE INDIVIDUALS fMMEDIATELY RESPONSIBLE FOR OBTAINING THE INFORMATION, I BEL EVE THE SUBMITTED INTOstMATICN IS
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sT,an ACCURATE AND COMPL ET E. t AM AWARE THAT THERE ARE RUE,.,, CANT PENALTtEs FOR suButTf1NG FALSE INFORMATION , INCLUDfMG
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THE POSSiBiuTY OF FINE AND iMPRiscNuENT. sEE 18 u.S.C. 91001 AND 33 u.s.C. e tale. rmen m. anNr tw iMeum mer ic4ans s naen .e se i70,000 SiONATURE OF PRINCIPAL EXECUTIVE I l7 'I M.. I I 3 37 h1 i 7 TYPED OR PRINTED g sad er ==e4==n :. 1 a erm;e mamas sas s venras OFFICER OR AUTHORIZED AGEffT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# strechmem treret f& h , . < L EPA Form 3320-1 106-96) Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE
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L Paperwork Reduction Act Notice
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Pubhc reporting burden for this collecthm w forof someinfonnation aujor facihties.
I is esurna:c aurage per response for some minor facilities, to 110 hours0.00127 days <br />0.0306 hours <br />1.818783e-4 weeks <br />4.1855e-5 months <br /> as an average per rev.nindukg tir ifor nnewing with a weighted average far rMor and minor facihties of 18 hours2.083333e-4 days <br />0.005 hours <br />2.97619e-5 weeks <br />6.849e-6 months <br /> per respon.w, d A comp'eting and ,
I
! instructions, searching existing data sources, gathenng and rmuntaming l the data n reviewmg the colintion of infortwdion.
'this collection of information, includmg wggestions for reducing d tothis the burden, j to Clicf, Branch, PM-223, U.S. Environmental Protection Agency,401 M 5f reet, SW Washingtoa, DC i
} Of fice of Infornution and Regulatory Af fairs, Office of Management and Budget, Washin l . -
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General Instructions if u
- 1. If form has been partially completed by preprintmg disregard mstructions directed a already preprinted. "Pcnrit Number," and (and facility name/ location, if different),"
2 Enter "Permitter Name Mailmg Address "Docharge Number" where indicated ( A separate form is required for each d2scluure.)
- 3. Enter dates beginning and endmg " Monitoring Permd" cosered by form where indicated
- 4. Enter each " Parameter" as specified in rnonitoring requirements of permit.
spe:-ified in putnt.
t
- 5. Enter "Samp!r Meanrement* data for cach parameter under "petety" and high *(hmlity* in un
%rrage' as nonnally anthmetic average (geometrie :ncrape for br'cnal param tero of nli for exh parameter obtamed during "Momtormg Perimr. "Marunum" and "MannmW ;ue n and low measurements obtained during "Momformy Permd"Entci 30-day average o requirement:
of hample mC35urCmentS obtainCd during m0mlormg pCDDd undCI *MatU.Wm )
" as speofied in permit
- 6. Enter "Pernns Rcquiremenr' for each parameter under Tuantity" and *(bdity (a net'or
- 7. Under "No h* cnter number of sample measunncats during momtoring Nr. penod that exece mmimum or 7-day average as apprepnatc) permit requiremem for caci parameter. If rane, excr both as "Samp!c Measurment" (actad frequency of cunph:7 aad an$ns use (e g , Enter "I hnt." for continuous
- 8. Enter "Frequemy of Analysit" i tc )
daring monitoring p<r od) and as *Pernnt Frywrement" speaf;cd in pernu period) and as i
- 9. Enter " Sample 7)pe* both as "Samp!c Mcomrement" (actual sample type used dunng Enter "Gra
- Permit Requiren.cnt " (e g.,
continuous monitoring, ele ) d conecthe b
- 10. Where violations of permit requirements are reponed. mtach a brief explanation to desco adions taken, and reference cach violation by date.
i l f data entry.
I1. If"no discharge" occurs dunng momtoring period, enter "No D!.scharge" across form n p ace o Olncer of Authori:cd
- 12. Enter "Name/Dile of Prmcopal Decutne OHicer" wnh " Signature of Prmap,d Decutne Agent," " Telephone Number,' and "Date' at tettom of form
- 13. Mail signed Report to Office (s) by date(s) specified in permit Retam copy for your records d from Officcu)
- 14. More detailed instructions for use of this Dncharge Momtoring Report (DMR) fann may specified in permit.
Legal Notice
~
bfully can This report is required by law (33 U.S.C,1318; 40l C.F.R.125.27). Failure to report or f lties not to emed $25,000 per day result in civil penalties not to exceed $10.000 per day of violation; or in cnmma pena of violation, or by impnsonment for not more than one year, or by both.
I
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EPA Forre 3320-1 (Rev. 08-95)
PERMITTEE NAME/lDORE03mF.,e,N.wt n (Iv-.w) a;ATIONAL POLLUTANT D'SCHARGE RmemADON SYST98 (/W'OfSI FOtm Approved. _ '
NAME DeSCHARGE MONITORING REPORT (DMRI
' % 'f C 45%LST ?DJ'? iTh"3 (2- t r* 197-191 % !! f o l 4 T R Y ? SCC"CM WW AoomS .i.3.
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PERMIT NUMBER oeScHARGE NUM9m pm m p ., J ryg{
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1<77? MITORW6G PERIOD 'I E J U IA
'; r 3 7 7 7 A L L c T PDNPR 3 T A ~ i YEA 81 MO DAY YEAR MO DAY
- LOCAM*8 FROM e, 1- t3 TO aS 5 -
i1 M0 la C ISC:Ia FG r. j l H.6 4--o; ngyT3 ,u.n99e (2G2tp (22-23J (24-251 126-271 (28-29/ (30'31/ NOTE: Reed instruedens before comp oeng l Weis foepi.
PARAMETER 13 Cent On41 QUANTITY OR LOADING I4 Cent on&J QUANTITY OR CONCENTRAN wo, mEcuencV i SAMPLE (46-53) 154-611 (30-45) 146-531 (54-679 OF EX
! (32-37; aNm, TYPE %
AVERAGE MAXIMUM UNITS MtNIMUM AVERAGE MAXIMUM UNITS c.em gg,.gf gg ,.ya, 1 SAMPLE r
a' 1i ts ~ ) % q r y %
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MEASUREMENT O, CO A. Os O /le- m 3) catoes ? > c :: c e 6 : c o ^. ;
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. 3 -. 3 " t ? T 5i SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT
~ PERMIT ; '
REQUIREMENT SAMPLE MEASUREMENT PERMIT ^
REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PNAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND " TELEPHONE DATE AM FAMsUAR WITM THE INFORMATION SUmemTTED MEREIN AND BASED 04 g
,9, f' MY INOuPRY OF THOSE INDIVIDUALS IMMEDIATRY RESPONSIBLE FOR '
- j l.
i OSTAiNING THE INFORMATION. I SELIEVE THE sueulTTED INFORMATION IS Y#
David o.rndorf TRuE. ACCURATE AND ccMetETE. I AM AWARE TWAT TnERE ARE SIGNIFICANT PENALTIES FOR SUBMtTTING FALSE INFORMATION, INCLUDIsfG
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41 a*- 393=9113 97 Ot1 "97
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Cheniatry Manager TsE FOsSiesuTY OF FINE AND iMeniSONMENT. sEE is u.S.c. s tooi AND ss S408sATURE OF PRINCFNL EXECUTWE TYPED OR PRINTED U.S.c.
sad e isis. amisseee er menennen: .- aanw
.: ewap seenmee awr.bienase swe se se sto. coo AREA NUMBER er serwasa a meree ier s yeero OFFICER OR AUTHORIZED AGENT CODE jYEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# ettschments here/
e EPA Form 3320-1108-96) Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
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Paperwork Reduction Act Noticci ' :
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,.i Pubk regerting Imrda for this collution of informMion is estimated to vary from a range of 10 hours1.157407e-4 days <br />0.00278 hours <br />1.653439e-5 weeks <br />3.805e-6 months <br /> as an ,
s scrage pes respoese f..r reme minue facdities, to 110 hours0.00127 days <br />0.0306 hours <br />1.818783e-4 weeks <br />4.1855e-5 months <br /> as an average per response for sor6e major facilities, ,
M. { yth 2 sul;hted averns h r major :md minor facilities of 18 hours2.083333e-4 days <br />0.005 hours <br />2.97619e-5 weeks <br />6.849e-6 months <br /> per response, including ~ time for reviewing -I
. iingructions, tearchinp eri:tmg data' sources, gathering and maintaining the data needed, and completing and ,
i '
l' raiewing ths col!cctiun cf infornatien_ Send comments regarding the burden cstimate or any other aspect of (t% c'llection e of informat en, including suggestions for reducing this burden, to Chief, Information Policy i I
l'
' B&nch, PM-223, 0.5. Fmironmental Protection Agency,401 M Street, SW Washiagton, DC;2M60; and to the J Office ofInformation ed Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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' General Instructions
~
l I'l. fit form has been putially completed by preprinting, disregard instructions directed at entry of that information
{already preprinted. -
]
2? Enter " Permittee NamaA! ailing Address (and facility namc/ location, if different),*
- Permit Number " and l 1" Discharge Number" M ere indicated (A separate fonn is required for cach discharge.) <
-l I
- d. Enter dates begimdng and ending PAlcmitoeing Period
- cm ered by form where indicated. ;
- 4. Enter cach "Paramirr" as specified in monitoring requirements of permit.
l 5.- Ents "Nample Atwrcment' data for each parametcr under "Guannty" and "Guality" in units spebied in permit.
" 1wrnge* is nennW arithmetic as crage (geometric average for bacterial parameters) of a!! samp!c measurements
. l
- fer each paramcta obtained during "A/omformg Permdi "Alarimum" and "Alinimum" are normally extreme high and low measuraxnts obtamed daring "Attmitoring Period." (Note to municipals with secondary treatment.
requirement: Enw % day average of sampic measurements under "Accrage," and enter maximum 7. day average - ,
of sampic measurcants obtained during monitoring period under "Afarimum.") . l 4 6. Enter "Permet Re.prement" foi cach parameter under "Guantity" and "Guality" as specified in permit. . ,
l 7.c Under "No &" emcr rumber of sampic measurments during monitoring period that exceed maximum (and/or l minimum or 7-da e.crage as ap- spriate) permit requirement for cach parameicr. If none, enter ?u". l
)
- 8. Enter "Frequena rf Aralysis" both as " Sam;de A/easurment" (actual frequency of sampling and analysis used i 1dming mordtoring period) and as " Permit Requirement" specified in permit. (e.g., Enter " Cont " for continuous i monitoring, "1/7" int one day per n eck. "/60" for one day per month, "l/90" for one day per quarter, etc.)
- 9. Euler "Sanp/c /)p" both as " Sample A/cosurement" (actual sample type used during monitoring period) and as
, . " Permit Requirewnt," (e g., Enter "Grah" for individual sample, "2IHC" 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 siolation by date. i i1. If 'no discharge" occurs during monitoring period. enter "No Discharge" across fann in place of data entry.
- 12. Enter.."Name/7itle of Principal Erecutive Oficer* witil " Signature ofPrincipal Executive Oficer ofAuthorired Agent," " Telephone Number," and *Date" at bottom of fann.
~
I
- 33. Mad signed Report to Office (s) by date(s) specified m pernut. Retain copy for your records. .
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J14. More detailed instructions for use of this Discharge Afonitoring Report (DAIR) fann may be obtained from Office (s) specified in pennit.
, Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Faihtre to report or failure to report truthfully can result;in civil penalties not to exceed $10,000 per day of viohtion; 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.
4 -
p y EPA Form 3320-1 (Rev. 08-95) 1P' 8
I l PERETTEE NAME/ ADDRESS (F=nhdrFarshyNeue'ImesNeseffNIhrow) NATIONAL POLLUTANT OtSCHARGE EUMfNATIOed SY"YEM (NPDES / Form Approved.
NAME DISCHARGE MONITORING REPORT (DMR/
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if A L L '~. ? c G W R ii : i A
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ADC.AESS p , 3, j)x g 'S ? *
( 3 '10 , ?5) N
- 17 i '? ; a 4 7 I !) O F "! ') ) ". i . PERMIT NUMBER DISCHARGE NUMBER ,. ,,
p{qg
, ,i o T w ;} ) y 7 , 3 1*T7' MMRM PEROD # 3 0 "
, ' *. is e s yALL7i T 3Wp4 *r?"!, YEAR MO OAY YEAR MO DAY
- e LOCAT m FROM
, 1 > 1 TO :+ 3t ?e- t a p qc:1nnr l
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- w . 3? . *A 3 . rnn (20u21) (22-231 (24-251 126-271 (28-29) 13D-319 NOTE: Reed inetructione before c6mpleting thie fomn.
(3 Cerd on#y/ QUANTITY OR t.OADING I4 Cerd OWrf QUANTITY OR CMCENTRATIM PARAMETER 148-531 (54-619 NO. FREcufMCY' SAMPLE 1384 61 146-53) (54-619 OF (32-371 EX ANALyss TYPE %
l AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS *2-83) 164-sai i
tes 7a
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,37.,. REQUIREMENT , _s ,yp7, ., q 77yq, ,,j SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I MAVE PERSONALLY EXAMINED AND i TELEPHONE DATE AM FAMtUAR WITH THE INFORMATION SUSMITTED MEREIN; AND BASED ON e MY INQUIRY OF THOSE INOtvlDUALS 1MMEDIATELY RESPONSi8tE FOR OSTAINING THE INFORMATION, f GEUEVE THE SUBMITTED INFORMATION IS 4,
['
, /4 DOvid Orndorf muf, e CURATE AND COM M I AM AWARE NAT NERE ARE SIGNIFIC#NT PENALTIES FOR SUBMtTTING FALSE INFORMATION, INCLUDING k' ,, 6];,h1 h f 0388h3 ih[
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THE POSSIBlUTY u.s.C. s 131e. m OF e,MFINE r ee.AND IMPRIS.ONMENT. een,es may w m , e SEE 18 U.S.C s70,000 91001 SNATURE AND OF33PRNGCIPAL EXECUTIVE TYPED OR PRINTED W ormartmeC - : et eerween 5 memns w s yearms OmCER OR AUTHORIZED AGENT m NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATIOrs OF ANY VIOLATIONS (Reference s# ettechments here/
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EPA Form 3320-1 (08-951 Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
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', 'Public reporting burden for this collection of information is estimated to vary from a sange off l0 houg as an :
' average per response for some minor facilities. to !10 hours as an average per response for sonenojor facilities, !
i 3 with a weighted average for major. and minor facilities of JS hours per response. includicg tir6for reviewing ,
. instructions, searching existing data sources, gathering and maintaining the data necdad, and completing and i reviewing 'the collection of information. . Send comments regarding the burden estimate er rny.uthen aspe(t of !
(thir, collection of information, including suggestions for reducing this burden, to_ Chief, Infonnation Policy
;B' ranch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Wehingtoa, DC 7G4f20; and to the
- Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. ,
. _ _ . _ . - _ e I *
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General Instructions . i
- 1. lf form has been partially completed by preprinting, disregard instructions directed at er ry'of triat ihformation already preprinted.
- 2. Enter " Permittee NametMailing Address (and facility namellocation, if ditTerent)," " Permit Number ", and '
' Discharge Number" where indicated. (A separate form is required for each discharge.) ,
- 3. Enter dates beginning and ending "Momformg Peread" covered by form where indicated. !
4 Enter each " Parameter" as specified in monitoring requirements of permit.
- 5. Ente'r " Sample Measurement" data for each pararneter under "Guantity* and *Guahty" in uningpecified in permit.i "Arcrage" is normally arithmetic average (geometric average for bacterial parameters) of all ramph maamrements ;
for each parameter obtained during " Monitoring Period"; " Maximum" and "Mmimum" are normally extreme high and low measurements obtained during "Manitoring Period * (Note to municipah with secoadary treattnent } requirement: Enter 30-day average of sample measurements under " Average," and enter maximwn 7-day average ; of sample measurements obtained during monitoring period under "Narimum.") j i i 6. Enter " Permit!(equirement" for each parameter under "Guantity" and *Gaality" as specified in permit , i
- 7. Under "No &" enter number of sample measurments during momtorirg period thm exceed muimum (and/or j
- minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0"'
- 8. Enter' _" Frequency of Analysis" both as " Sample Measurment" (actual frequency of sampling and analysis used i during monitoring pcriod) and as " Permit Requirement" specified in pernut. (e.g,, Enter " Cont," for continuous !
monitoring, "u7" for one day per week, "160" for one day per month, "l/90" for one day per quarter, etc.)
- 9. Enter " Sample 7)pe" both as " Sample Measurement" (aced sample type used during monitoring period) and as z
" 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 cach violation by date. i
- 11. It'"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
12' Enter "Namerfille of Principal Executwe ODicer" with
- Signature of Prmcipal Executive OBicer of Authori:ed Agent," " Telephone Number," and "Date" at bottom of form.
I
- 13. Mail sig'ned Report to Office (s) by date(s) specified in permit. Retain copy for your records. j i
,14, More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Office (r) l specified in permit. .
~ '
~-
cegal Notice l
~t This report is reeguired by law (33 U.S.C.13u; 40 C.F.R.125.27). Failure to report or failure to report truthfully can ,
result in civil penshies not to execed $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. t EPA Form 3320-1 (Rev. 08-95) e [
r PEnterTTEE NA8dE/ ADORES S #admidoree Namsbremen grDeprows tsATKNeat pottutaseT orScManor suasseatices SYSTEhe (RPDFS) FOem Appegwed. , [ psAnEE DISCHARGE MONITOR 30G IEPORT N1 ! . 1F4VCE'7)LLET P0 d 9 UATIJ1 (?- 19 ff7-tsi 19K.I's?AkT S OPU R Oh6 80s-paa Mad ADOREES p . J . _ 3 ) g 1 "4G<'C '*r ($'J9R 05) rrs; navI? aireoyr PERMIT NUMBER orScHanet etuasoEn p , gg - l 3 P 1 N [ r; "; r 3 a f 3 ft 15 0 M MOfMTORUGG PERIOD ~5EO# M F !! 7 C 7 7iLL$f PQWP9 3 A TDF YEAR MO DAY YEAR i MO DAY ., ., e
- LOCATION
- FROM -; t 17
- : t TO ;s ; t/ sI cu 10 c t S c ;t g M r. r..
NOTE R*** IR*'N***** &) ~ l Mt*'I' f*'F-i t n -+ u . nstry i nayn v * ' 1202ri 422 23) 424-25) t20-211 126-291 130u291 ' 2 PARAMETER f3 M W ONW M L MNN # M NO. Na sAppLE 146-5M 154-691 t30-451 146-65 154-619 or (32-37j EX ,,,gy,,, TYPE % AVERAGE MAXIMUM UMTS MINIMUM AVERAGE MAXIMUM ~ UNITS sruse ,, , ,gg yg, La>, I i. - N y I r %
. N UI ?fiEAT E NT Plast SAMPLE MEASUREMENT PERMIT O, CO A bob y3) oeee3 egene ee3% .
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SAMPLE i' MEASUREMENT PER;AIT , i REQUIREMENT _ l SAMPLE ' MEASUREMENT PERMIT , REQUIREMENT s SAMPLE MEASUREMENT
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4 PERMIT . ; REQUIREMENT ! SAMPLE l MEASUREMENT i PERMIT REQUIREMENT .i 6 PNAR. EXECUTR/E m e centiFv unoen passatTv or taw THAT e Havr enveSossatty exmaasseen asso Aas FanseUAn visTM THE IIeFOsasATIOst SugestTTED MEftEsse: Afeo BASEo 000
/ TELEP N DATE I Rev teeOUHty OF THOSE IIsorViouAtt InsanEDIATEtv nESPOpfSISLE FOn
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' David Orndorf OWTAftessee THE sePolupATIOpe, I BEufvE THE SUBamTTED pleFonhAAT100s et ' l/ YM I Taue. accunate ano comenteTs. I ans amane Tuav THEne ane SpoletFICApeT PEgeALTIES Fon SutamTTueG FALSE popofesaTIOce. NectuomeG _ % 2W J.J# f A 4p* 393-5113 97 011 27 : Chemintry Manager Twe possestrty or rNec
.Ue S.c. seOseATURE ano s OF PRNOCIPAL E18ECUTIVE er - e iste. nnema.asso marveSomanenT.
www misse sesene m. aireman rme es,ee is u.s.c. i,soci se sto.seo 3 ,,, TYPED OR PRWTED _ _ _ eramenen a menem min s peeral OFFICER OR AUD00RREED AGE 85T CODE NUGABER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a6 errechmener heref EPA Form 3320-1 108-96) Previous ed6tione may be used. IREPLACES EPA FORM T-40 WNBCN MAY NOT SE USED l PAGE OF ! 3M' 4 5/ MI C13-% 33 1 [
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Paperwork Reduction Act Notice: m .- - _ , - {"
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}, , iPybik reponing burdm fa this cot!ection of informadon is ' estimated to vary from a range of I0 hours as an i i shrage pr retponse fx kme minor facilitics, to l10 hours as an average per response for son'io major, facilities, . 4 , Qvith itwij hted g averappt major and.ndoor facilitids of 18 hours per response,' including 1lme for reviewing -
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; t instmctinus, marchinr exi: ting data sources, gathering and maintaining the data needed. and' completing and f 4 *
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. seviewing the culfecti.m of infon:stion. Send comments regarding the burden estinute or aliy other, aspect of :
j this sitection of infanint;on, 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' =i
- . i Office of thformation zd Regulatorp Affais, Omee of Management and Budget, Washington, DC 20503, '
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l t General Instructions "
$J1f form has been prtially completed by preprinting, disregard instructions directed at entry o'f that informa
! M! ready preprinted. - - j
- . .? *Enter *Perunttee Mmeafading Address (and facility namcilocation, if ditTcrent),"
- Permit Number: and.
t . Dischrge Numbre" where indicawd. (A sepamte form is required for cach discharge.) A Enter dates begim;ing and ending %mformg Period" covered by form where indicated. ,
- 4. Enter each "Pararmu" as specified in monitoring requirements of permit.
- 5. Enter "Sanp/c Mm wrmnr' data fer each parameter under "(Juantity" and "Guahty" in units spccified in pennit.
%erage' is ncrm@ arithmetic average tgeometric average for bacterial parameters) of all samp!c measurements fer exh paramet a obtamed during "Momfaring Periv1'; "Mamnum" and " Minimum" are normally extreme high
~
s nod low meawramts obtained during " Monitoring Period" (Note to municipals with sendary treatment requitement: Entr '0-day ave: age of samp!c me.asurements under " Average? and enter maximum % day average 6
^ of sampi measusenants obtained during moidoring period under "Manmmn.")
4
- 16. Enter " Permit Reymrement" for cach parameter urider " Quantity" and "Guahty" as specified in permits i i
- 7. sunder "No n" ever number ol' sample measunucols during monitoring period that exceed maximum (andor minimum or 7-da3 merage as appropriate) pennit requirement for cach parameter. If none, enteri"0". -
- 8. Enter "Frcquency of Analysir both as "S.unple E amnnent" (actual frequency of sampling and analysis used - I tring morutoring paiad) and as " Permit Requirement" specified in permit. (e g., Enter " Cont," for continuous 1 nionitoring. "//P tot one day per ucek. "180" for onc day per month, "l/90" for one day per quarter, etc.)
i' 9. Enter "Samp/c hee" both as "Sompte Measurement" (actual sample type used during monitoring period) and as "Permet Mequiremmt " (e.g., Enter " Grab" for individual sample, "RRC" for 24-hout composite, "N/A" for continuous monitenng, etc.)
~10f Where Tiolations of pennit requirements are reported, attach a brief explanation to describe cause and corective ,
actions taken, and reference each violation by date. I!. If"no discharge" occurs during monitonng penod, ente; "No Discharge" across form in place of data entry.
, 12. Butcr' 'Namenitle of Prmapal Decutive Officer" with " Signature of Principal Secutive Oficer ofAuthorized Agent " " Telephone Number," and "Datc* at bottom of form.
;13. Mpl signed Report to Omce(s) by date(s) specified m penmt. Retain copy for your records "14. More detailed instructions for use of this Discharge Monitoring Report (DMR) form may be obtained from Omce(s)
; specified in permit.
- k. Legal Notice This leport is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can
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resul.t in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of Violation, or by imprisonment for not more than one year, or by both. t,
, EPA Form 3320-1 (Rew 08-95)
- 4
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PERETTEE NAME/ADORESS(7=MrFarebyNeevleestw(D@way NATIONAL POLLUTANT OtSCHARGE Et fMtNADON SYSTEM (NPDES / Form Approved. NAME DISCHARGE MONITORING REPORT (OMR/
"av - 7ALLE* F9'r N ,
74"I1i (2-7 61 (7 7-ist 4"g, [ c T A_ 4 [ '; y c ? R OMB No 20404004 App og O MM ADDRC3_,,3 , ,
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(7;y a y 3 $ i, g PERMtT NUMBER DrSCMmot NuMsER v , ,p 7 y 3 g t"'e* .? ! 7 T 9 7 > $ D 0 ". T
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"? 7ie 7 ', L L '. f 739i'- 3 T1T i i YEAR MO DAY YEAR MO DAY _
LOCATION FROM -
? ' TO : s t *
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3 - , , . e 3 .. . n 3 - e (2G271 (22-23/ (2*257 r26-211 (28-291 (3&3f/ NOTE: Reed instructione leefore completing this fo,m. r PARAMETER (3 Cerd Orefri QUANTITY OR LOADING (4 Cerd Oa/rf QUANTITY OR CONCENTRATION N O. FREQUENCY' gg. (46-531 (5
- 6 11 M4SI ~46-531 (5
- 6 91 OF (32-37s EX AnAtys,s TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ms, fgggg, ,gg.m SAMPLE ., ~ u - e r . .~ m ~ e s mg,, { t3g MEASUREMENT
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PERMIT oeer Sn :- e cc e g ; e .
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MEASUREMENT
, s . ; ) PERMIT .ectie Sn^*+c e < c e *: $ o c 7,' 7,5 g !; a, t y agg
., . , ,. .- p,,,3 REQUIREMENT .y& g y 3 y g r; . g;gynq, ,;fg SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERM 3T REQUIREMENT NAME/TTTLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT WAVE PEMSONMLY EX AMWED AND r TELEPHONE DATE AM FAMtUAR WITH THE INFORMATION SUBMITTED MEREN: AND SASED ON /
MY INQUIRY OF THOSE tNDMOUALS FMMEDIATELY RESPONSP81.E FOR . J
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}'/[n'4 087AmmG THE INFORMATION. I BEUEVE Thf SUBMITTED INFORMATION ts ! . J TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE #7, ' A
,ditV i u. ( ' m 4 I O T a, 3:GNdFICANT PENALTIES F08% SUBMITT!NG FALSE INFORMATION. INCLUDING
, , THE POSSI8tuTY OF FW v.s.C. s 13te. p>ien E.ANO IMPRISONMENT. SEEsicaan IS U,.S.C. 9100,1 AND 33 0I) 39 M i13 47 O1 27 SENATURE OF PRNGCIPAL EXECLfmfE TYPED OR PRWTED and er aumromsa : - anMar ewee seen,Me
- er 6er-. e maaene awr.aw srus y nae se a sto,opo AREA NUMBER OFTICER OR AUTHORIZED A00NT CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# artschmentS here/ g g4ggy r
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3 . , ;v ,r EPA Form 3320-1 (08-95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE
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Paperwork Reduction Act Notice ._ f 5 3 I1 p e i Public teresting burden for this collectiori of information is estimatal to vary from a range of 10 hErs as ah l 4 ! l ; average per response for some rmnor facilities, to 110 hours as an average per response fdr some major facilities,
,with a weighted average for major and minor facilities of 18 hours per responso incloshog tirat fnr reviewing j' ,
l J l , l '
. instructions, searching existing datamources, gathering and ' maintaining the data needal, and completing and
! } reviewing ,the collection of information. Send. comments regardmg the bunien estimate or any other aspect of j ' lthis. collection of information, including suggestions for reducing this burden, to Chief, Infoncation Policy
; Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 70E0; and to the i p ' Office ofInformation and Regulatory Affairs, Office of Management and Budget, Washington,'DC 20503.
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. General Instructions' i fl[. If form has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted.
i t. - Eutet "Permitter NameMailing Address (and facility namellocation. if difTerent)" "Pmnit Number," and ~ { s ? Discharge Number" where indicated. (A separate form is required for each discharge.) f $. Enter dates beginning and ending "Alonitoring Permd" covered by form where indicriedi ,
- 4. Enter cach " Parameter" as specified in monitoring requirements of permit. J
. i
'5. Enter "Samp/c Afrasurement" data for cach parameter under "Guantity" and "guality" in units specined in penmt. i
." Average" is normally arithmetic average (geometric average for bacterial parameters) of aH rample measurements ,
for each parameter obtained during Afomformg Period", 'Atarimum" and "Atmimum" are normany catreme high and low mcasurements obtamed during "Afonitoring Period" (Note to municipals with seccadary ucatment j
- l. requirement: Enter 30-day average of sample measurements under " Average." and enter muimum 7-day average ;
of sample ~ measurements obtained dunng momtormg penod under "A tarimum "1 , ; I
- 6. Enter " Permit Requirement" for cach parameter under " Quantity" and "Quahty" as specified in permitj - ~
+
,7..Under."No Ex" enter number of sample measurments during monitoring period that exceed maximum (and/or j
? minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter *0".
, 8.' Enter'" Frequency of Analysis" both as " Sample Afeasurment" (actual frequency of samplir:g and smalysis used l
during monitoring pvriod) and as "Pernn! Requirement" specified in permit. (e.g., Enter
- Cont," for continuous )
monitoring. "1/7" for one day per week, !//30" for one day per month,"1/90" for one day per quarter, etc.) I
- 9. Enter " Sample 7)pe" both as " Sample Afeaturement" (actual sample type med during monitoring period) and as j
- Permit Requirement " (e.g., Enter "Grob" for individual samp!c, "2411C" for 24-hour composite, "N A" for )
;' continuous monitoring, etc.) ,
J
'10.;Where vNiations of permit requirements are reported, attach a brief explanation to descrine 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?Dtle of Principal Execunve Ofcer" with
- Signature of Principai F.ccutive Opcer of Authori:ed " .l Agent * " Telephone Number,* and 'Date" at bottom oiform. ;
- 13. Mail signed Report toLOffice(s) by date(s) specified in permit. Retain copy for your records.
i
- 14. More detailed instructions for use of this Discharge A/uniforing Report (DAfR) form may be obtained from Officc(s) !
l _ specified in pennit.
? Legal Notice !
I
, ,e uis 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 j result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day l l of' violation, or by imprisonment for not more than one year, or by both. .
J l ., < U ; ^ EPA Form 3320-1 (Rev. 08-95) 4
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PEmetfTTEE NAGEE/ ADORE 53thher *fh%esa gropw) sr.tiONAL pOLLUTmt DesCMARot ElmsmAvioN smtw (APDES) . Form Approved. NA" DISCHARGE MONfTORING REPORT (OMM/
,f ;7"' VALLET POVid 'i
- 4 t T 3 " (2- f'* If 7-f s/ 'I N I ! 1 COSLTg; mM r AooRE:S;. , 3, p E, 3 -,. --eri< +e4 -
pm .3 g APP *ff"f!= os-arse PERMIT NUMBER DISCHARGE NUMBER *
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.; J I ^ ? [ T'lI 9 % 7 7A I5? #'10N MOPflTORWG PERIOD FAC W ;;A 72 7 Y2.LLTI I' P2 0 2 iTi7I3:
s YEAR MO DAY YEAR MO DAY - *
- LOCATION FROM 4o i > >1 TO tr o 1 it ? DT"rHAFGE [ { Me 3* ,. rtyes ,ayn,rp (202r> (22-23/ (24-25J #26-271 (28-291 (30'37/ NOTE: Reed bistructions hofere"c'ompleting this foupe.
PARAMETER ts cent on&# QUANTITY OR LOADING (4 conf Onys QUANTITY OR CONCENTRATION NO. mEom I46-53) 154-619 (3e-451 146-531 f54-6 tl OF SAMPLE (32-371 EX a =ysi, TYPEg AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS arus, fe,_ses ras 7ar
- SAMPLE w ar<-^^. .m g. e. a e-
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3,~,.+~>. , , ( }3 g 1 ,qqq 5 7 q PERMIT negge9 n e r. r. g
- 3 . c. o ,n m 3ng 3,9 .
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MEASUREMENT 3, r*- I 7, c) N.,,$ 3# erri.$> 3:,33 ; , q PERMIT c a e+ e u a.teege $ .ee ennen p ;p 3 ;7pgy, gg
-e<,- REQUIREMENT y g 9 79 eet :, ; y e yL.,, ,3, 3 g .j ,y ,,7 g
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,ySgq 1. 3 g PERMIT - 9 p o c e r, e weg 3 g 9- g y ;, y r; g, y g g f p g gg ^
p,,., ,,7 . 3 -. 7 3 gc REQUIREMENT g33 y.,,,. n 7 ,_ 7 7qg g g7 , g L3d, I *i "M307? Op SAMPLE i
- 33) useer p3ege mm -
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' .') PERMIT .. ag3py erpgny p $ .n p e c u c. ; mgg 3g ; p
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SAMPLE MEASUREMENT
' PERMIT -
REQUIREMENT I SAMPLE MEASUREMENT PERMIT ( REQUIREMENT ' SAMPLE MEASUREMENT PERMIT REQUIREMENT . NAME/ TITLE PNAI. EXECUTIVE ON l i CERTiry uNoER PENALTv OF law THAT e wave PERsONALLv EXAMINED AND TELEPHONE DATE AM FAMlUAM WITH THE 19tFORMAftON SUBMITTED HEstEm: AND BASED ON MY INOUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON99LE FOR [I .J 3 CSTAINWG TME mFORMATIOes. I SEUEVE THE SUBMITTED INFORMATION IS /j ----./, David OrndOr[ TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE .
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O# ~ A SIGNIFICANT PENALTIES FOR SUBMITTING FALSE MFORMATION. iNCLUDfttG Chrniatrv Mananer - THE POSSIStuTv OF FmE AND msPRISONMENT. SEE 10 U.S C. 51001 AND 33 412 3,93-5113 97 01 2 e, SIONATURE OF PRIIWCIPAL kXECUTfvE m TYPED OR PRINTED U.s.C. sauf e late. :#.- Pea mse er emeremsw easer
.: er wwse see-s.* sesewee s moee Nr a peerasmer.hiesuene n=es se seOFFICER s r0.000OR AUTHORIZEo AGENT CODE NUhWER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference et effechments herof 3 EPA Form 3320-1 (06-96) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE OF 3 9 , q
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- 1 Paperwo,rk Reduction Act Notice <
iPubhc rep'ening burden fr r this col lectinn of information is estimated to vary from a range tif 10 hours as an y ,
;j 9
! ayrrage per response f 4r some minor'facdities, to )10 hours as an average per response for some major facilities, -
M. Nith a weighted 3Yeugc'kr nujor and ndDor facilitierof.18 hours ph responsc[ including t!me' for reviewing ' ' 4
. Unstnictionp, fearching ethring data sodrces, gathering and ' maintaining the data needed, andl completing and ' !
I ' hdiewing the colleeth n of information. Send comnents reptding the burden estimate or.any other; aspect of- . F lthis colicction of infomation, including suggestions for reducing this burden, to Chief, Info,rmationj Policy l J I Branch, PM-223, U.S. Ensironmental Protectiun Agency,401 M Street, SW Washington, DC 20460; and to the
; l Office of Infdtmation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. ;
.dm A ._W.~.__. _ - . . _ _ - - . ._
1
! General Instructions !
i 11.;If funn has been patia!!y completed by preprinting, disregard instmctions directed at entry of that infonnation l Lalready preprinted. - < i
- 2. Enter " Permittee NamcWaihrg Address (and facility name/ location, if different)," "PermitJNumber" and
' 5" Discharge Numivr" where indicated (A separate fann is required for each discharge.) - t, l
' 3. Enter dates beginning ard ending "Alonnonng Period" covered by fr .rc indicated. j
.4 center each "Paramevr" as specified in monitoring requirements of permit. a l
- 5. Enter "Somp/c A(;mn ment' data fcr coch parameter under " Quantity" and "Quahty" in units specified in permit. ,
l "Awrage" is non v4 arithmetic average (geometric average for bacterial parameters) of all sample measurements , l for each paramekr obtained dming "Alonitoring Penod"; "Afarimum" and "Afinimum" are normally extreme high :
- and law measurcment:; obtamed during "Alonitoring Period" '(Note to municipals with secondary treatment !
requirement: Emcr 30 day astrage cf sample measurements under " Average," and enter umimum 7-day avenge - !
, of sample measurcuents obtained during monitoring period under "Afarimum.") -
I s c 6.; Enter "Permir Reporement" for each parameter under "Guantity" and " Quality" as specified in permit. l i i
-7.. Under ?Nd Ex" cmer rumber of sample measurments during monitoring period that execed maximum (and/or
; miniomm or 7 day average as appropriate) permit requirement for each parameter, if none, enter?O"; , j
_ S. Enter '"/6 equenct qf Analysiv" both as " Sample A/easurment" (actual frequency of sampling and analysis used ' ! daring monitoring rcriod) and as "Pernnt Requirement" specified in permit. (e g.. Enter " Cont," for continuous . s a monitoring, "/6" im one day per u cci, "ldD" for one day per month, "#90" for one day per quarter, etc.)
~
9.S Enter " Sample 1)pe" both as " Sam;>le Aleamrement" (actual sample type used during monitoring period) and as
" Permit Requirement.* -(c g..' Enter " Grab"' for individual sample, *2,fHC" for 24-hour composite, "N/A" for
- continuaus monitoring. etc.)
- 10. f.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" ocems during monitonng period, enter "No Discharge" across form in place of data entry.
'12. Enter *Namn'ntle of Pnncipal Erecutive' Officer" with " Signature of Principal Executive OficerNJAuthori:ed Agent,' " Telephone Number," and *Date" at bottom of form.
j3. l Mail signed Report to Of' ice (s) by date(s) specified in permit. Retain copy for your records. .
.14. More detailed instmctions for use of this Discharge Afonitoring Report (DAIR) form may be obtained from Office (s)
- 9. specified in pcmdt. -
Legal Notice
]
His reput 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 l= result in civil penalties not to exceed $10,000 per day of violation; or in enminal penalties not to exce<xl $25,000 per day 1 of viclation, or by imprisonment for not more than one year, or by both. l s ;
'E l
1 e f ; EPA Form 3320-1 (Rev 08-95) Qm -
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f PERM:TTEE NAME! ADDRESS (IMFererpNeee/LerememifD@we) NATIONAL POLLUTANT DISCMARGE ftm4MATION SYSTEM [ NPDES) Form Approved. NAME DISCHARGE MONITORING REPORT (OMR/
- E1V7a V)LLEY p 3 .' F 3 if',*IJ: (2- m (r 7-f 91 'J N I T ? C37 LINO %R OMB No. 2040 0004
,res 05-31-98
.*~,e .r ADDRESS ~ ,3 , t3y >; % %, n .
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, Approvelg ge . .
7m; 74y13 nhsy1p PERMIT NUMBEa c ScHARot NuMeER p _. p 7 ., 3 I#
-' sit 7ye3p p ; 'i 1"$77 MONITORING PERIOD M%3Y 9eiV ' 1 A i. I. !. T 'e ? U 7T5T!l YEAR MO DAY YEAR MO DAY .
LOCATION FROM >L ; > st TO aA 1? !; e *- c s3 J I S C 58 A F G " [- [ C C:7
.,.4, m, yv3 3 , e r. .? (20 27/ (22-231 (24-25/ (26-27/ (28-29/ (3D-3FJ NOTE: Reed instructione before completing this (71Fm.
PARAMETER (3 Cerd OaM OUANTITY OR LOADM (46-531 I4 Cong QUANTITY OR CONCENTRATION NO. mEM SAMPLE (S 4-6 19 (36-459 446-63) (S 4-6 91 OF m (32-37; EX ANALyss TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS n243, gg m f,g ya, 4 SAMPLE & s. e ~ n + 3 r. e, y s - 4eyap ( 17g g MEASUREMENT 7 7 fy 7gg Q J Qg 3qq, ; .
, PERMIT - nece** -nee 39 e st ,h cemec. 9,3 ggggy g g t3
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. rety :. 3, .4 MTfTMUP MkIf*W T' SAMPLE 3+a^^ co;ces
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y,, , REQUIREMENT s xn 3 f 3, yyg r.y qy 3r gg t SAMPLE
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REQUIREMENT .n y .. 33y7, ,, 7 3-n 3%9 SAMPLE :a~~ y, . -,, v. n c y , e e 'd e - ( 19) 3 ; f *t ,, 4 .s.
.u MEASUPEMENT /
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. o. SAMPLE nc' : q'^Stc 5&.9005 ( 19) f f7IL. r, MEASUREMENT
&v ao O 7 ;n,6 3 1 1 PERMIT . ' n *: '- c 0 0 ' e 3 0: e- '-? necMu :
.? ? s '- rDALY . nap e e - , - - , g,, REQUIREMENT .. , yp,azy g,7gyg, = ;;f t SAMPLE MEASUREMENT PERMIT s REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED ANO .
TELEPHONE DATE AM FAMIUAR WITH THE MFORMATION SUSMITTED MEREIN: AND BASED ON C-
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t MY INQUIMY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR / ,, OsTAmmo THE mFORMATica i eEUEVE THE SUBMITTED mFORMATION IS y Dastd OrndotL t TRUE. ACCURATE AND COMPLETE. soNmcANT PENALtlES FOR SUBMITTmG FALSE INFORMATION. mCLUDING t AM AWAPE THAT THERE ARE ,f -' ' j 4'
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THE POSSSIUTY OF FINE AND IMPRISONMENT. SCE 18 U.S.C. 91001 AND 33 u.S.c. e 13te. e names sewer swee se,anse n=F hetare snes se se #70,000 I '+ bu M M 113 Y7 V1 ~7 SiONATURE OF PRINCIPAL EXEC'UTIVE TYPED OR PRINTED *w er anwh=== n - : et terween a menen ans s Fe= ras AREA OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# ettschments here/
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EPA Form 3320-1 (08-951 Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE 33, qfy g']*973d p OF
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/ : 1 "J Paperwork Reduction Act Notice - J"s"
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Puhhc reporting burden fo' r this collection of information is estimated to vary from a targe of 10 hwes a d - j % ! average per res.ponse for some minor facilities, to 110 isours as an average per response fJr sotm nujor facilities with a weighta! average for major and minor' facilities of 18 hours per response,jacludbig tilne for; reviewing [ in.structionp, scarching existing ' data sources gathering and maintaining the data needed, and completing and o
' reviewing the collection of information.. Send comments regarding the burden estimate or say other aspect of . 'this collection of information, including suggestions for mlucing this burden, to Cl.ief .formationiPolicy ,
l lBrimch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, Ih.: Ml50; and to the l
; Office of Info'rnation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503/
_4 _' _7 i
- General Instructions
'.l. If. form has been partially completed by prepnnting, disregard instructions" directed at entry of that ,infornution already preprinted. .
F i2. Enter
" Permittee Nat.:e/A/ ailing Address (and facility name/ location, if dilTerent)." " Permit Number " and ,
; Discharge Number" where indicated. (A separate form is required for each discharge.)
l
- 3. Enter dates beginnirg and ending "Afonitoring Period" covered by form w here indicat :d.
hi 4. Enter each ' Parameter" as specified in monitoring requirements of permit. ! ^' l '5. Ent'er " Sample Alcasurement" data for each parameter under " Quantity" and "Guality" in unfir, exific6 in pennit.
"Averef c" is normally arithmetic average (geometric average for bacterial parameters) of all sample measuremems I for cach parameter obtamed during "Alonitoring Period"; "Afarimum" and "A/inimum" are normally extreme high l
.and low measurements obtained during "Alomtoring Period" (Note to municipals with secoadary treatment j mquirement: Enter 30-day ascrage of sampic measuren,ents under " Average." and enter maximum 7-da average i of sample measurements obtained during monitoring peria imdct "Alaximum ")
6.1 Enter " Permit Requirement" for cach parameter under " Quantity" and "Guality" as spectfied in permit!
~
l l 7.;Un' der "No 6" enter mimber of sample measurments during monitonng period that exceed maximum (and/or . l
> minimum or 7-day average as appropriate) permit requirement for cach parameter, if none, enter *0*. j
.8. Enter " Frequency of Analysis" both as " Sample Afeasurmert" (actual frequency of sampimg and analysis used l during~ monitoring pdod) and as " Permit Requirement" specified in permit. (e g., Enter " Cont " for continuous '
monitoring, "l/7" for one day per week, "Ido" for one day per month, "l/90" for one day per qua ter, etc.) l
. 9. Enter " Sample I)'re" both as " Sample Afeasurement" (actual sample type used duriig monitodng period) and as J
,
- Permit Requirement," (e.g., Enter " Grab" for individual sample, "N//C" for 29 hour comy> site, "N/A" for continuous monitonng, 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. l 1
- 12. Enter "Name/ Title of Principal Executive Officer" uith
- Signature ofPrincipal hecutive Ojlicer of Authori:ed l Agent " " Telephone Number," and *Date* at bottom of form. }
i
- 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 Descharge Afom/oring Report (DAfR) fonn may be obtained from Office (r) l specified in pennit. i Legal Notice
~
1 This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can j result in civil penalties not to exceed $10,000 per day of violation; or in crim'.nal penalties not to exced $25,000 per day
~
ofl violation, or by imprisomnent for not more than one year, or by both. I EPA Form 3320-1 (Rev. 08-95) < i i
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PERMITTEE NAME/ADDREZS(7=ehdeFarawpN==steresse(D@mo NATIONAL POLLUTANT DtScM ARGE EU441NATf0N sm (APDES/ Form Approved.
*EY VILL?? P3453 ' * *, ' I ' T -
t7 SIE3EL G i, N G *GDb M Ne q AP P ADORE N ,3 , 91g 1 P**" ' c'T ' PERMIT NUMBER l
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- DacHAAGE ICUMBER
("?SF ~} $ ) A * ? ': ; ) % 7 [ i' D H % C 'J 9 t ,, y{ggg 39iP?I".V 3RI' ' ' . 1 'l ~ 7 7 MONITORING PERIOD C' M I#
- < P itY C i 71LLEY P% F" 7 T & E ) ? YEAR MO DAY YEAR MO DAY .
LOCA N FROM ;7 56 TO 96 1' .i t M3 yn 31":CagPO? {_{ $?h -
- ,
- s. . ,3yyn 3. n,:e (2a27s (22-231 (24-25J (26-271 128-291 (3t>371 NOTE: Reed instructions Were compl oting thle fase.
(3 Ces Nys QUANTITY OR LOADMG (4 Cad On&A QUANTITY OR CONCENTRATION NO. mEcufNcYd SAMPLE PARAMETER 146-539 154-611 130-451 146-539 154-691 OF 132-371 EX ,,gy,,S TYPE.s AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ssse g,4,,; gg,7a,
! ,1, I9 2F')llT ,- SAMPLE ,
nq y y g n .- p 3 .) ; 3 eyne; j /
" b 4 9 TdEAT*"NT PLANT 3ns3 g ) y REQUIREMENT PERMIT ; g r -) o y n r n n r* p ccNM3 eMM? CCMM *
*** .k MELY' 3 TIM %
7 y -, y, ,m.- 7 3, y 7, , y, 3p. p, y y ,g ,-, 7O#6 SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUfREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT A NAMERITLE PRMCIPAL EXECUTWE OFFICER I CERTIFY UNDER PEN ALTY OF LAW THAT I HAVE PERSONALLY EJE AMINED AND f / TELEPHONE DATE AM FAMtUAR WITH THE INFORMATION SuBMfTTED MERON: AND BASED ON MY INQUWtv OF THOSE INOtVIDUALS IMMEDIATELY RESPONStRLE FOR
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OBTAINING THE INFORMATION, I BEUEVE THE SUBMfTTED INFORMATION IS 'f d. David Orndorf TRuf. ACCURATE AND cOMetETE. e AM AWARE THAT THERE AP.E sioNecANT PENALTIES FOR susMirriNo FALSE mFORMATioN. mctuDiNo
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412 393-5113 97 0,1 27 Uh ert i 9 : r y ManaFe1* THE POSSIS 8UTY OF RNE AND tMPRIS,ONMENT. u.S.C. t t ais. m andw awa smens awr Amens, anos a, se # 70,000SEE 18 u.S.C. 91001 AND 33 SiONATU'IE tJ PRMCrid EXE 3pg , TYPED OR PRWITED mw er ===*=,= n :.ra.r aeni.ame==say ras omcER OR A*.meAtizEOA6ENT NUMBER VEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refererece e# srtechmerres here/ EPA Form 3320-1 (OS-36) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED l PAGE OF 4 - . _. _. . _ _ _ _ _ _ . _ . ___
p ~ . ,.: i # m . ._ ".__ . . 4.____- - . _ . . _ _ _ _ - . Papenvork Reduction Act Noticer , "" ' q 3
- l. ! Puhhv ryhrting Lurda fer tds collectiori of information is estimated to vary imm a range bf 10 hours as an I cj jfuag6pr rssponse fx some minor faciliiies, to !10 hours as an average per respon.e for som6 nujor facilities,
~
l
.wird a wehhted averap Rr major and 2ninor facibties of 18 Imurs per response, including time for reviewing
; instructions, iearchiny existing data sourus, gathering and maintaining the data needed, and completing and _
?
l i reuewing thd collectian if infornmion., Send comments regarding the burden estimate or any other aspect of 4 I
;this collection of info;nution, including suggestions for reducing this burden, to Chief, Information Policy i l : Branch, PM423, U.S Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the ;
- Office of Information ud Regulatory Affairs, Office of. Management and Budget, Washington, DC 20503.
i 4._.._..~... . _.-. ._._ l
. General Instructions l I
l Ic1T form has been prtially completed by preprinting, disregard instructions directed 'at entry of thatTinformation '
<1 Talready preprinted. .- <
2.JEnter' "Pennittee Nume.0/ ailing Addrexx (and facility name/ location, if different)," " Permit l Number," and i
'"Dircharge Nundu r' w here indicated. (A separate form is required for cach discharge.) ,
l e
- 3. Ent'cr dates begim ing and ending "Alonitorms Period" covered by form where indicated.
- 4. Enter each "Paran rter"as specified in monitoring requirements of permit.
o l
~ 5. Enkt "Samp!c Afwurement' data for each parameter under *Guantity" and "Guahty" in units specified in permit., . t "dwrap* is narrmily arithmetic average (geometric average for bacterial parameters) of all sampic measurements D'
' for caen paranv:ta obtamed dming "\/onitoring Permd", "Afarimum" and "Alinimum" are normally extreme high and low measurm:nts obtained during "Afamforing Period" (Note to municipals with -acondary treatment ,
, requacment: Entr 10-day average of sample measurements imdct " Average," and enter manmum 7-day average .
of umple mesure uents obtained durity; monitoring period under "Alaximum. ") l
. 6J Enter " Permit Repirement" for each parameter under "Guannty" and "Guahtv" as specified in permit. l
- 7. Under "No Ex". nter number of sample measurments during monitoring period that exceed maximum (and/or : I minimum or 7-de as erage as hppropnate) permit requirement for each parameter."If none, enter "fr..
~
i j 8.' Enter " Frequency 3f Analysis" both as ".Wmple Measurment" (actual frequency of sampling and analysis used daing monitotimt period) and a " Permit Requirement" specified in permit. (e.g., Enter " Cont " for continuous -
,. . monitoring, "'/7* for ope day per weck, "//30" for one day per month, "#90" for one day per quarter, etc.)
% Enter "hnp/c We* toth as " Sample Afeasurement" (actual sample type used during monitoring period) and as
" Permit hequirement," (e.g., Enter " Grab" for individual sample, "N/IC" for 24-hour composite, "N/A" for centmucus momtonng, etc.)
~10. Where violations of permit requirements are reported, attach a brief explanation to describe bause and corrective actions taken, and reference cach violation by date, 1 1
1i. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
'12, linter "Namdi'itle of Principal Executive Officer" with " Signature of Principal Executive Oficer ofAuthorlied Agent," "Teltphone Number," and "Date" at bormm of form.
- 13. Mail signed Report to Office (s) by date(s) sp. :rmit. Retain copy for your records.
,> 14. More detailed instructions for use of this Dixe, ri.toring Report (DMR) form may be obtained from Office (s) specified in permit.
Legal Notice This report is rquired 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 impriumment for not more than one year, er by both, r- < , EPA Fonn 3320-1 (Rey,08-95) e t f t
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. . - . _. ~__ _m.-,- . .- m.-- ~ ..__-m, . _ . _ m . . . - . - _ , . . .. m i PEfesTTEE NAGE/ADOfESS musteFasesFMens'f-(DM NATscesAL pottuTANT -_- Z__~ ELIMeseAMON SYST9s fMIDESJ Fonst Apgwowed. _...
mang DISC 8mRGE MONITOIWee IMPORT (DMR/ ' 9TilV&R 7 ALLEY POWEF GTriTI3M (2- M U 7-M uLD4004M i, ROM
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' D5-31-98 f ADDRE20 9 , ') , 3)g 1 "*7S'"'" ' ' ' *
(3093 T3) 1. , '
.?Tr'.; DaffD 3R E DO N MMT NUMM N NN -y .,gygg(
5 HIP?tv390Rr Pa 15077 neomTonseG PeuoD h4JUP
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8 EAVE [ VALLNY P O V M 3 ? %.I I P YEAR MC DAY YEAR MO DAY . . - LOCATION
, FROM as 17 01 TO 96 i/ ti 0 05. N 3 3 75C d t R 3 T: - l l OC#
- 2svt. na y 7Y &nnWv (2O21) 422-2sl 124-26l 120-27) (20-299 (s0 311 ' M N**$ O 4 PARAMETER 13cwson&# QUANTITY OR LOADNee (4 cent mi&A QUANTITY OR CONCENTRATMIN NO. W 3Amptg toe-sar tse-ets tan-ess tee-sst Iso-sts or r is2-37/ EX m ye. TYPE :
AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS e m byg ^ SAMPLE 4 ccon3 Seynye Meeti ( 12) O
//Jo MEASUREMENT 7, 9 p 7,9 g ;na. ;
m' n3 1 3 a PERMT - ae m wne e ' m 4e oz soeen: 9.0: a wcE/c na: en, .nu c 3, y REQWREMENT w33 w rv y nn 0 -
- hy r ani s t p- << *< M y st ,
SAMPLE Muse ec m e m oct
' L id T4 *PiOUI? OR ( p 3) / 7
- +dNubMT hLm MEASUREMENT o ma t a t;o l O 3a Es'C
;?wo 1 3 3 PERMIT gpan; Jepng' cetece- $000$A; IcoccyciN c *a c '
MC!c[4 ' 371*t A { e r t_ +t e r a -,.ge y a r : ._ REQWREMENT gy: ggy. es i r t. w h d en ~ Soes MONfd .i i SAMPLE : MEASUREMENT , PERMIT . -
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i REQUIREMENT 4 S AMPLE . 1 MEASUREMENT s PERMIT ' ' REQUIREMENT . ', SAMPLE . i l MEASUREMENT , l PERMIT ~ <- REQUIREMENT , ; SAMPLE
- MEASUREMENT e
, PERMIT , . ! l REQUIREMENT , SAMPLE l f l MEASUREMENT PERMIT , ^
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REQUIREMENT .j, pgAME/ TITLE PRWeCFAL EXECUTIVE OFFICER e cERTiFv uNota PEssaLTv oF Law TWAT e HAvE rE1tsossatty ExaMiNEo aseo / TELEPHONE DATE ? AM FAMIUAR WITH THE WeFORMATIO8e SUOMITTED MEREIN; ANo SASED One t MY IB60UIRY oF THOSE IIIDtVlouALS IMAPCDIATELY RESPOfeSISLE FOR ' - ';) , . OSTA18eles4 THE lesFORMAT1080, e BEUEVE THE SugamTTED 18eFORMATIOes IS * ' i David Orndort' TRUE. ACCURATE aNo cOnsplETE. e AM aware TWAT TweRE ARE
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SIGuelFIOANT PEleALTIES FOR SUOMITTING FALSE INFOfWAAT70N. lleCLtCIIe6 C.ncriin t ry Managm. isE possiesuTv oF FINE ANo umFRisONames'. SeE is u.s c. s iooi ANo as -- . ** U , _ @ t o7 P1 -'7 u.s.c. t 1sie. #wasame anser ensee asseusse mer sneemse mese esp so s70,000 -StGB'IA'TURE OF FINIOCW'AL EXEdJTIVE TYPED OR PRINTED w er mesmuse ' r ermeneese a mance w s mi OFFICER OR AUTHOINZED AGEffT h, , NURSER YEAR MO' DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference se artsefwnents here/ t P i l EPA Form 3s20-1106-951 Prewous editions may be used. tREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE ! 60/ M3-9s3u g OF
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;, - Paperwork Reduction Act Notice
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, Public reporting burden for this collection of infonnation is estimated to vary from a range df 10 heurt as an -
g! ' average per response for mme minor facilities, to 110 hours as an' average per response fut sorte mayor facilities, ; with a weighted average for major and minor facilities.of 18 hours px. response, includicg time for_ myiewing
- instructions, t.earching exist _ing data' sources, gathering and maintair.ing the data needed, and cmnplEting and
; reviewing the collection of information._ Send comments regarding the burden estimate or any other aspect of .
3 :this collection of information,-including suggestions for reducing this burJen, to Chief, Informatim 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 20:03. l 4
- General Instructions l
If form has been partially completed
- y preprinting, disregard instructions directed at ' entry of that infornwtion f.('already preprinted.
,2. Ebter " 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 and ending "Afonitoring Pt:wd" covered by form w here indicated (
l 4. Enter each " Parameter" as specified in monitoring requirements of permit. F
- 5. Enter " Sample Alcasurement" data for each parameter under " Quantity" and " Quality" in units spedbed in permit.
" Average" is nonnally arithmetic average (geomettic average for bacterial parameters) of all sampf,: measurements :
for each parameter obtained during "Afonitoring Period"; "1.faximum" and "Alinimum" bre normally cureme high and low measurements obtained during "Afomforing Period." (Note to municipals with seccadary treatment requirement Enter 30 day average of sample measurements under "Arcrage " and enter maximum 7-day average of sample measurements obtained during monitoring period under "Afarimum. ") .
..6. Entei
- Permit Requirement" for cach parameter tmder " Quantity" and " Quality" as spectlied in permit. , 1 o .
- 7. Under "Na Er" enter' number of sample measurn ents during monitoring periad thra exceed maximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. ~1f none, en!er "a". >
- 8. Enter " Frequency of Analysis" both as " Sample Afeaturment" (actual frequency of sampling and analysis used
'during monitoring period) and as " Permit Requirement" specified in permit. (c g , Enter Tont " for continuous monitorint,. "l/7" for one day per week. "l/30" for one day per month. "//90" for one day per quarter, etc.)
9 Enter "Sanple 7ppe" both as " San:ple Afrasurement" (actual sample type used during monitoring period) and as "Pe>mit Requirement," (e.g., Enter " Grab" for individual sample, "NIIC" 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. j f l 1. If"no discharge" cccurs during monitoring period, enter "No Discharge" across form in place of data entry.
'I 1
- 12. Enter *Namer litle of Principal Executive Ofcer" with "Segn.sture of Principal Executive Ofcer of Authorized 1 Agent," " Telephone Number
- 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.
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+
- 14. More detailed instructions for use of this Discharge Afonitoring Report (DAIR) form may be obtained from OfIice(r) specified in permit.
fU Legal Notice
'Gisjeport is r$ uired 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 dQ
]
e f violation, or by imprisonment for not more than one year, or by both, i
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i i EPA Form 3330-1 (Rev. 08-95) 1' j' , i a
PEnamTTEE NAtaE/ ADORE 33pemForsh9 N-viermass(DWI-@ NATIONAL POLLUTAfeT Ot9 CHARGE EUnemATION SYST98 (APDES1 . Form Approved. NAesE DeSCHARGE MONITORWG REPORT (DMRf Ohm No. N t
'EAVER lALLEY POW 3G sit?IDN ~
(2- ' ' . (' 7-8 81 QU"' PALI. 013 ' AOOREW , 0, m Approws, ,iga,pire,s 05-31-98 i 3)t Q , n n 3 r: ,. i r. ,33 m ( gs p gg , PERMIT NUMBER mSCHARGE NUhAtm s??M; -.D O I O auO09? F - prML , pier rn waa r ta 1s97' n u3a e lT e m 1EAif5R.7 ALLEY POWER 3f4TIU? YEAR MO DAY YEAR MO DAY . , LOCATION FROM TO
#5 L? t 95 3? $1 WO 71 0, D I S C H A 'i F, M - l NOTE; Reed instrucesRe before~oesRpletlRg thk festn.
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;*%. nav7 i yvnang (2a211 (22-231 (24-251 - (2s-27/ (28-2s/ r3asti.
PARAMETER is cent on&i QUANW OR LOAMG I4 Caci % Q4AANm OR CONCENTRADON NO. meouenc" SAmeLE ! 146-53! 154-619 (30-451 146-5M 154-61) or- r (32 371- EX asegys,e TYPE't - AVERAGE MAXIMUM UNITS J MINIMUM AVLtAGE __ MAXIMUM UNITS nu3, . Iso-ass - 'tes-For .
.s SAMPLE +
+. e **- a. %. ~e" ' c "u e~+ 9 ( g O / ,
7,33 7, SF 7 GmL ! t
>9100 [ ] 3 PERMIT c emw 39 m y ; 4 37 geg- ),3 - 4 mp; gg. )
REQUIREMENT '
'pptacgv gsqcr v3?gr *Se "?rON Nat W s' ly' I
'L34, 19 ? )M 0'J I T 3 -f SAMPLE <
cp o g g. g ., e33g poege / - !
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f O ' r# } 3 6. PERMIT . p qpp.- : s et.g e y e p p e. mm. p.n c,4 n3 g ggg gy , 377gg REQUIREMENT me.Tgone 3,qe y3t9r g , , , , . p,y7 4 ,7 ;, %,
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M f.7 R [ F F , 737AL SAMPLE e,oce3 m ;30 e g n ,, , { g .. i
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- 3. n ., , t MEASUREMENT <*8 . O, b . O o f-a. /c.. .
,7 % D 1 2, 3 PERMIT ^ nugn A e e c cer c :o n g g r;m gpp3py ; q ,4p 3 g y s 7 gggf ggg79 I p e r n e u ,- -@2q yn n REQUIREMENT g33 9 ,, g , p y 79 SAMPLE .
MEASUREMENT l
. PERMIT ; -
REQUfREMENT SAMPLE - MEASUREMENT [
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= PERMIT - ,
REQUIREMENT SAMPLE MEASUREMENT PERMIT ; - , t REQUIREMENT l SAMPLE > MEASUREMENT , PERMIT REQUIREMENT ? NAMElTITLE PfWGCFAL EXECUTIVE OFFICER s cERTiry uMDm PmALTv oF LAW THAT I HAVE PERSONAL.LY EAAhelf8ED AssD ' AAR FAAAIUAR VulTH THE IBfFORhsATIO88 SugaMTTED HEREsM: AfeO BASED Ost N TELEPHONE -DATE f 1 h4Y INQUIRY OF THOSE WIDtVIDUALS testeEDIATRY RESPostSIBLE FOR /, ./ Dayid Orndorf o*T**** ** "'oaa'AT'ON. e sEufvE rnE Suses TTED iHrORasATices is chenistry. Manager TRut. ACCURATE AND condPLETE. 4 AAA AWARE THAT THME ARE MNIRCANT PENALTIES FOR sumamTTWO FALSE INFORh4ATION. INCLUDIIeG t g .- I m'y L /*Vme, -[' / THE POSS100UTY Cf FueE AfsD IRAPRISONt#ENT. SEE 18 U S.C. 91001 AfsD 33 4 p6 g'3ggg e g g y u S.c. e 131o. pasasse emser eness assmusse mer sicem aime se se sto, cop 8000sATURE OF PRINCIPAL EXE TYPED OR PfWITED mad er assh=== : - st esewesa s aisaane w a pars # AREA NURSER i OFFICER OR AUTHORIZED AGENT CODE YEAR MO DAY ; COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refersnee af ettschmener heref g
'4*H "AALL R: 43 SISCM4Fi? F T' L 3 P.
- T ' M ' t. 7 D ~ 3R V ! '3 T 'l# P 3 6.
- IF 3'HSR T 'I A M T P. A C E A 9 3!' N 7 9 :
t EPA Form 3320-1100-961 ProveOue editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE if4ED.) PAGE OF * , ~ 0 0 6 3 D 610 0 3 - M UI L ___ __ _ _________ __ _ _ _ ._ - ~m . ~ . _ . - - -_ n - _ _ _ _ . _ , _ _ _ _ . _
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Paperwork Reduction, Act Notice. ' " j t j l Public wpmting turden (cr this collection of information is estimated to vary from a range of 10 hours as an 7 (
@ j. ; average pdr respee f 4 wme minor facilities, to 110. hours as an averaye per response fer some' major facilities, j y ~l lwith i weighted averg;. for uujor aud minor facilitissmf 18 hours per resporise,(including time for rekiewing ;
j t instructkms, fearching en ting data r,ources, gathering and maintaining the data'neeled, and completing and I ~ reviewing the coi lecti;c of infornation. Send comments regarding the burden estimate or any' other aspect of
' l
!this collectico of info mation, including suggestions for reducing this burden, to Chief, Information Policy I : Nr'a nch, P4223, US Environmental Protection Agency,401 M Street, SW Waddngton, DC 20M0; and to the j effice of information att Regulato(y Affairs, Office of Manzgement and Budget, Washington, DC 20503.
- , . t i
l- , ; n.
- . General Instructions 2 t
1
!1.;1f form has been partially completed by preprinting, disregard instructions directed at entryif il5at information , i already preprinted.. . .
i ' jnter' "Pennittee Ncmc/Afadmg Address (and facility name/ location, 'if different)," " Permit Wumber " and . ,
, ' 'i charge Numba" dere indicated. (A separate form is required for cach discharge.) mt , ;
- 3. ' Enter dates beginning and ending "Afonitoring Period" covered by form where indicated. o
! r
, o 4.. Enter each #farameter" as specified in monitoring requirements of permit. '
t i 5.; Enter "Sampfe Afercment dma for each parameter under "Guantity" and " Quality" in units specified in permit. j "Awrage" a ncrmWy arithmetic a <crage (geometric average for bacterial parameters) ciali sample : for each parameta ebruned during "Alonttoring Period" "Afanmum" and "Afinimum" areextreme
, normallymeasureme high -
l 4 aml;]ow nicaturmcnts obtained during "Afonitormy Period." (Note to municipsis with secondary treatment ! 4 requirement: Ena c 30-day aver he of sample measurements under " Average." and enter maximum .7fday average ; _ f orsample measurements obtamed during monitoring period under "Afarimum ") . , !_ t l
'6 " Enter Yermit Reprrment" for cach parameter under *Guantity* and "GualiCv" as specified ;n pennit.
O '7. Under'"No E " enter number of samp!c measurments during monitoring period that exceed maximum (and/or l
.mhtimum'or 7-day acrage as appmpriate) permit requirement for cach parameter. If none, enter ?0"J j s . .
,C >
.f>.-Enter :"Fecquenry of Ara /pis" both as "Seunple Afeamrment" (actual frequency of sampling and analysis used - i Jdcring momforing period) and as " Perm!t /tequirement" specified in penmt. (e g., Enter " Cont " for continuous l
- monitoring. "l/7' for one day per weck *1/30" for one day per anonth, "//90" for one day per quarter, etc.): l 9.! Enter'"Sunf el 7)pe" both as " Sample ifca.wrement" (actual sample type used during monitoring period) and as
" Permit 'tequirement," (e.g., Enter " Grab
- for individual sample, *24/IC" for 24-hour composite, "N/A" for
; continuous monitoring, etc.) ,
10.- Where vi~ o lations ofpnnit requirements are reported, atfach a brief explanation to describe cause and corrective
, actions taken, and re.erence cach siolation by date.
~
I1. If "no d[scharge" oduits during rnonitoring period, enter "No Discharge" across form in place of data entry. 1, . - ~ . , .
- 12. , Enter "Name/ Title of Principal hecutive' Oficer* with " Signature of Principal Executive Oficer ofAuthorned j Agent " " Telephone Number
- and "Date" at bottom of form. '
$. Mail signed Repert to Office (s) by date(s) specified 'in permit Retain copy for your records.
., 1.
[ i4. More detailed instructions for use of this Discharge Afonitor/ng Report (DAf16 form may be obtained frorn Officc(s)
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specifiedin perm;t 1 Legal Notice - q Thisfreport is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to repo'rt truthfully i result in civil penalties act to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day 4 of violation, or by iroprisonmcat for not more than one year, or by Imth. a
'l : j
. EPA Form 3320-1 (Rev. 08-95) ,
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FEUMTTEE 80AW/ADOfE334=se=6FeestsyMausmesse==(Dt- >< NATiossAL POLtuTAssT coscHAfter a;nsesATiose sYsTes Feent Appeeved.
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( HIIM 75) t a n; p ai r; an oonr PERM NUWE3 N uunmEn p,.77ggg 3 H I F P l t 'i ? O E ' 7! 1537' NOf4NG PEfu00 M J O *t
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7 C R V 5.* it 74LLCT POV N S T' A T I J N YEAR MO DAY YEAR MO DAY LocATwo FROM -r 3 1. >t TO "s i/ i 4L Ot7 C ISCHAMCP l - U # C a' + s++n per71 % a : n t\ 3 n s 12O2fl 422-2M 124-25) - 426-279128-2M f30371! N N i ML MM PARANTER (3 M W (d C"W W MAMlW M NO. mecum ggggg , 146-53 15+61) (30461 946-5m 15+09) or
#37-37; EX mm TYPES AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS asus ,,,,,, me, SAMPLE
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e r , tr y - -awe y g; rr REQUIREMENT wo :,y g yq p777 up - qqf7 l SAMPLE *: e c ar e
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MAL ( 8l -n 'f ) r 9 ei t O ' 1 3 ;3 - PERMIT Ac9sn* > enee - a :e c onMe MEPMI % EPDAT. 3 C EE. L T ' R F i31
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vernrne i n -c ritn REQUIREMENT g 44 y. .n y 7, y ,y; en e%c t i(ngayyyg SAMPLE a e tt a e t enSe? egeg@4 ( ) q) MEASUREMENT /gri i l 11113 1 7 g MMIT . ;supey eeetu 4 me ceygg pgppp ;pgp3 g ; gggy 73 3 c r y ct y~ ~97+ y e, r_ 3 REQUIREMENT 333 .yg ,ggz .gg7L7 y7 v,. j L SAMPLE MEASUREMENT PERMIT . l REQUIREMENT , 6 P M AL M OppgCER l CEnTIFY tAIDEn PWeALTY OF law THAT f NAVE pen 9OpeALLY ERAbeneED AssO s I TELEPHONE DATE Ane FAAAILsAR WITH THE NeFoslasATIOst suSRAITTEO MEnEue: AflO SAsED 050 = A AAY lesoulftv OF THOSE IIIDtWIOUALs Ibeh8EDSATELY nEsPosesIBLE FOft I / . OSTAfgelsee THE IsfrOfhPATICII. I BELfEVE THE sugadITTED WeFOmeAftons es / David Orndorf Taue. AccunATE Asso consetETE. i Ann AwAnE THAT THEnE AnE .ty .- e/ % .7 4 Chenistry , . tanager mann THe ,eic.A.nv.,PEmA,Lms con sumamTTwea ratse enomeAnom. =ctuomo 412 393-5113 97 01 27 i o v.s.c. e isie. sasammes.Asso espiesoeuwseT.
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TYPED OR PMWWTED sas er . - 3y o piesE: ersse stassanne mersEE is u.s.c. nessene enewson a meas > ==a s yumrw mas.s i.ooi se Amo ss sto. coo stepsATURE OF PINIOCIPAL E CUffvt ! 0FFICER OR AUTHOfu2EO AGESIT CODE 98UtdBER YEAR MO DAY r COMMENTS AND EXPLANATION OF ANY VIOLATIONS IMeference at effochments here/ ;
*f f " 9 A Z I N E 4 N 3 It 1.5 3 914 N9dIT7RIKG 70 8 " ' Y. ' OE"TVO Sf?IO15 OP MfT LTYOP.
I EPA Form 3320-1108-951 Prewous editiOne may be used. IREPLACES EPA FORM T-40 WteCH MAY NOT BE USED.) PAgE OF
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; l ptihhe~repiting burdm ict this colixtion of infonhation is estimated to vary from a range of 10 hours as an #
) au rye per r6 pense ! r renw minor facihties, to 110 hours as an average per response for sorne major facilities, '
l with) w4bted averagfer majorud mindr facilities of .18 hours per response.'includmg tind for niviewing - - l j ;indingtionsit.carchiny <xistins data' sources, gathering and maintaining the data needed, and completing and ! i 1 : reviewing the col!cction. bf infarroation. Send conmient> regarding the burden estimate or any other: aspect of i
! this co!Iection of inf"rmat.on, including t.uggestions 'for reducing this burden, to Chief,'Information Policy l
{ Branch, PM-223, U.S. EnWronnwntal Protection' Agency. 401 M Street, SW Washington, DC 2GE0; and to the ;
! Office of Infonnation acd Regulatory Affaini, Office of Mans;ement and Budget, Washington, DC 2050L ,
l . 4 General Instructions t
- I.;1f form has bet.n partially completed by preprinting, disregard instructions directed at entry of that'inforrnation j
+1 ready preprinted. - >
r . . l2. Enter " Permittee Name?Afailing Address (and facility namcIlocation, if ditTerent)" Permit Number " and ' '
- " Discharge Numb # where indicated. (A separate form is required for each discharge.) ,
- 3. Enter dates begim'ing ;md ending "Afonitoring Period" covered by form where indicated. .
- [
- 4. Enter each "Parancur" as specified in monitoring requirements of permit.
9
.4. Enter " Sample Af wrrmenf* data for each parameter under "Guantity" and "Gunlity" in units specified in permit. 1 i
Werge" is ocrm!:y arithmctic average (geometric average for bacterial parameters) of all sample measurements for eat.n pammeta obhined during "Alonitunng Penod'; "Afarimum" and "Afinimum" are normally extreme high
.and low measurenn nts obtained during "3fomroring Period" (Note to municipals with secondary treatment trqmrctaeol( Emer 30. day aserage of samp!c measurements under " Average," and enter maximum 7-day average ,
of sample measut ements obtaincd during monitoring period under "Afarimum ") { W Enter "Penmt Repircment" for each parameter under "Guanbry" and "Guahty" as specified in permit,
- d. Under ."No_ E2" enter number of ' sample measurments during monitoring period that exceed maximum (and/or
< minimum or 7-df.y a6cmge as appropriate) penuit requitcment for each parameter If none, enter "0".
u 8, inter ."#requency of ealpis" both as " Sample Afrusurment" (actual frequency of samplitig and analysis used daring monitoring period) and as "Pennit Requirement" sprified in permit. (e.g., Enter " Cont," for continuous . monitoring. "l/7* for one day pr
- week, "160" for one day per month, "l/90" for one day per quarter, etc.) .
- 9. Enter " Sample Upc" both as "Somp!< Alcasurement" (actual sample type used during monitoring period) and as -
" Permit Requirement," (e.g., Enter " Grab" for individual sarnple; "2.ric P- 2t. 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.
'll, if"no discharge" occurs during moni:oring periodienter "Nu Discharge" across form in place'of data entry.
.12, Enter "Namemtle'of Principal Executive Officer *' with
- Signature of Principal Executwe OJJicer ofAuthorized Agent " " Telephone Number," and "Date* at bottom of fann.
~ +- [13. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your records.
14, More detailed instructions for use of this Discharge A/omforing Report (DAfR) form may be obtained from Office (s) 7 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 imprisonmect for not more than one year, or by both. 4 EPA Form 33201 (Rev. 08 95) , h l._- k s
PERMITTEE NAME/AODRESS WFereb9Naine'Imesa==(ffN!broert NATIONAL POLLUTANT DISCHARGE FUMfMATtON SYSTEM (NPDES / Form Approved. N NAME J~gy ;gLLg7 ,gj;, 73e7 . _WjE M N M m i[t7% D 7a; py7 r c pr e y OMS No. 2040-0004 ADORESS9 ,3 , ^ ' ' ' ' ' ' ' ' ' ' * ^EE# #** 88 ij! 1 ( $ D 4 'i 'i)
.Iiv; Di(!9 1 ; S ? O t' :. PERMIT NUMBER DeSCHARGE NUMBER p , g 7. 4 a ,t n, ,, .r p - 2c r. s.n a -
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- i. 12e77 a n ,y 3 '
FACEITY MONITORING PERIOD '
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LOCAT m FROM TO o<
!> .i z $e0 4n 7 I r C'i A f ;( l l 300
. r-a . r- r; , ,1= (20 217 (22-23; (24-251 (26-2h (28-291 (3&3,j NOTE: Reed instructions before*~cornpleting this form.
(3 cent omy QUANTITY OR LOADING (4 Card on&f QUANTITY OR CONCENTRAN NO, FREQUENCY' PARAMETER SAMPLE 146-531 154-619 13 M SI 446 531 (54-691 OF (32-Jn EX ANALyss TYPE T AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS m.es, fsm, g,m SAMPLE +. e e e r MEASUREMENT e :. e, * ~ 3 f. t + . 3- { } 7) '.,)
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PERMIT K{Q 7ff /& ( t, 3 .) r - t 3 , e3933- n. o er e e >- o -, ,p c- t. ,13 : e ;,3 - gggf gg REQUtREMENT
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MEASUREMENT 4Q 4, y C g/ g/ gg s 39 i
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- ,, ,7 3 ; REQUIREMENT ,y ,g 3y, p, a f; eyp p37gy
- 7. E 4 , 11 :' il ; ; 7 SAMPLE a5*eae 1.% e e e ? eg e i e
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;3e pgg7a SAMPLE MEASUREMENT PERMIT REQUIREMENT SAM *LE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER s CERTwv UNDER PENALTY OF LAW THAT 4 HAVE PERSONALLY ERAMINED AND ~
TELEPHONE DATE AM FAMILIAR WITH THE INFORMATION SUSMITTED HERElN: AND SASED ON ,-' . / MY IMOUIRY CF THOSE fNotVIDUALS PMMEDiATELY RESPONSIBLE FOR /9 [ OSTA!NtNG THE sNFORMATION, t SEUEVE THE SUBM1TTED INFORMATION IS UllV i d (IfildO r ,- TRUE. ACCURATE AND COMPLETE. f 6 AM AWARE THAT THERE ARE >g , j. [,' f 'f , N -/ SUGNIFICANT PENALTtES FOR SUBMITTING FALSE INFORMATION. INCLUDtNG Cheni s t.ry himar,c r *7 ? (n t i 11 07 n1 7? THE u.s.C.POSsresuTV e 1319 ewism. OF FINE.AND e, Mar IMPRISONMENT. mese essa,we awr 6icam ibweSEE ne so18 U.S.C. 91001
#r0.000 AND 33 OF PfuMCIPAL EXECdfTIVE g SiONATURE - - '
TYPED OR PRINTED a Nrermovenesc a - er6er- ar smenens saar s reeras GmCER OR AUTetORIZED AGENT NUMBER YEAR MO DAY COCE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s#strechments herel EPA Form 3320-1 108-95) Previous editions may be used. IREPLACES EPA FORM T-40 WHICri MAY NOT BE USED.) PAGE
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- ' Paperwork Reduction Act-Notice '
i L i m- , ; -j Public (eporting burden for this collectio:i of iriformation 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 respouse far some nujor facilities, ;
;with a weighted average for. major and minor facilities of 18 hours per response, inclu3,ing ! tire for reviewing '
l j- instructions, hearching existing data sources, gathering and maintaining the data needed, and hornpleting and i
, Ineviewing .the' co!!cclion of information. . Send comments regarding the burden estimate or any othei 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, D^ 20460; aind to the j l
!OfTice of Information and {egulatory Affairs, Office of Management and Budget, Wa.shington, DC 20503; 4
1 1 e General Instructions ;
-) : I'..lf form has been partially completed by preprinting, disregard instructions directed at entry of that information already preprinted. l
- 2. Enter " Permittee Name/Afailing Address (and facility namellocation, if dificrent)," " Permit Number," and ?
( " Discharge Number
- where indicated. (A separate for.m is required for each discharge.) ,
h . m 4,3. Enter dates beginning and ending "Alonitoring Period" covered by form where indicated. , t . ?
;4, Enter each "farameter" as specified in monitoring requirements of permit. {
5.. Enter "Samplc Alcaxuremeni" data for each parameter under " Quantity" and "Qualiry" m uruts specified in permit-- i
" Average" is normalle arithmetic average (geometric average for bacterial parameters) of all sample measurements ,
- for cach parameter obtained during "Momtonng Period"; "Afaximum" and "Alinimum" are normally extreme high ;
- and low measurements obtained during "A/uniforing Period" (Note to municipals with secondary treatmerit t requirement: Enter 304y average of sarnple measurements under Wrage,* and enter maximmn 7-day average l
- of sample measurements obtained during monitoring period under "Afarimum ") l
'6.TSnter " Permit Requirement" for each parameter under *Guantity" and *puality" as specified in permit. ,
i
- 7. Under "No Ex" enter number of sam;>1e measurments during monitoring period that exceed inaximum (and/or i reinimum or 7-aay average as appropriate) permit requirement for cach parameter. If none enter *0",
8J Enter "Ficquency of Analytis" both as " Sample Memurment" (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, "l/90" for one day per quarter, etc.) l
. 9. Eriter'" Sample 'l)pe" both as " Sample Afeasurement" (actual sample type used during monitoring period) and as !
" Permit Regrirement," (e.g., Enter "Grah" for individual sample. "MK" for 24-hour composite, "N/A" for !
continuous monitoring, etc.) { 210.lWhere violations of permit requirements are reported, attach a brief explanation to describe cause and corrective , actions taken, and reference each violation by date. j I l'). If"no discharge" occurs during monitoring period, enter "Na Discharge" across form in place of data entry. s . . -
- 12. Enter "Name/ Title of Principal Executwe Oficer* with
- Signature of Principal Executive Oj]icer ofAuthort:ed i
,. p = Agent," " Telephone Number," and "Date" at bottom of form.
13' Mail signed Report to' Office (s) by date(s) specified in permit. Retain copy for your records.
^
- 14. More detailed instmetions for use of this Discharge Afonitoring Report (DAfR) form may be obtained from Office (r)
' U specified in permit. ,
. Legal Notice j T 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 m criminal penalties not to exceed $25,000 per day ! of violation, or by imprisonment for not more than one year, or by both. ;
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L . EPA Form 3320-1 (Rev. 08-95) !
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PERMITTEE NAME/ADORESS &=rwe Feree N==WLereme= efDi jlt-==$ NADONAL PULLUTANT DtSCHARGE EUMSNADON SYSTEM (NPDES) Form Approved. NAME N M R N G R N T (D OMS No. 20N 7-, 7 ; L ;, , y-4 7 g 7 7 y< , tt7 -(ypg ;y 7 7, y y ,, ADDRE!S 2. 3. 57 1 ; " il Tr e f PERMIT NUMBER i DIScHAAGE NUMBER n (3H3" 1 i) Y.f"
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LOCAt m FROM 1 ! TO 94 1 i; no? O 3 3 3 t 4 i a '; r { j co? r+,. ,s 7r3- ,~!' s m r' (2&2ts (22-23; (24-251 (26-27s (28-2s> (30'3t1 NOTE: Reed instructions before completing this falm. PARAMETER (3 cento W QUANTITY OR LOADING I4 Cant OW QUANTITY OR CONCENTRATION NO. FREQUDeCt I46-63) (54-611 (36-451 14 s-5 3) (54-sty oF SAMPL,E (32-37; EX ANALyS,S TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS es* ts4-ses (snos SAMPLE c,3e**~ .ene < n e. e t 9 e s , { ) ,) MEASUREMENT [ Y j, [,(>.5_ h , 0, rr6 b m; .
; s . PERMIT w y .> 3 3. a 33ege e 33 ,p. opnpa ;,p 3 gygyf, q39 c,, , . - . - 7,,,, REQUIREMENT ;3g , . ; 7 .,, p y - ,. g 7 7 y ,, ;,, 9,q -., g -- ,-
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, o PERMIT 7,nene %eene 9 - ; atown (; i t} -) e g y g y, g pppy . , . , , . REQUIREMENT y 3,, y , ,, , , , , ..
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_,_7 73, . . 73 , . , t, p , y , ,, ,, 7 ., 7 9 7 4 SAMPLE MEASUREMENT PERMIT REQU6REMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PR!NCIPAL EXECUTIVE OFFICER I CERDFV UNDER PENALTY OF LAW THAT e NAVE PERSONALLY EXAMWED ANO e / TELEPHONE DATE AM FAM4.lAR WITH THE INFORMATION SUBMfTTED MEREIN; ANO BASED ON MY fNOUtRY OF THOSE INDIVfDUALS IMMEDIATELY RESPONSIBLE FOR
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,,,av i u, O rn a.orf OBTAINING THE MFORMADON. O BELIEVE THE SUBMITTED fNFORMADON IS ,h 1r , I g)
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v TRvE. ACCURATE ANo COMPLETE. : Au AWARE THAT THERE ARE i
/ t L .jAA>uff )
Cltem s t ry .m.n ay,e r 3 9GN#RCANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING -- r g e sJ Nls 1-
+1y 9' 4'1 2 '#
THE u.S.c. POSSIBlilTY OF FtNE.AND e 13ie. sFea.o. .nm ei,MPRIS.O.NMENT. Mw., m. eieS,EE w nae10u. U Se C.,91001 s 7o,000ANO 33 SIONATURE OF PRfMCIP ELL EXE TYPED OR PRINTED .: er een g, eas er meremen t-- s meams.as s r ras OFFICER OR AUTHORki'D AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e# ettechments herel EPA Form 3320-1 (08-951 Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
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l Paperwork Reduction Act Notice:
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^
[ ! Pubhe repor'ing t burde fcr this cc.llection of information is estimated. to vary from a range of 10 hours as h ;; , l 1
! i ayirage per response fs a me minor lfacdities, to 110 hours as an average per response for some major facilities, j ! hvith a weighted avengfcr nujor and minor facilities of IB hours per response, including time for reviewing ,
l l !mstructmnp, searchint existing data sources, gathering and maintaining the dats needed, and completing and y !
~
l- : rcWewing the coIIccti.2 of infoumtion. Send comments regarding the burden estimate or any other aspect of [ j jth6 collectian of inf rmat:on, including mggestions for reducing this burden, to Chief, Informatiori Policy [ j Branch, PMd23, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the , l
, Office of loformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503, j n
t l L _._ > i (
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^
-Gsneral Instructions -
~ '
L -
!1cIf fann has been cartially completed by preprinting, disregard instructions directed at entry of that:information >
-already preprinted- - t 4 2. Enter ~
- Permittee Named /uding Address (and facility name/ location, if different)," "Pendit Number," and
' " Discharge Numtn" w here indicated. (A sepamte form is required for each discharge.)
9
- 3. Enter dates begimung and ending "Afonitormg Period" covered by form where indicated. :
- 4. Enter each "Paramerce" as specified in monitoring requirements of pennit..
e ,
'5. Ento "Sompic Mmerment' data for cach parameter under "Ouantiiv" and "Guality" in units specified in permit. , j Wrage"is norm *y mthmetic average (geometric average for bacterial parameters) of all sample measurements for eacte parametcr ottuned during "A/omforing Period"; "Afanmum" and "A(inimum" are normally extreme high l 4, and low mcasura mis obtained during "A/onitoring Period." (Note to municipals with secondary treatraent
. requirement: Ena Eday as erage of sample measuretnents under " Average " and enter maximum 7-day average z j
. . :of sample measurements obtained during monitoring period under "Afarimum ")
^
l6.' Emcr "Perrmt Requirement" for each parameter smder "(?uantity" and " Quality" as specified in pennit.
- 7. Under "No In" esta rumber of r, ample measurments during monitoring period that exceed maximum (and/or
,iminimum or 7-day as erage as appropriate) permit requirement for each parameter. If none, enter "0".
'8. Enter PFrnjuency qf halysis" both as "Samr/e A/eaturment' (actual frequency of sampling and analysis used .
Eduring monitoring period) and as " Permit Requirement" specified in pernut. (e g., Enter " Cont " for continuous - monitoring, "l#' for one day per week, "/60" for one day per month, "//90" for one day per quarter, etc.)
. 9c Entel" Sam d/ e 7)p" both as " Sample A/carurement" (actual sample type used during monitoring period) and as "Pennit Require ment " (e g;, Enter "Grah" for individual s. ample, "NIIC" for 24-hour composite, "MA" for continuous monitormg, etc.)
'10.;Where violations of permit requirements are report'ed, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date
~11; If "no discharge" ocons during monitoring period, enter "No Discharge" across form in place of data entry.
-l2. Entet;"Namemtie of Pnncipal Executive Oficer* with " Signature of Principal Executive Oficer ofAuthori:cd Agent,* " Telephone Number.* and *Date" at bottom of form.
~
;13; Mail signed Report to Office (s) by date(s) specificd in permit. Retain copy for your records
- 14. More detailed instmetens for use of this Discharge A/cmitoring Report (DMR) form may be obtained from Office (s) specified in permit. l
.. 1 .
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 l result lin civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to r .ceed $25,000 per day i
of violation, or by imprisonment for not more than one year, or by both. i i 4 . 1 EPA Form 3320-1 (Rev. 08-95)
PEnaNTTEE NAtdE/ADOMSs thedWaerenewamorgmen grDWheat NAT10 mat PottuvaseT twecesanos EummmAT10N svstas (APDE31 Fomi Approved na sg DescHAReE MONITOR 508 REPORT #DAMI
%EA732 ( P. I, L ?. T P3402 3 T A T I ?r g - (2- m f r 7-m ' M IT 2 3ERVICE VA OMS %@r '
AconEss p , 3, mo **ca,-c*< '$ti a (sugg 09 'f'l** '8 i ATIN; JAFID GM DO W PERMIT NUMBE3 suscHan9E IMMER
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3HIPPIvn rit n 15377 u g ggy m m "A10? . LocAnON 90Afth 7ALLET P 3 W f '+ 3?iLTI39 YEAR MO DAY YEAR MO DAY *
- FROM % 1y at TO % 1' $1 'Oct 90Reesi prgCHApOg 400 i gcm. nayTn 9asn3"e (2cL21s (22-23 (24-25s (2s-27; (25-2m (Jo'37, - NOTE: h Wl h,,, essRe iseine Wds h I PARADETER (3 w w i OR Le to w %s MWM N M NO. r ---
- SAtrLE (4s-53 (547) f35-457 tes-53 tsurf oF -
(37-371 EX wass TYPE,* , AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS neasi fo u g, og r SA E t@MH i 4,01, iW 3 t D lf T T Pt l' 93g Web $$ $$ m e
~tRU *RP47FENT PLA%? O
PERMIT . pnpng
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MEASUREMENT e PERMIT ; m REMN . [ SAMPLE MEASUREMENT 3 PERMIT , REQUIREMENT ! SAMPLE ! MEASUREMENT . PERMIT i j REQUIREMENT S AMPLE - MEASUREMENT PERMIT .
'l REQUIREMENT 1 SAMPLE MEASUREMENT i PERMIT REQUIRESENT 6MMM i CERTIFY uB8 DER F9eaLTY OF LAW THAT 6 MaVE . ,miiLY EEUWAINED afs0 mAA FaA41Uan WWITM THE IISPOIIRAATIOes sugamTTEO MER8ee; afl0 SASED 080
,- TELEPHONE DATE AfY leeQuiHY OF THosE INDIVIDUALS mansEDIATELY REsPOIssleLE Foft -
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.t OSTaississe TME INFORasATION, 9 SEUEVE THE sugestTTED eleFOfRRATION is '
- g. I i
Davi Orn orf Tauf. AccunATE amo consFtrTE. e ans amvant TWAT TwEnt ant seasoFicassv FeenLTiEs Fon sumamTTina PatsE issFosumafion. sectuomes
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THE posecuty oF n=E amo mariosossuser sEE te u,.s.c. e soci ano as - SteNATUIIE OF M g 412 393-5113 97 01 27 TYPED OR PR56TED u.s.c. ene er a tste. ameususe muureressw ensee a.manee mer.assena
. s menen. a s yeessmese ao se sto. cop opricER OR AUTHORIEED A4ENT AREA cnn, NumeER YEAR MO- DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS fReference of effechments heret O b t ' . ( b a t ie r EPA Form 3320-1 908-96) Prewooess odroons may be used. IREPLACES EPA FORM T-40 W99CH aAAY 900T OE USED.) g ,7g 7 ,gg PAGE OF
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m - ., . ~ . . . . , PERAMTTEE NAM /AODRESS thhehenwpNo.s/w gregw.,) NATIONAL pouuTANT c>scwARoE EuMNsAnON SYSTEM (NPOES) Form Approved. I NAE H F A if E R ii?LLFf f3WE2 i Y A ? I"; y (2- r ol NN N '0"si rt 7-t !N!r 2 3 E 9 7 I C t' WA O W No. N ? EP * '
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(3poR D5)
&?EN; DAFIC OR M D() y e PERMT NUMBER ot9CHMIGE NUMDER y 4 .
.IHIPDIS R31i F8 15077 NIOMTORM PERIOD "AJ3R '
" ? % 7 E h. 7 6 L L '* T P3WF4 ~Y%TI3" YEAR MO DAY YEAR MO DAY '
LOCA M FROM a t, 1, t1 TO u +, 1? 41 Me 90 0;ggggy3P j Q cet NOTE Reed M W oompienRt deinforRe.
\*vt. n*7*a a: en9-r (2& 21) (22-23) (24-25) g26-27; (20-29) g30w3rp PARAMETER (3owir W mMM M LOADWG 14 w W NNM M NM NO. 'REcugNCf SAM'LE I46-539 154-619 13tM61 446-539 166 619 O*
13M71 EX ANaysis . TYPE
- j AVERAGE MAXIMUM UNITS MNIMUM AVERAGE MAXIMUM UNITS mm (s+ser fe m 15 '* 3 % C U " ! SAMPLE < 3339e; w e g e r. c9agge
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;20'i0 1 3 0 PERMT ggpp; pppgq7 ccc m etccyg egegen See .t gggtg '371 9 c.qny, ~. c y , , n e:
REQUIREMENT g , , , . y,g , ,_. 3.m SAMPLE MEASUREMENT PERMT = REQUIREMENT , SAMPLE i MEASUREMENT r PERMT-
- REQUIREMENT
{ SAMPLE MEASUREMENT PERMIT REQUIREMENT - SAMPLE MEASUREMENT
- PERMT '
REQUIREMENT L SAMPLE . MEASUREMENT r PERMIT > REQUIREMENT SAMPLE MEASUREMENT i PERMT ' i REQUIREMENT NAM (ITLE PMAL EXECUThff OFFICER I CERTIFY UNDER PEhALTY OF LAW THAT t HAVE PER90 8 ALLY EKAMtNED AND AM FAMILIAR WIT I THE WeFORMATION SUOMITTED HEREIN; AND BASED Oes A TELEPHONE DATE MY INQUlftY OF THOSE IIIDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ' J. . .
./
CGTA4NING THE IteFORMAT1088. I BEUEVE THE SUOMsTTED INFORMATIOes IS / ', Day Ld O rn<3or.g TRU ACCUR ma E,NeANT , ATE AND COMPLETE. I AM AWARE THAT THERE ARE ENALnES Foe sueMiTTwo Fast mFORManON. mCluDmo
' ' fh' ' ,e Jg' NA' s I
im. . u , - ,,, u.m,wr THE POSSuPIUTY OF FueE ANO IMPR,90NMENT. SEE 10 U.S.C. 91001 AND 33 - 412 393-5113 97 01 ,,
& 7 u.s.C. n 13:e. amasMw unr mee smanne may menusse ow. . se ssom sooIWATURE OF PRNOCIPAL EXEt TYPED OR PRINTED COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Metae s# ettschments heref sav er
- -erserw e nw.m.-w s Fearms OFFICER OR AUTHO842EO A6EffT - @ MJMBER YEAR MO DAY
- t
() h i * - t' b n l' n C , EPA Form 3320-1108-36) Preh odraone may be used. (REPLACES EPA FORM T-40 WteCH MAY NOT BE USED.) PAGE OF j n ,7gfqg )gy,p qq _ _ , .- . , , - - . -,,o,- , , - . , . - - - , - - - - .,_ . - . . . . . . . . ,,. , _ . . . - -
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[
. Paperwork Reduction Act Notice ,
'i
- ;Public reporting burden for this collection of information is estimated to vary from a tunge of I'O hours u kn inverage per resporae for some minor facilities, to 110 hours as an average per response for wmt raajor facilities, with a weighted average for nujor and minor facilities of 18 hours per response, including time for. reviewing
; instructions, searchig existing data sources, gathering and maintaining the data needed, and completing and
! reviewing the. collectmn clinfonnation. Send comments regarding the burden estimate or any other upect of ,
f $this collection of information, including suggestioris for reducing this burden, to Chief. Infonmtion' 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 f Management and Budget, Washington, DC 20503, i
General Instructions
,1cif fonn has been partially completed by preprinting, disregard instructions directed at entry of that information
'a! ready preprinted.
2lEkter " Permittee Name/Maihng Address (and facility namellocation, if ditTcrent)," " Permit Number," and
" Discharge Number" where indicated. (A separate form is required for each discharge.)
- 3. Enter dates beginning and ending "Afemitoring Period" covered by form where indicated.
~ 4. Enter each " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sam;>le Measurement" data for each parameter under " Quantity" and "Guality" in umts spe:ified in pernut "Arcrage" is normally arithrvetic average (geometric average for bacterial parameters) of au mmple mesurce:-u for cach paranHer obtained during "Afamtormg Period"; "Afaumum" and "Ahnimmn" are normally chme high '
and _ low measurements obtained during "Afonitoring Period" (Note to municipals with sccoadart treatment T requiremect Enter 3041ay average of sample measurements under "Arerage," and enter maximum 7,iay average i of sample measurements obtained during monitoring period ander "Afarimum.") 6J Enter " Permit Requirement" for each parameter under *Guantity" and "guahty" as specified in permit.
- 7. Under ."No Ex" cater number of sample measurments during monitoring period that exceed maximum (and/or i minimum or 7-day average as appropnate) permit requirement for each parameter. If none. enter "0", ' l
. l
- 8. Enter "Frequemy of Analysis" both as " Sample Afeasurment" (actual frequency of sampling and analysis used during monitoring psr od) and as " Permit Requirement" specified in permit. (e g., Enter " Cont," for continuous monitoring, "l/'"/for one day per week. "ldF' for one day per month, *1N0" for one day per quarter, etc.) ;
- 9. Enter " Sample Type" both as " Sample Afeasurement" (actual sample type used during monitoring period) and as :
" Permit Requirement," (e.g., Enter " Grab" for individual sample, "21//C' for 24-hour composite, "N/A" for continuous monitoring, etc.)
10.'Where violations of permit requirements are reported, attach a brief explanation to dexribe cause and corrective actions taken, and reference each vio:ation by date. I1. If"no discharge" occurs during monitoring period, enter "No Discharge
- across form in place of data entry.
- 12. Enter "Namerfitte of Principal Deestive OJJicer" with " Signature of Princir>al Secutive Officer of.1uthori:ed l Agent,*
- Telephone Number," and "Date" at bottom of fonn.
- 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 Ahmitoring Report (DAIR) form may be obtained from Office (r)
< specified in permit. !
. Legal Notice
~
~
This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can result in civil 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 3320-1 (Rev. 08-95) c > ,
-+ _
PERMITTEE NAME/ADDAE;$trad.Medry.wterews(D*w) NADONAL POLLUTANT DISCHARGE r'JMWGADON SYSTEM (NPOEs1 Form Approved. OtSCHARGE MONITORING REPORT (DMRJ NAME ,
,y y 4 t, L g 7 %
3, 7. -- ; 7 3, p . u p-t s/ (r 7- t 91 111 7[P3gL *; e %T R A -M 7 No N. Approvel e res 05-31-98 f.DDREW , 3, ~3g a ** * ' ' ' ' ' ' . * (305" 7 C; ) aea>e 3
$T?t; 9A7[3 7yN30:P PERMIT NUMBER DE;OHARGE $* UMBER 4 +;. _ =7qg{
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Ff,CluTY t F I ;- P [ N P 3 "t * ?A 1M7' MONITORING PERIOD *NE q , g, , yg, ,y p)4,q 5 y g ,7 ;) y YEAR MO DAY YEAR MO DAY
- LOCATION FROM w* !? *1 TO ac t 11 ??? NO DISC 9&M F l l ' MO NOTE: Reed instructions before completing this faen.
sm+*. -sera 3 e u y :- 2 (2G27) (22-23/ r24-251 (26-271 (26-29/ (Jo's,j (3 cerd orwys OUANTITY OR LOADING I4 Cerat ordyl OUANTITY OR CONCENTRATION NO. FREQUM SAMPLE PARAMETER (46-539 154-619 (3 s 4 61 (46-531 (54-sty or (32-371 EX anatyg, TYPE = AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS mm gggf gg m SAMPLE MEASUREMENT 3eenew
- ts e e p s 7, / J
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a99 i S PERMIT cuy 9 e p p.
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PERMIT - n e g e M: y e e c. =: 3 g : m -- cuece }3 ;Qp g r g g rJ - 3Ag ~ e r , ,, . , . ,c y1; . REQUIREMENT m. 43 gyy 337gy jy sqr ,
.;7 apn ;2 3 ; r. SAMPLE MEASUREMENT
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" q ', ' Y T R; ,; 9 A V MEii 3 S t. g ; y p PERMIT 'nopcBe N o e c er e e r< 'p- 37 30 ( v g g, y gg3 ret 3 ,- 4 3qs 7.,j REQUIREMENT . .s y y 3g 9 ygy ,,, y ygq yg7 gr f
, y r; p g g y P- g- SAMPLE eedet- oct.-e> ;p:en;
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.,Ai7 MEASUREMENT O , D( / O,Od/ b 5/
n e r, n g , n PERMIT 4qnpe - er M9; n e pt e acc9e3 n c 4 Mr s r a ?. e . EErtl S T I 5 a. 3
-. e REQUIREMENT ug yy j,y;7 .n
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,7 333 SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PCRMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTNE OFFICER I CERDFV UNDER PENALTV OF LAW THAT I HAVE PERSONALLY EXAMINED AND
'r 4,e
/
i TELEPHONE DATE AM FAMIUAR WITH THE 1NFORMATION SUBMITTED HEREIN: ANO BASED ON %
/}
My mOuwtv OF THOSE WeDMDUALS IMMEDIATELY RESPON98LE FOR '
/
oeTAmma THE mFoRMADON. I BEUEVE THE SUBMITTED INFORMADON IS Y - e ,- 4 g -,
,avf.d J Urndorf TRUE. ACCURATE AND COMPLETE. I AM AWA THAT THERE ARE 7 saNmCANT PENALDES FOR SusMiTTma FALSE m,RE
' < (1 'I -< \
Chet^tte t ry !! AthigC r ORMADON. =CtuDwa I
,12 393-5113 97 01 27 THE POSeesuTV OF FINE AssO IMPIUSONMENT u.S.C. e 131s. m asisaw ow sseuse . SEE mey 18sa.e sica,e u S.C.
e, se 91001 AND 33 ssONATURE OF PRWedPAL EXECUTIVE s to.oco AREA TYPED OR PRWTED saar er mar *=== n- er aer a monens a,ma s yearms OFFICER Oft AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference esettschments herof EPA Form 3320-1 (06-96) Previous odetions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF q p
- - ,, .-. . . - .- - ..)
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I J l: s Paperwork Reduction Act Notice: '
' k l.
pq g u . j , ~Pubhc seporting tusan fu this ceWction of information is estimated to v'ary from a range of 10 hours as an ' ;;
, ahi ra ,e pdr responw f a some minor facihties, to 110 liours,as ariavera'ge per response for sorne major facilities, 4
? with i weighted averrge.ftr trujor and minor. facilities of 18 hours pir Jesponse,b.duding time foireviewing
~
i finstmetiore, bearching exiding data umrces, gathering and maintaining the data needed, and[ completing and 3 i (reviewmg tha co&cti>a of information. ; Send comments regarding the burden estinate or any other aspect of '" Jt his collec't ion of infwmtion, induding suggestions for reducing this burden, to Chief, Information Policy i l- "Brimch, PM-223, U.S. Ensironmental Protection Agency,401 M Street, SW WashinEton, DC 20460; and to the l Office of Information ard Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. t l j 4_ _ _ . . . . . . _ _ _ _ _ _ - + 1 i j ..f
! -- [
i General Instructions f ,m ;. ^
, il. If form hu been partially completed by preprinting, disregard instructions directed at entry of that information -
La1 ready preprinted ' j
- 2. Enter " Permittee Name4/ailmg Address (and facility name/ location, if different)." " Permit' Number ", and .
; [ 1" Discharge Number" w here indicated. ( A separate form is required for each discharge.) =
1
;3. Enter dates beginnig at:d ending *Afonitoring PerioJ* cmcred by form wherc andicated. ,
- 4. Enter cach "Parar1cter" as specified in monitoring requirements of permit. l
- ', i
;5. Enter %np/c 3fwrement' data fer each parameter under "Guantity" and "Guality" in units specified in permit. ,
"Averogd* is norm 4 aathmetic average (geometric average for bacterial parameters) of all samp!c measurements . i for each paramekt oNamed during "Alonitoring Period", "Alarimum" and "Alinimum" are normally extreme high i
.and low measurements obtained < hiring "Atomforing Period" (Note to municipals with secondary treatment l requirement: Enw 20-day aserage of sample measurements under " Average," and enter maximum 7. day ascrage - j of sample measuuments obtained during monitormg period under " Maximum.") .~ l t
i 1 y 'b.- Eoter ??ermit Re<parenwnt" for cach parameter under " Quantity" and "Quahty* as speedicd in pctmit. _+ ' l l
- 7. Under "No Er" est number of sample measurments durin'g monitoring period that exceed tnaximum (and/or i minimum er 741ay nerage as appropriarc) permit sequirement for each parameter. ;If noncfenter "0";
- 8. Enter "Fhquency 2r Aralysi3" both as " Sample Alcamrment" (actual frequency of sampling and analysis used l
! .&, ring'momforing period) and as " Perm!I Requirrment" specified in permit. (e g., Enter " Cont " for continuous I monitotirig, "1/7" for one day per weck. "1/30" for one day per month, *//90" for one day per quarterictc.)
, 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, "M/C" for 24-hour composite, "N/A" for
, ,dmtinuous monitoring, etc.) .
, . . l 10.,Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective i actions taken, and reference cach violation by date.
.]
l i1L If "no discharge" occurs during monitoring peritxi, enter *No Discharge" across form in place of dati entry. ;
- e i 12; Enter "Nabe/Tiric'of Principal Executwe Ofcer* with " Signature of Principal Executive Oficer ofAuthorized l
' Agent,* " Telephone Number," and "Date" At tmttom of form.; j
- i 13.- Mail signed Report to Omce(s) by date(s) specified in permit. Retain copy for your records. - 4
., '14. More detailed instmetions for use of this Discharge A/onitoring Report (DAIR) form may be obtained from Omce(s)
! specified in permit.
-^ Legal Notice , !
Tliis report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to r port or failure to report truthfully can resull'in civi! penalties not to exceed $10,000 per day of violation; or in critninal penalties not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both. , 1 p a ! i d! . -
. EPA Form 3320-1 (Rey, OL95)
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mt4TTEE NAtdE/ADOfESS fBasheForshy#en.M . g@qhowJ M;.TIOesAL POLLUTafsT DesCHARGE EuemasAnOss SYSTEM (APDE31 -- Form Approved. !
*a DISCHARGE MONITORING REPORT (DMR/
NARAE "E%VE4 V3LLET f3WTh ST%I107 (2-F8/ f f 7- 7 8f ' U;41T~2 $3VAC# T ?t ? H N ,. 1 ADORESS p , 3,
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? A f l M ft L SU PPIN'oDRT FL 15?77 MONITORING PEhsuD D# ,
- 8 A li E 9 YfLLEY P O # l' 9 5EL?I3" YEAR MO DAY , YEAR MO DAY ,
LOCATION FROM <; wA 1, TO e 1 1; e40 ' NO D!SO"8HOF l s ) 00" I y?*v; n e y 7 ') eo73DP (20'271 (22-23J (24-25/ (28-27) (20-291 (30L3F/ NOTE: Reed h 6 m %. PARAMETER (3 w W QUANM M WAmNG I4 cow W QUANTITY M CONCENTRATION NO. h SAMPLE ' (46-6 3 164-611 130 4El (H I64 691 OF (32-371 EX m yne TYPES & AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS e ,g gm . g SAMPLE 4 y ey e . c- t a a S c ec;gn ( 17 g - [ MEASUREMENT ;
. PERMIT ; p er g *t as t i 3)qg1 [ )_ 9 $$60&& 0 84 5. 3, (I n ._fr t o u p - 3.0 #
g[Ogf. ;pJri" f' tr 3 e c e REQUIREMENT gn e r ? y r- n
- 7,e- .,333 7 9 7 gyg g . 3 7, y , g ry pe Spyg
, :9tIDS, T3rAL SAMPLE ocot?' o o rea : t > cense ( Iq) MEASUREMENT i]SPYYDEO 19 e. 3 3 1 3 3 MMMIT . noen Meyc ui .q gsce- 30- g g; ;9 gig gf . ggp*6 re;3- o, .n - 7 e e ,i r . REQUIREMENT g33
,,4 4 j 7 z gggy , ,. 7 g ,,g,g SAMPLE
'L94 IR 3H031T OR ( 03) 6030A? 0000$0 077 t M f "Fr9 T R M A T 1 ?' 1 T PLRh! O '*)
is g o 1 ) p PERMIT - ), 3 31 p33 y - WeM CM3M MO.*A0$P ##& '# E3ht!' MSMD t ph,97ep r,er vim. REQUIREMENT 4 gp p yg4 y - pn - , cec * >' , SAMPLE
- NV14Iv#, P*) f A L MEASUREMENT te$ut enot>> Mertoy
( 19) :
, y 5, g g L {
, ) n t 3f) } 7 p PERMIT -
7 seccen. >
.eencae r c rA C Co?2C4 EP397 ;PQORT ~
W I t' F, / ;RAQ eeto: e* ". e :; 9 y et t g REQUIREMENT + gy9 ., g 4 g. . gp ggg g7g gg SAMPLE $0W9 ! ' 7 L T T 7 d -' , P70RL MEASUREMENT sac ~et ototea O t t ac c $ ( t 3)
; e q q .q g (
rang; t [, p i PERMIT ; $ c c a t er acteto c in? $080e2 2000 m e@M G / 7 1 S{M/ , $ A Lt t r e r g c u r ' de: - y p e. y ; REQUIREMENT ngs g y ;; gig ' 1,a3L , g 3g y g 4
- 2. ) D , 'AR M3t1~ m n SAMPLE o
- W ** cec S 0 2' Sne*> ( t o) ,
- 3. r> "t Ay,, .n. -. MEASUREMENT 13192 1 1 ') . PERMIT 1 c a.c o u - .t er't 0 c t 3 0 ^- 497 ens 25 30 .
gm/ pp .. , REQUIREMENT ge> .gg;AYL
'p rtu r N r ~q,cs 731., I D R 't L Y1 5 % W ii QBTR SAMPLE MEASUREMENT PERMIT REQUIREMENT paatsstTITLE PIMAR. EXECUTRIE OFFICER I CERTIFY UNDER PseALTY OF LAW THAT 6 MAVE PfRSOceALLY EXAM #tED AfeO AM PAnMUAR witTH THE WIPopmeATIOes sugestTTED HEREtse; Afe0 SASEO ON MY NeOUWlY OF THOSE IseDIVIOUALs IMa#ETAATELY RESPOessOLE FOR Os a
[' TELEPHONE DATE OSTAlfeneG THE WeFOftAATIOes, 8 SELfEVE THE SUOMITTED IssFOfmeATIOfe is ,f JA#/ Q' paV1g grngOr{ - TRUE. ACCURATE AND COMPLETE. I AM AWAftf THAT THERE ARE ! Q[ f, /4,, %_. setimericAfsT PesALTies FOR sumassTTese FALCE IseFOfmAATices. IseCLUDese ' - - ' - a m'a*ry m ,, m, ,w -- - THE POsmesury OF Fue -
, meLT .=ermaman
-- _ _ .s .on EE is u.s.C s tooi afso 33 - *
,1 ' m -%113 47 01 27 .-
u.s.C. e isie. fRaism.E.AseD mi e , s s ro. coo SIGNATURE OF FRNICIPAL EXECOTIVE g g ! TYPED OR FREETED mis er
- erasew e mamme sis s yeard NUtdBER YEAR MO OFFICER OR AUTHORIZED AGENT DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Meterance ateffachments here/
l i [h D;y,i, p.c $. , ^I c l: ,. 1 FL r
$1 T rk f, MdGa spr# u .+ r /~ M u r L .
EPA Form 3320-1108-951 lWeas editions mey be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE 3g. j 3 g3,gg3g y OF
, . - ._. . . . _ _ . . . _ , - - -,- _ ___ _ _.- - _ _ ---.--m - . . , . . - ~ , - - . - . _ - - -. ~ ~ - - - -, - - - - - . - - - - - - - - -
.w
, ,..a. .
I _.._._l,_..___. ' 4
. Paperwork Reduction Act Notice -
f e ipublic reporting burden for this collection of information is estiinated to vary from a range of 10 hours as an <
- j. average per regense for some minor facilities, to 110 hours as an avnage per response for some nnjor facilities, ,
i with.: weighted average for major and minor facilities of.18 hours per response, includmg tirne for reviewing ~ l .
- instructions, searching existing data sources, gathering and nuintaining the data needed, and comp;eting and reviewing the, collection of information.. Send comments regardmg ibe burden estimate or any other asgect of l ;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 Strat, SW Washington, DC 20460; and to the 3
.OfTsce ofInformation and Regulatory Af fairs, Office of Management and Budget, hhington, DC 20503.
i General Instructions ' I. If form has been partially completed by preprinting, disregard instructions directed at entry of that information r ' + L La! ready preprinted. _ _. 2.Ehter
- Permittee Name<Alailing Address (and facility name/ location, if difTerent)," " Permit Number " and "l?ischarge Number" where indicated. ( A separate form is required for cach discharge.) ,
' 3. Enter dates beginning and ending *Afonitoring Perio#' covered by foam where indicated ;
- 4. Enter cach
- Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample Afeasurement" data for each parameter under "(Juantity" and "Guahty" in units spe:ified in permit.
" Average" is normally arithmede average tgeometnc avtrage for bacterial parameters) of all nanipl: measurements for cach parameter obtained during " Monitoring Perio#'; "Afaumum" and "Afinimr,m" are nonmdly extieme high and low measurements obtained during "Alonitoring Period" (Note to municipah with secondary treatment requirement: Enter 30-day average of sample measurements under "A verage," and enter maximum 7-day average ,
of sample measuremeats 6tained during monitoring period under "Afaximum ")
- 6. Enter ' Permit Requirement" for each parameter under "Quantsty" and " Quality" as specified in penuit. '
l 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 rcquirement for each parameter: If none, enter "0". ' i S. Enter "Frcquency of Analysis" both as " Sample Measurment" (actual frequency of samplirg and analysis used l
'
- during monitoring peri od) and as " Permit Requirement" specified in pemdt. (c g., Enter " Cont " for contirmous ;
monitoring. "l/7" for one day per week "//30" for one day per month, "F90" for one day per quarter, etc.) )
- 9. Enter " Sample Type" both as "Somple A!earurement* (actual sample type used during monitoring period) and as
" Permit Requirement " (e.g., Enter " Grab" for individual sampic,"NHC" for hour composite, "N'A' for continuous monitoring, etc.)- ;
I
- 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective l actions taken, and reference _cach violation by date. ' ,
1
- 11. ~ If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry,
- 12. Entcr "Name/Dtle of Principal Erecutive Officer" uith " Signature of Pnncipal Erecutive Ofcer ofAuthori:ed Agent,* " Telephone Number,* and "Date" at l>attom of form.- l l
+ 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 (DAfR) fonn may be obtained from Office 0) J lspecified in perndt. ,
1
, 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 1o result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day ,
l 1 ofviolation, or by impnsonment for not more than one year, or by both. I l 4 EPA Form 3320J1 (Rev. 08-95)
PEmestTTEE NAedE/ ADDRESS WFarmer.helsremese(D@wwi@ NADONAL POLLUTANT DeSCHARGE ELIMWAMON SYSTEM fMPOfS) FOmtApprOved NAhAE NC MNm N (D 3yy 7y 7 73LLEy pggnq , 7 4 7 y 1, , t7 73} gy3ypp , g g n OMB K2040-0004 ADORE 1S p , '), - 4S( 0 5* ***C 9 7 PERMIT NUMBE*1
^*1
- DISCHARGE NUMBER
($0R7 n5) W'"$'f ' A;rs; 317;O "T%007p - p g pLg (
,1IPoP0P3r? :
3 1 M 7 MONITORING PERIOD "# D E
'#N"
.CtyF '
7 ALLEY v0;Pt 3 ' A. r T ') 7 YEAR MO DAY YEAR MO DAY
- LOCAWM FROM qs 1 a1 TO 9t ;y ii O6a ny pigCpgngg g j $00
*P*n. q 7r7 ?eur6'e (2& 271 (22-231 (24-25/ (25-27s (26-2s/ (Ja31; NOTE: Reed instructions before[ completing PARAMETER (3 Cent ontri QUANTITY OR LOADING I4 Card Omry; QUANT!TY OR CONCENTRATION NO. *EM SAMPLE I46-539 (54-691 (30-459 e46-539 I54-6 tl s (32-371 EX ,, or tys,s TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS esa fg4.,,f f,,,
SAMPLE n , er . = e e*333+ MEASUREMENT 3 ; $ 9 e e. g 13 i
>]qq0 1 3 ,
PERMIT .:. m e Secen e ec 3 ,g mng 3,3 7 jyggf; gg 7 3. , ., <+ - ,, REQUIREMENT g, , 5g7739p. ;q. yyg 3,- - 74 7,, y SAMPLE ee yes
)LIy,' p 3 p *, L MEASUREMENT nowe3 3;cen
{ 19}
'33P54DPD .jsla 1 1 7; PERMIT - cugno Sooece t :c- c ? *p st er t *1 (0 0- .j s!Cgf' 313-REQUIREMENT e x-r p e y v ,9c , y-= :. e$$ "O t7h e iT U Mr * '~ / L 'P M >IL 4JD ; 2 n 13 t- SAMPLE w * *: e & eta 3c; O$3Me MEASUPEMENT
( lu)
. ~ e 3 N. . , ? i. . .n -G .* a 1 4 g ,, ~ .q PERMIT enew w o g.u g ' r, g l ') M r 3 7 C REQUIREMENT gecee 4 .
EICT/ 2 R '3 ec.ncy, .: s - + - y3e: , ,.; n .3 y gyg- p p 7, y gy gg gg SAMPLE q 3) e s e.y y e 3 e. g 3 synee
'L:W, TN 03FOUf? On sim rburen PLur MEASUREMENT hhd ;
me
, 3 ^, 5 9 1 7 , PERMIT :pgpgce. nrngqr o t M t;*. O c.* $ M : cMuc t t agg/ gylwg "
REQUIREMENT rngre" ' nse ?qi!v 39 39 my,y 57 . . . , 3m gp SAMPLE MEASUREMENT i PERMIT - ' REQUIREMENT SAMPLE MEASUREMENT l PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT -
~p.
NAN PRWCW'AL EXECUThfE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PfRSONALLY EXAhMNED AND AM FARMUAR WMTH THE mFORMATION SUBMITTED MEREm; AND BASEO 04
/
TELEPHONE DATE
; f MY mOUIRY OF THOSE INDIVIDUALS fMMEDIATELY RESPONSISLE FOR l
ff David Orndorf OsTamma TwE mFORMATiON. i sfuEvt THE susMiTTED mFORMATiON is .e ' . o TRUE. ACCURATE AND COMPLETE. I Aas AWARE THAT THERE ARE i LA4 f Cheulstry Manager s'oa'ac^at PtaaLTies 'oa sUeMiTTwo FALSE WFORMATION INCLUDING
*14
- m **s113 M 01 '*' 7 THE POSS1000TY OF FINE ANO IMPRISONMENT. SEE 18 U.S.C. 51001 ANO 33 U.S.C. t 131s. mammee esisaw sw semanee mer emense mise age se 870,000 S00 NATURE OF PRuscePAL EXEdfflVE g TYPED OR PRWTED mas er __ . et terwe.a a msnme mW 6 yearms OFFICER OR AUTHOPIZED AGENT CODE NUGABER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af ertschments herof NO D $ f k es rn t EPA Form 3320-1108-914 Prow 6ous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF ,
03"e35/961003 083f! 1
e %'> ' r- _ y: . ; 4' . . i ,_
,i
- ' Paperwork Reduction Act Notice- ;
i [
~
l PuMie reporting turdt a for this codection of information is estimated to viry from a range of 10 hours as an
.l i ayerage rer responsrfar rome minor facilities to 110 hours as ariaverage per response for some major facilities, ;
I I
' with a weighted averm fer major and minor facilities of 18 hours per respome, including time' for reviewing ,
; udtructiam, reirching existing data sources, gathering and maintaining the data needed, and completing and 3 l
; reviewing ;th4 colhxtia, 6; information. LSend comments regarding the burden estimate or any other aspect of - l lthis collection of infonmt'on, including suggestions for reducing this burden, to Chiefc Informatiori Policy 3
- Branch, PMd23, U1 Environnwntal Protection Agency,401.M Street,ISW Washington, DC'2M60; and to the l 4
[ Office of Information and Regulatory Alfairs Office of Management and Budget, Washingtaa, DC 2' 0503. { _.w____i__.__._.._ . -j 6 1 4
-General Instructions :
I
~
; kIf funn has been paitially completed by prrprinting, disrrgard instructions directed 'at entry of that information
' already preprinted.. _- -
, . ;2. Enter " Permittee Samethiaihng Addren (and facility namelhcation, if difTerent)," "PermitbNumber," and . ;
*Dircharge Number" u here indicated. (A separate form is required for each discharge,)
- 3. Enter dates beginning ard ending "Alonitoring Period" covered 19 form where indicated.
l 4[ Enter cach "Parancter" as specified in monitoring requiremer s of permit. _ {
- .5 Enter " Sample Almrement" data for each parameter under "Guantity" and "Guality" in tmits specified in permit. I iferrnge" is ncnmd;y anthmctic average (gcometric average for bacterial parameters) of all sample measurements a j
~
- for each paramet r obtamed dming 'Alcmteing Period"; "Afarimum" and "Afinimum" are normally extirme high and low measmvments obtained during *Ahnitoring Period." (Note to municipals with secondary treatment i
( requirement: Enter 30-day average of amph, measurements under "Arerage," and enter maximum 7-day average i ! of sampic measurcments obtained during monit -ing period under "Alarimum. ") . ( l
- 6. Enter "Perrmt Rep rencnt" for cach parameter under "guantity" and "Guality" as specified in permit. -
{t
- 7 Under "No &" enter number of sample measurments during monitoring period that exceed maximurn (and/or
; mininmm or 74by a dage as apprcpriate) pennit requirement for each parameter. If none, enter "0".
- 8. Enter "Frcquemy af Analysis" both as " Sample A(casurment" (actual frequency of sampling and; analysis used , ;
- sdaring munitoring period) and as " Permit Requirement" specified ia permit. (e.g., Enter " Cont," for continuous ' ,
monitoring "l//" for one day per week, "l/30" for one day per month, "l/90" for one day per quaner, etc.) . t
- 9. Enter "Lmple 7)pe" both as " Sample Areasurement" (actual sample type used during monitoring period) and as '!
MPermit Requirement " (e.g; Enter '" Grab" for individual samples "241/C" for 24-hour composite, "A%1" for
, enntinuous monitoring, etc.) .
i .
% t i-. .lo.LWhere violations of permit requirements are reported, attach a brief explanation to describe cause and corrective .;
= actions taken, and reference each violation by date. ;
I'1; If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. 12 Enter "Namenitie of Principal hecutive OJJicer" with
- Signature of Principal Erecutive Ofcer ofAuthori:ed i
~ * ~
' Agent.* " Telephone Number," and *Date" at bottom oiform. ,
l 4 i o .
- 13. Mail signed Report to Office (s) by date(s) specified in permit Retain copy for your records.
. L . . t 114. More detailed instructions for use of this Discharge Afonitoring Riport (DAIR) form may be obtained from Office (s) specified in permit.
[
< 1 Legal Notice 1 l
-< 4 This ireport is rekuired by law (33 U.S.C.1318; 40 C.F.R.125,27). Failure to report or failure to repod truthfully can f result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day f of violation, or by imprisonment for not more than one year, or by both, -
j
.q
?
L L EPA Form 3320-1 (Rev. 08-95) g 9 V 4 _ . , . m.
PERMATTEE NAAE/ADOMEDtrededeFordeyNamierEarames(Difbrs=e NAME ic10NAL POLLUTANT DISCMARGE EUMfNATION SYSTEM (NPDES / Forrn Approved. DISCHARGE MONITORING REPORT (DMRf
- E T 'i # ,
V%LLE( P 9 V P 'i 3 T A T Il'! (2- 78# f'7-f81 #%IN 'E4EY INI " g y,* gg4 A00REOsu,3, 3yg ** c . *c = (spap 95) %1 gO as
*TT9; 34iIi T H D n !! ? PERMIT NUMBER DISCHARGE NUMBER y
, y{qg{
3% t N> I e ; o :n r ?4 10 ? ? FACILITY MONITORING PERIOD "4J3' LOCATION i f 1 */
- YALLf? PO = I3? 9?A'IO' YEAR MO DAY YEAR MO DAY _,,
FROM ,; ; ? - TO ot i? 31 '1 e s3 0tqc3A90 c$0 >r m,e,< [
- n. nr a nnne h0TE:
120'211 122-231 (24-25) 126-27I 128-291 930'399 Reed ineeucsone Wore hme ~c%{ % foros. PARAMETER 13 Card On/yf QUANTITY OR LOADING I4 Card on&f QUANTITY OR CONCENTRATION 146-53 c54-s ts (30-451 146-52 NO. MEQU9eC" SAMPLE (32-37/ 154-691 OF EX ,,,ty,s TYPE e AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,er.88 ts&ses (s9 701
, SAMPLE e ;. e. 3 ^ r enaegt ocecat ( 12) .1 3 , ., n m t , -
MEASUREMENT
. PERMIT 3 3,m e sectee o act ,,0
( GJ c c e. C a * - 7,^ 7,3 Y- /
- 3c) $4 vb,.- r - '-- s,tle REQUIREMENT JIG / R&B toit 4Tnrunw *t?ity* in P M *"
; 3 t r g ;, ppgg SAMPLE cre*wes went: 2 p.
MEASUREMENT pe.w 3 ( 1a) 99 y p. * .4 m
),z jo j ; -
. PERMIT w r; ,u - ewete c a
- ec4396 Q 7,7 gp fg,y / 3g hp '
30 - g y q7. ggp.c
, . . , ,,s s . REQUIREMENT
. ,c1 7,p. y.,, y ,, g g. pg p .g ft 3pg
'("4, 7" ^)uDO{? 33 SAMPLE 03 ace . + 9 7e ye es .y s c ;.
7[ ( r 3g T C, Ok 1t ; -<
> 1. 71 [ q i nLAnr U.U/3 O 4 hi.
s .s m 1 7 - PERMIT ,n23 n-:nnt ettes eccesa cot.cce ccc ' TE W crr s-:- REQUIREMENT fl5?D t v ,*r. ,.
,g ,p -3,7,y ,7 ,n p. g
.. , c ,, . s e v3.,, SAMPLE Mrn*' io^^93
"[,,*
MEASUREMENT 4 Met r ( 39) A O , 'f $ /,6d O Jo 66 3r) s [ y r PERMIT occa:Sc *aeCSe r 0 30t 't u c c e RE)3HT .tSPOR7 elCM/ -JA3
. r. i y $ - 3 , c .- 7gya REQUIREMENT eoe'
'o 17r IMT a#T 93/L MONT,r
- jt;pau$, y;cet SAMPLE i c h - ^ ^- 0 Feta; $?N63 MEASUREMENT Q (, c t i e. e e (
- J) p
- gg () g }y, a 1 4 0',', D PERMIT - ceh3^ 0 9 e
- 0 t: t u Mthee 2070 -Ca#pec 1 1 / FIC5/ 333
.e q ,e em- yy,.,, REQUIREMENT w 39 qq :qy ;pr 3L vgp
, 3 4 3 yp ; SAMPLE cco&'
- c '. t e ' otie$:
MEASUREMENT ( 19) ., j pjjg sa
;y, 29: fy,p /7, p O. 7g u ,, q ; y 1 0 PERMIT ' 'a c 9: t
- S e c e t 's ? 70' 00744S JS VLCp,/
1 50 O*p-r
,,p, ,.
cq3-- y , ,j . RECUIREMENT y 3 >- o ., 9 gyg py gf sy 3 ;y( y,c m SAMPLE MEASUREMENT PERMIT . REQUIREMENT NAMEfTITLE PRINCIPAL EXEOUTNE OFFICER e CERTtFY uNDER PEULTY Of LAW THAT t MAVE FfRSONALLY EXAMWED AND AM FAMIUAR WITH THE e0 FORMATION SUBMITTED MEREIN: ANO BASED ON A ,A j TELEPHONE D TE MY INQUIRY OF THOSE WDIVIDUALJ IMMEDIATH W RESPON98LE FOR OSTAWtNG THE INFORMATION, 8 SEUEVE THE SUBMtTTED tNFORMATION t$
.f f / J
.V /,
f f
/\- -/'/f'
/
I);W ld U Ttid O r g TRUE. ACCURATE aNO COMPLETE. 4 AM AWARE THAT THERE ARE 4 ',/ Y, F SIGNIFICANT PENALTIES FOR SUSMITTING FALSE INFOftMATION. INCLUDING - -- e
.+12 3g3 al13 p
g%',,,rp.v 4w- n ,, c , THE PossiestfTY OF Fes*E AND IMP 950*eMENT. SEE IS
- 7 C. 31001 AND 33 . ..
6 g 41 .-3.7 u.s.C. s 131s. namese eeMar ei.e sinnee mer ew* 5 mee se as a10,000 s00 NATURE OF PRINCIPAL EXECUT'IVE AREA TYPED OR PF.INTED andermenemen - - :er ser-m s eemes ass .sf OFFICER OR AUTHORt2ED AGENT MJteER YEAR MO DAY COOE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af attachments here) p g o. SeI W $- M e UF'O'r7*'f #I EPA Form 3320-1 106-961 Previous editions may be used. (REPLACES FPA FORM T-40 WHICH MAY NOT BE USED.) PAGE 1 e, i a. : / l $ 1 Q ll .4 nu'34
!. OF
c , , e 1 r'j
~ q <
!J L Paperwork Reduction Act Notice ,' !
, .. . q( '
( > Public reporting burden for this collection 'of infonnation is estiinated to vary from a range of 10 hovrt e an average per reymse for 5.ome minor facilities, to 110 hours as an average per response for sont major ficilities, I
'with a weighted average.for major and minor facilities of 18 hourrs per reeponse s includmg tisfor reviewing !
; instructions, surching existing data sources, gathering and maintaining the data needed, snd comp;eting and ,
. reviewing 'the collection of information. Send comments regarding the burden estimate of any other aspect of '
l this collection of information, including suggestions for reducing this burden, to Chief, liifonnation Policy
; Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the. )
- Office ofInfonnation arid Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
.m .,
c J - - -
, i
- General Instructions ' : _
i
!!/lf form has been partially completed by preprinting, disregard instructions directed at entry of tbat information already preprinted. .- -. .
i
- 2. Enter "Permitter NameAfailing Address (and facility name/ location, if di!Terent)," "Pmrit Number," and
; " Discharge Number" where indicated. (A. separate form is required for cach discharge.)
i
- 3. Enter dates beginning and ending ' Monitoring Period" covered by form where indicated. i
'_ ;4. EMer each " Parameter" as specified in monitoring requirements of permit.
'5. Enter " Sample Afeasurement" data for cach parameter under " Quantity" and
- Quality" in units spec'ified in pennit. l "Awrage" is non. ally arithmetic average (geometric average for bactcrial parameters) of all sampk measurements l
, for cach parameter obtained during "Alonitoring Periocr; "Afarimum* and "Afinimum" are normally extreme high ;
and low measurements obtained during "Afomforing Period." (Note to municipals with secondary treatment !
- requirement: Enter 30-day average of sampic measurements under "Arerage." and enter nuximum 7-day average '
of sample measurements obtained during monitoring period under "Afaumum. ") ! 6.i Enter " Permit Repirement* for each parameter under " Quantity" and "Guality" as specified in permit. ,-- _- ,
'7.'Under "No Er" enter number of sample measurments during monitoring period that exceed maximum.(and/or '
[ L minimum or 7-day average as appropriate) permit requirement for cach parameter. If none, edter *0", , j
'8JEnter "Frepency of Analysis" both as %mple Measunnent" (actual frequency of simpling and analysis used !
'during monitoring period) and as " Permit Repirement" specified in permit. (c g , Enter *('ont " for continuous i
< monitoring, "l/7" for one day per week *l/30" for one day per snonth, "16(r for one day per quarter, etc.) - g
- 9. Enter " Sample Type" both as " Sample Afeasurement" (actual sample type used during monitoring penod) and as (
" Permit Repirement " (c g., Enter
- Grab" for individual sample,:"24HC" for 24-hour con posite, "N/A" for j continuous monitoring, etc.)
'10.:Where violations of rmit requirenients are reported, attach a brief explanation to describe cause and corrective actions taken, and rc etence cach violation by date.
I1. If"no discharge" occurs during monitoring pcthi, enter *No Discharge" across form in place of data entry. [
-l2. Enter "Namenitie of Principal Executiw O$cer" with
- Signature of Pnncipat Exeative Oficer of Authorized
(
, Agent *
- Telephone Number," and *Date" at bottom of form. l t ~13. Mail signed Report to Office (s) by date{s) specified in permit. Retain copy for your records. j I4, More detailed instructions for use of this Discharge Afonitoring Report (DA/R) fann may be obtained from Office (r) :'
specified in permit. Legal Notice i 4 s
~
This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to repost or failure to report truthfully can ! result in civil penshies not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day ; of violation, or by imprisomnent for not more than one year, or by both. l . - i i
~
EPA Form 3320-1 (Rey,08-95) j 4 P
- . . - ~ - - .
PERMITTEE NAME/ADORESS(AwhoFerdlwyMa=vlorence(DgProw) ETIONAL POLLUTANT DrSCHARGE EUMMATION SWTFM (NPDES; Fenn Approved. NAME N _%,EMm m G M Tft7% O y 3y. y g ggy y ;ggg ;7y777 7)y my qgqr 7pp3 OMB No. 2ON4 ADORE 03 p , 7, 3;1 . "''; 9 ' t ' ( "> i
- 7 ?51 ## Y'N 03' r3; 74,;) 3 epq,e PERMIT NUMBE3 DesCH ARGE NUMBER p ,,, 7 ,; y {
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MONITORING PERIOD r-
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3 ;3; - 7 , ,;7,t LOCATION FROM ' ' "i TO 9+ 1, 4t uO? tO D y 7 7 :.r 3 n n e - l l %$ . -, . -s *yrn , n7'e (20L27/ (22-23/ (24-251 (26-27/ (28-29/ (30'371 NOTE: Reed instructione before"~ c ompleting this felm. (3 Cmf on&F QUANTITY OR LOADING NO. mEQM ggyp(g I4 cm(On/r; QUANTITY OR CONCENTRATION PARAMETER (46-531 (54-619 (30-451 (46-531 (54-619 OF s (32-371 EX AnALYus TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS cas; fmgj ggg7o,
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PERMIT g . 3, or p ,e n5ect c0e$^" 4 M r.: C o ' ^u': 0 i l' M [, Y STI;t 7 REQUIREMENT c ,, . . . 3,a q. , , _ ,, gy- r,t, ,g . ,
>coe SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT m
NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER : CERTIFY UNDER PEN ALTY OF LAW TMAT 4 HAVE PERSONALLY EXAMINED AND
/ TELEPHONE DATE AM FAM!UAR WITH THE WFORMATION SUBMtTTED HEREIN; AND BASED ON / \ [ j MY INQUPRY OF THOSE WOtVfDUALS rMMEDIATELY RESPONSIBLE FOR /
DGV1d U.TildO II / OeTAIN*NG THE mFORMATION, t SEUEVE THE SUBMITTED INFORMATION is c M '
'/ -,#
chenistry Manager sT,cN RUE,, ACCURATE AND COMPLETE. s AM AWARE TMAT THERE ARE
,, CANT PENALT:Es FOR SUeMiTrma rALSE mFORMATiON. iNCtuDiNo ~['
412 393-5113 97 01 27 THE u.s.C.POSSI8tuTY s 1 sis. sRenenw OFanwar r'*tt.AND si. IMPRISONMENT. Ma,=. m y men,sw #in SEE. uptosoU.S.C l 1001 AND s10,000 33
&lONATURE OF PRINCIPAL EXECUThit g TYPED OR PRINTED sap er msnmueC- - .: er eerw a s memns ane s yearms OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# ettschments heraf EPA Form 3320-1 106-95) Prev 6ous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF 3 3 p, g,
( .p. u. .
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w l 2 - !m W' 1 - J - Paperwork Reduction'Act Notice 4 -
- - - +- *
{ .. , ,
, i PuMie-repiting burder fcc this collection of information is estimated to vary from a range hf 10 hdurs as a,n -
!' ' : average per response fs ecme minor facdities, to 110 hours'as an avera)e per response for sorh -
! with a weighted avertp fer major and niinor facilities 0118 hours per response, including time for reiviewing -
; instructions, rearching exiuing dxa sources, gathering and maintaining the data neede.d. and completing and -
i
- l i . aviewing the co!!<xtiua ur infennation. Send cumnents regarding' the burden estimate or any other aspect of l
; this 'co!!ation of infamation, induding suggestions for ralucing this burden, to Chief, Informatibn Policy i l-
~ Bnuxh, PM 223, U.S Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the
.j (Office of Information cd Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
m .L ___._ .m __ _ - _ _._ j v LGeneral Instructions it
?7 .
11 If form has been putially completed by preprinting, disregard instructions directed at entry of thdinformation : 4 "already preprinted- ~ 2.- Enter " Permittee Namc 3failing" Address (mid facility namc/ location, if difTerent)," " Permit Number," and . ._ f Discharge Numb # dere indicated. (A separate forni is required for cach discharge.) * !
- 3f Enter rbtes begim ing and ending " Monitoring Period" covered by form where indicated.
4[Ehict each "Parai u ter" as.speedied in monitering requirements of perndt. ! 3
.5, Entcr "Smnple Menarement' data for each parameter under " Quantity" and "puolity" in units specifidd in permit. .. $
Wrage" is nrrnc3ymnthmctic average (geometric average for bacterial parameters) of all sampic rucasurements i
- for-cach pirameta ebtained dante " Monitoring Period"; " Maximum" and " Minimum" are nonnally extreme high !
! and low measurmnts obtained during "Memitoring Permd." (Note to municipals with secondary treatment , l l nx;uirement: Enm 10-day aserage of sampic measurements under "Arerage " and enter maximum 7-day average ; :j
, of sample menur ants obtamed during monitoring period under " Maximum?) j
- 6. Enter " Permit Reprement" for each parameter uruler " Quantity" and " Quality" as specified in yrmil ,
1 O Under "No Ex" car number of nmple meamtments during monitoring period that exceed maximum (and/or . l
- mininmm or 7-day merage .as apprepriate) permit requirement for each paramcier. If none, enteco"J T. $n[ei"Frequcncy if 4ralystf both as "Nample Mcamrment" t' actual frequency of sampling and analysis used 1
!d. iring mhnitoring period) and as " Permit Requirement" specified in pennit. (e.g., Enter " Cont," for continuous - !
monitoring, "//7" fer one day per weck, "l/3u" for one day per month, *//90" for one day per quarter, etc.)
- 9. Enter "
" Sample 7)pe" both as " Sample Measurement" (actual sample type used during monitoring period) and as
, Prrmst Requirement," (e g., Enter " Grab" for individual samplei "241/C"' for 24-hour composite, "N'A" for
'contmuous momtonng, etc.)
- 10. Where violations of pennit requirements are reported, attach a brief explanation to describe cause and corrective
- ' actions taken, and rcference cach violation by date.
!! 1. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
- 12. Enter "Name! Title of Principal Executive Ollicer* with
- Signature of Principal Executive Ofcer ofAuthori:ed
' Agent," " Telephone Number
- and "Date" at bottom of fonn;;
~
e, ,
- 13. Mail signed Report to'Ofnce(s) by date(s) specified in pennit. Retain copy for your records. i' i . -
- 14. More detailed instructions for use 'of this Di3 charge Munitoring Report (DMR) form may be obtained from OfUce(s)
~i specified in permit.
]
n , Legal Notice ; l 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 4 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 violktion, or by imprisonment for not more than one year, or by both. j d
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' EPA Form 3320-1 (Res. 08-95) ', .l l .;-
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- - _ _ _ _ _ - _ _ _ _ ~
PERE 4TTEE NARE./ADDfESS W FereryNa=arfarersee (D@res@ NATIONAL POLLtffANT OtSCHARGE EUMtNATION SYSTEM (NPDES / Form Approved. NAME DISCHARGE MONITORING REPORT (DMR/ ogggy m
"A V r i VALLEY POW D 3 ? 3 T ! P, '2-87 f f 7-781 U"TT 2 C3OL T 3 2 'i H -
AcoRE s p , -), gy 2 -aa,'r(*r s, 2 - (333u rp) A N ' Y ' M, -7 3I-88 1?!K; 3Af!D GTNDO9p PE".MIT NUMBER y *ARGE NUMBER p , qg
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M10PInit M T rA 19077 MONITORING PERR4 95 M ,_
H*&VPA 7#LLMT P 3 4 5' I 17 & "'I l M YEAR MO DAY YEAR +40 DAY LocATm ~ FROM es s e ni TO as !? 11 cea a n I U g 4 n t; g t see s**t . n=o?3 m :- n 1 g t- (20L2FA (22-23/ f24-251 (26-271 (28-29) (30-311 NOTE: Reed instruc6 ens bef -completing ens foPm. (3 cerer onrys QUANTITY OR LOADING PARAMETER I46-531 I4 cent on/r/ QUANTITY OR CONCENTRATION NO. P"EQ M SAMPLE f54-619 (30-451 146-531 (54-619 OF e (32-37; EX AnA(yys TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM ' UNITS pes, ,ges, fg,.pg SAMPLE g MEASUREMENT 394 9.9 ec.pe3; g e g 3 ,,. g;
; q e r: p 3 3 3 PERMIT neence c o mr e r m . ,,g. enceco- ;, q -
g;ggy- pg a3q- y* Enc REQUIREMENT p,79 q,
- v e r p . ,. - 1 e ,., 3 g g 7 7q, SAMPLE
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MEASUREMENT e3nta- ee93.e .~9ecg3 { 19)
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PERMIT WMe o
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WW/ 99-
.cy3 ., ; 3, g, , 7 . g. ~ 3 sg 7 pgyg gy ,g7 ggyg
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kIG/ :nts , REQUIREMENT gg
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a gg o9 yap 3ys? p ;, 4 , , MEASUREMENT gg gg;
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~23 er e v - 2,c gyp, ftEQUIREMENT ,, 3 jg .,g;gy yy g ,. , . jun SAMPLE MEASUREMENT PERMIT ,
REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCNDAL EXECUTIVE OFFICER I CERTIFY UNCER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND / TELEPHONE DATE AM FAMIUAR WITH THE INFORMATION SUSMITTED HERON: AND BASED ON N j MY INQUIRY OF THOSE INotVfDUALS IMMEDIATELY RESPON98tt FOR \ r / / . { {O gIb{O I [ OeTAINING THE INFORMATION. I BEUEVE THE SUBMITTED INFORMATION IS { [f[d '
/
TRUE, ACCURATE AND COMPLETE. I AM AWMIE THAT THERE ARE g /j , , y (,q101'11 fil Ty eDIlGEC I~ SIGNIFICANT PENALTIES FOR SueMITTING FALSE $NFOf4AATION. INCLUDeNG THE Posse 8UTY OF FtNE AND IMPRISONMENT. SEE 18 U.S.C. 91001 ANO 33 P t1^ 109-%111 4/ O] 77 TYPED OR PRWTED u.s.C. s lais raamuse enMer meme seNues mer sicA,eN mwe se me aro. coo
- ereerwome s menens ow a ms S4ONATURE OF PRINCIPAL EXECUTIVE g - = -
awermer* nim _ omCER OR AUTHOREED ADE88T CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference erettechments here/ A_ ) , b, -bs c-e EPA Form 3320-1 (06-96) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE an u 4 / 3 61'O O ? "i J 4 y OF
1
. g
- - - - ya..ew... n.s.m m-m
; Paperwork Reduction Act Notice l Public reporting burden for this collection of information is estinuted to vary fmm a range of 10 Imur< as a i adage per response for some minor facilities, to 110 hours as an average per response for somt. nuior facilities l ;
with a weighted average for rgor and minor facilities of 18 hours per response, including time for reviewing i
' instructions, inrching existing data sources, gathering and maintaining the data needed, and emnpleting and
. reviewing the collection of information. _ Send comments regarding the burden estimate or any other n@ect of j this collection of information, including suggestions for mducing this burden, to Chief, Informt' ion Policy iBranch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Wahington DC 2040; and to the ?
Office of Infonnation and Regulatory Affain, Office of Management and Budget, Washington, DC 20503; t
,' , General Instructions 1.-If form has been partially completed by preprinting, disregard instmctions directed at entry of that information already preprinted. *
;2. Enter "Permittec Name4/aihng Address (and facility namc/ location, if di!Terent)," " Permit Number," and
" Discharge Number" where indicated. (A separate form is required for each discharge.)
- 3. Enter dates beginning and ending "Afonironny Period" covered by form where indicated
- 4. Enter cach " Parameter" as specified in monitoring requirements of pennit.
- 5. Enter " Sample Afeasurement" data for each parameter under *guantity" and "Grahry" in un:ts specified in permit. , ,
" Average" is normally arithmetic average (geometric average for bacterial parameters) of all Nunpla measuremer:ts
- for each parameter obtained during "Afomforing Period"; "Afarimum" and 'Afmimum* are normally cytreme high and low measurements obtained during "Afonitoring Period" (Note to immicipais with sccmdary treatmerit i - requirement: Enter 30-day average of sample measurements under "Awrage," and enter maimum 7-day average i of sampic measurements obtained during monitoring period under "Afarimum. *) !
- 6. Enter " Permit Requirement" for each parameter under "guantity" a:id "Guahty" as specificd in permit. I 7[Under "No Er" enter number of sampic measurments during monitoring period ttut exceed maximum (and/or -
minimum or 7-day average as appmpriate) permit requirement for each parameter. If none, cuter "0", l S. Enter " Frequency of Analysa" both as " Semple Aleamrment" (actual frequency of sampling and' analysis used l during monitoring p<riod) and as " Permit Requirement" specified in permit. (c g., Enter " Cont " for contimious monitoring, "M" for one day per ucek, " loo" for one day per month, "160" for one day per quarter, etc.) l i
- 9. Enter " Sample Type" both as " Sample Aleasurement" (actual sample type used during monitoring period) and as l
" Permit Requirement " (e g.,- Enter " Grab" for individual samp!c, "At/K' for 24-hour composite. "N/A" for J continuous monitoring; etc.)
i IQ.1Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
~
actions taken, and reference each violation by date. j l 11,' If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry. ) i
- 12. Enter "Name/ Title of Principal Executive OJ]icer* with " Signature ofPrincipal Ewecutive Ojpcer ofAuthori:ed i Agent " " Telephone Number," and "Date" at bottom of form. !
- 13. Mail signed Report to Office (s) by date(s) specified in permit. Retain copy for your records.
- 14. 'More detiiled instructions for use of this Discharge Af<muoring Report (DAfR) form ma3 be obtained from Omce(r) j specified in permit. j 1
Legal Notice ! Thiffreport is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failure to report truthfully can resuit'in civil penalties not to execed $10,000 per day of violatmn; or in criminal penalties not to exceed $25,000 per day l l of violation, or by imprisonment for not more than one year, or by both. l l l
+ ,
. 3
.i EPA Yorm 3320 I (Rev. 08-95)
( , l
PERamTTEE NAndE/AODRESS mededehe,Fewimanes efW NAnONAL POLLUTANT Dt9CHAAGE EUM= ANON SMT54 (AFOfSJ Form ( ..d. DISCHARGE MONITORING REPORT IDMR1
. NAtAE
< e, A V * ( /&LLf( p34?P iT1?I71 P-76/ 19 7-f 9/ fj 4 I I 2 AUY RMLN9 g g:y .y .
AOOREIS p , ") , 33{ g *"^'0 t" S** * ( $!! M "5) tTrF; MyiD 3uaoer PERMT NWBE3 DESCHARGE NUMBER
*F - ,5 u u.
".iHTPPIN m ?? P t. 1E177 MONITORING PERIOD M A E" g bTh7EC UAilEY 93V 9R ';TRTIJK YEAR MO DAY YEAR MO DAY LOCATM FROM sw 1/ li TO 9- i> il $$3 N3 D T 3 O A H O .S ^ ??f
??e3 sxvv, Se..nmnr (202iA (22-23 f24-25; (26-27; (28-291 (30'3ri NOTE: Reest instmeelene kWeTWRP l oting Wile 4.
PARAMETER 13 cent on&A QUANTITY OR LOADING I4 cent on&f QUANTITY OR CONCENTRATION NO. PRE N SA I46-52 (54-611 136-459 (46-5 2 154-619 of t32-371 EX m Y,s TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS nu3, g,4.,,, g,,ygy J i,13 :; , 73 pt L SAMPLE e g g t_ e y epos~c p y g 3 ;- ( ) g) MEASUREMENT 7 3 3',30 .1 } g PERMIT negae .3%e39 3 . rf e ggpeep q tgg .3 ggggj ggp.
.- g o c .r e *,e-. REQUIREMENT f33 3 . g .j .. pgypy yy. . g g .g i y ., e 0 - f SAMPLE
" 3' r.,s,..
MEASUREMENT o n #. e e n eeept * *: c c c c ( 14) DEOS T i ! d U R .T 7 "P!d
, 3 c. q s 3 g PERMIT cupe ta #en c toc ccetts 15 20 ' ^?
WICM 3AS
,. i. J , . e ., ,y-lyr v,3, REQUIREMENT m, p 3yg h g My iq
- r; / g, hoh?q SAMPLE ,
93yg3 p" "m ' '" ,
'LDW, IN ~ 3 9 3 i! [
- Oc 3 ~ * * ' ' ^
' 4. H ! '4 MT191f PLigt MEASUREMENT [ () b O rj
* #" -# *** ? EEXLY' STE REQ IR NT o ,.
3e. . ~ . . ,, 7 n w - , , ., .- ,,,, SAMPLE MEASUREMENT PERMIT REQUIREMENT > SAMPLE MEASUREMENT PERMIT - REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT , i SAMPLE MEASUREMENT PERMIT . REQUIREMENT - NAME/ TITLE PMAL EXECUTIVE OFFICER e cERnFY UNDER PENALTY OF LAW THAT e HAVE PERSONALLY EXAMMED AND 'N '1 , 'n TELEPHONE DATE AM FAMIUAR WITH THE INFORMATION sUeMITTED HERDN; ANO BASED ON i f /. MV tNOUIRY OF THOSE =DivtDUALs IMMEDIATELY RESPON98tf FOR i
/ / w
^ "o mt =F RMan N. i sEutvf mE sueMiTTED mFORMAnON is *'
David 0rNdorf TRUE."' ACCURATE AND COMM ETE. t AM AveA THAT THERE ARE f 4- "/. ad1 x s jf WoNiFicANT nNALnEs FOR sueMim FALSE m,RE ORMArm. =ctuDma
+12 393-5113 97 01 27 Chemistr2- Mannb>er THE POSSetuTY OF FINE ANO IMPRISONMENT. SEE to U.S.C. 91001 AND 33 u.s.c. t 131s. smnwmee womw snese seenme mer hiesume mwe se M troAce SiONATURE OF PRINCIPAL EXECUTIVE TYPED OR PMWiTED mar er mare n : _ _ _ --er anween s memne amr s years # AREA NuteER OFFICER OR AUTHORIZED AGENT CODE YEAR MO DAY COMMENTS AND EXPLANAT!ON OF ANY VIOLATIONS (Reference a# effechments here/
N(> l h t'. k0f?C EPA Feren3320-1 (08-96) Previous eds6one may be used. IREPLACES EPA FORM T.40 Wi#CH MAY NOT BE USED.) PAGE OF g pq g
. , ,. -. w_.., . - - . - . , - - - - --- . e--- = . r--. ._m -
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a m y .
- v. +
s . i.- i i L l
. Paperwork Reduction Act Notice-
* , l
- Public repmting burd= n for this collation of information is estimated to vary from a rr.nge of 10. hours as an
~ l
} . average per responw fa Lerm minor frilities, to 110 hours as an average per response for sorne major facilities,
} pith a we.ighted avenge fu major mid. minor facilities of 18 houn pernsponse, including time for reviewing ;
}' iinitrmtums, fearching exbting data ^ sources, gathering and maintaining the data needed, and ' completing and
- reviewing the col!cetica of infonnation. . Send comments regarding .the burden estimate or any other aspect of . .
I lth's i collection of infamaso, including suggestions for reducing this burden, to Chief, Information Policy l l Bouu.h, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC,20460; arid to the . F OMce of Informstion and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. ; g n .-.. :.a. _ - ~ - - -
~
~
General Instructions m , t
- 1. It form has been prtially completed by preprinting, disregard instructions directed at entry of that information i already preprinted.
1
- 2. Enter *Pernuttee Nameafarling Address (and facility namellocation, if Lictent)," " Permit Number
- and l
"Dischorge Number" where indicated (A separate form is required for cach discharge.)
- C 1
- 3. Enter dates trginring ned endmg "A/omraring Period" covered by form where indicated
- 4. Enter each "Parai eter." as speciSed in monitoring icquirements of permit. # '
5 Enter " Sample At awrement data fer each parameter under Guantity" and "Guality" in units specified in permit. .
% crag .is normMy arithmetic average (geometric racoge for bacterial parameters) of all samp!c measurements ;
for each paramettr obtained during *Afomtoring Permd"; "Afaumum" and "Afinimum" are normally extreme high ! and new measuremenh obtained during "Atonitoring Permd (Note to municipals with secondary treatment , t rrquirement: Ever 304iay average of sampic measurements under " Average," and enter maximum 7-day average j of sampk measuramcats obtained during monitoring period under "3/aximum.") ,
'6. _ Enter " Permit Requ:rement" for each parameter under " Quantity" and
- Quality
- as spccified in permit. , l
, D! '
- 7. Under "Nd Er" ennt number of sample measurments during monitanng period that exceed maximum (and/or minimum or 7-da average as appropriate) pcrmit requirement for each parameter. If none, enter "0". >
- 18. Entei " Frequency qf Acalysis" both as "Sunp/c A/casurment" (actual frequency of sampling and analysis used
, dging monitoring period) and as " Permit Requirement" specified in permit. - (e.g., Enter " Cont," for continuous -
monitoring. "#7" for one day per weck. "160" for one day per month, "upa" for one day per quarter, etc.) - ;
- 9. Enter "&unple n// both as " Sample A/casurement" (actual sample type used during monitoring period) and as l
" Permit Require /nent," (e g:.' Enter " Grab" for individual sample, "24HC" for 24-hour composite, "N/A" for ;
Jcontinuous monitoring, etc.)
. 10.LWhere violations of pennit requiremems are reported, attach a brief explanation to describe cause and corrective actions taken, and reference each violation by date.
11, if"no d$ charge" occurs during monitoring period, enter "No Discharge" across form in place'of data entry. :
- 12. Enter "Namemtle of Principal ErecutivJ Oficer" uith
- Signature ofPrincipal Erecutive Oficer ofAuthorized
' Agent," " Telephone Number," and *Date" at bottmn of form. )
- 13. Mail signed Report to OfUce(s) by date(s) speciDcd in permit. Retain copy for your records.
i
- 4. l14. More detailed instructions for use of this Discharge Atonitoring Report (DAIR) form may be obtained from OfDce(s) >
' specified in permit. 1 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 trutnfully can , L result in civil penalties not to exceeA $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day l of violation, or by' imprisonment for not more than one year, or by both. )
, o EPA Form 3320-1 (Rev. 08-95) t _-- _ _ _ . - - - - - ,
PERACTTEE seAesEIADORESS puwere,hw! eregn, w esAnOssAt mOttuTAmt osecManoE euaAmAnOss sYsraA (AFDFS/ Form Approved. "' NAtaE DeSCHARGE MONITORSMB REPORT #DMR1 aand MSV9 V4LLh!.POWCE I T M I 3 'l 72- F " (7 7-N U517 1 3IL OM9 O W h M. - - s .
- j. ADDRESSp 3 , g3 4 " e,m, ectr t9' PERMIT NUMB A DescHAmeonamR (5UFR 35) I'l'1** Y' -
y ir;s: ra yIa 9aaow _ 7yyyL S M I P P I*r D O R T - P ;L 150'? '~UO2
.. ? A V ? P- 7&LLEY POVER STATIS4 MO MOMTOREWG PSUOD
.: I YEAR DAY YEAR MO DAY LocA m .
FROM es 1i qt TO as ?/ 11 o fr 4 ' 9 0 g [ S C H ;, P C "' l j ecc r r> v n . msv*s nuepue t262tl 422 22124-251 - 126-211 (20-297130usts NOTE R** M & ~ 5 % M PARAMETER (3 w % i QUANTITY OR LOANNG I4 Carst %f OUANTITY OR CONCENTRATM3M NO. mEousec" SAhrLE l 146-531 154-611 130-4GI I46-6M 954-691 or . 132-37A EX was TYPE + ' ? AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS soum ,g pg [ SAMPLE CMn63
,3 33rce* e a: e e s t y
( 12) O / f l MEASUREMENT 7, M 7, M 7 Md . i PERMIT - r
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(3conOFn MEASUREMENT
/ $6 3 37, Y O / h6d t
[ 3 7 6' k ,i .a v ~ g - PERMITg .cogeet- ' cye4*$jo e$ LC O W 40 ' 37 ^ 100 l4 GKL Y. ' RAS
, ,. s ,
kne: 7,, 7r REQUIREMENT .e 3 3 .s. y agg: ' fj t. p L y =g M/ L ; SAMPLE ML 1,I D oM.. ~ g A ~* L. up3e $tette a#t40) ( 19) I R F :) n E X TR ~C 9k 4 G ,R ' MEASUREMENT 4 $~ <f C l' 7 M !
,5 ,
3 _ PERMIT ' c o eg ey ; *r c M t t . C 00 :cMep 15 20- + W LI LM '
) h :., ,5 5 e1,3he y s_ r , . REQUIREMENT uny ; mi n y p f) y gbo N Y v/L SAMPLE L , ;d IV 03FD9IT g ( 03) tic #C3 000720 *COOCe / ._ ;
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SAMPLE i MEASUREMENT ' PERMIT : - t
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l REQUIREMENT ' SAMPLE j a MEASUREMENT PERMIT . , [ REQUIREMENT 4 SAMPLE - [ MEASUREMENT - PERMIT. ' i REQUIREMENT fn 6 PMAL EXECUTnfE m e cERTrev unoER resALTv or LARAf THATI HAVE PERSOISALLv EXAAAlesED AND TELEPHOffE DATE ARA FAhAIUAR WITH TMt 'erORBAATIOso SuBIAITTED MERElet; AND SAsEO Oss , 1 ', i t#V 1980UlftY or THOsE thfDMoUALS ftAAAEDIATftY REseOfesIBtf POR ' [. , ., i OSTAINefeG THE mrORhAATILM. I SEUEVE THE SugaAITTED INFORBAATIOes IS / Dayid Orndor1.- TRUE. ACCURATE AfdD CO M ETE. 8 ABA AIAfARE THAT TMERE ARE sionincAnT reemnEs poR suommTnma FAtst arORnAAnOu. metuomo W ~g , , ~',- [ % t r l
"" . . . .- THE consesury or n=E Ano = _ _ nr. sEE is u.s.c. e iooi Ano as t fa , dwq13 97 01 27 i SIONATUIE OF PRNICFAL EX@UTVE TYPS OR PMITED u.s.C.
mis er 5 isie. drisnmasse answ rmer sne.se a.ssesses e nasamemer andsieAuses s pensi mise ass se sto. cop NURSER mesmessnesse OFRCER OR AUTHOREED A%IENT A hA rv YEAR MO DAY I COr/sMENTS AND EXPLANATION OF ANY VIOLATIONS IReference af steschmener here/ I l l 6 EPA Form 3320-1108-95) Previous editone may be used. IREPLACES EPA FORM T-40 Wt#CH MAY NOT BE USED.) -- PAGE OF O0100/%1003-03N L l t
. - _ . . . _ . . . _ - . - . . . _ . - - - . - . - _ . . . _ .---__--_-_m--wn__,,~ , , , , , _ . _ . . . - - , . . . , . _ - . -_ w - . - , , . . , , - . , _
7, , 7 w J 'l Paperwork Reduction Act Notice
' Public reporting burden for this collection of information is estinated to vary from a range of 10 hotrs u an
- average per response for t.ome minor facilities, to 110 h~ours as an a~verage per response f6r some taajot facilities, .
I qwith a weighted average;for major and minor facilities of.18 hours per Jesponse, including tirne forsviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and - treviewing the collection of.information. Send comments regarding the burden estimate or any other ageet of
.this collection of information, including suggestions for reducing this burden, to Chief, Information Policy i Branch, Pht-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the
,0ffice of Information and Regulatory Affairs, Office of Management and Budget, Wahington, DC 20503.
_a General Instructions ,, k
' t.Alf form has been partially completed by preprinting, disregard instructions directal at entry of that information already preprinted.
- 2. Enter " Permittee Name/Afailmg Address (and facility namcilocation, if ditTerent)." " Permit Number," and p
- Discharge Number" where indicated. ( A separate form ss required for each discharge.)
- 43. Enter dates beginning and ending "Alonitarmg Period" covered by form whei indicated l4. Enter each " Parameter" as specified in monitoring requirements of permit. 5
- 5. Enter " Sample Afeasurement" data for cach parameter under " Quantity" and " Quality" in units #pecified in permit.
" Average" is normally arithmetic aserage (geometric average for bacterial parameters)tf all rample measurements r- for caen parameter obtained during "Afomtoring Permd"; "3/asimum" and "Afinimum" are normal'y extreme high and low measurements obtained during "Afonitoring Period." (Note to municipals with secoadary treatment requirement: Enter 30-day average of sample measurements under " Average " and enter maximum 7-day average of sample measurements obtained during rnonitoring period under "Afarimum ")
64 Enter " Perma Requirement" Sr each parameter under "Guantity" and "Guality" as specirted in pemiit.
- 7. Under "No Er" enter number of sample measurments dming monitoring period that exced rnaximum (and/or minimum or 7-day average as appropriate) permit requirement for each parameter. If r.one, enter "0".
8.~ Enter " Frequency of Analysis" both as " Sample Afeasurment" (actual frequency of sampling and analysis used during monitoring period) and as "Pernut Requirement" speciGed in permit. (c g., Enter Tont," for continuous monitoring, "//7" for one day per week, "Ido". for one day per month, "hvo" for one day per quarter, etc.) '
- 9. Enter "Sarnple 7)pe" both as " Sample Afeasurement" factual sample type used during monitoring period) and as
. -"Permit Requirement," (c g., Enter " Grab" for individual samp!c, " Art /C" for 24-hour composite, "N/A" for
, < continuous monitoring, etc.)
110. Where violations of permit requirements are reported, attach a brief esplanation 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/ Title of Principal Executive OJJicer" with
- Signature ofPrincipal 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 (r) specified in permit Legal Notice This tynrt is required by law (33 U.S.C.131B; 40 C.F.R.125.27). Failure to report or failure to report; truthfully can result . olvil penalties not to exceed $ 10,000 per day of violation; or in criminal penahies not to exceed $25,000 per day of violation, or by imprisonment for not more than one year, or by both.
n ,. t-EPA Form 3320-1 (Rev. 08-95) w $ . , .
PEmemTTEE NAEADDES(3= sends 7ssesyNeus/Ler====(W NATIONAL POLLUTANT OtScHAfteE EUMesATIOst SYSTEM (AFDES) ^ Feffvt ApgNewed.
# b M E; V: I 71 L L M F 3!/ E:t 57%?I3F ff 3 b-'YURBIC" FLD3 3 t'9e ADDRE2S N L . p g 't "''(;r'* * *
('i'J P 7 SM " k*'P'** t77N; PAVID 30EDORP PERM NUMBER OracMARot uuMem p ,
-pyg4L
,eIPPN~POwr M -15 0 ? 7 MTORWG PSUOD I LI P y BM Y*.1'fALLEY POMER 5?ATI3N YEAR MO DAY YEAR MO DAY . .,,
LocAn m . FROM 4, 17 fy t To a r., - 12 11 000 NOTE; M NO DI3m M6 ( ) ~ Sc3 N a e v a; s atgyn Qvn%2n 12O 219 122-23I (24-25) (26-27) (20-291 130"31) ' - PARAMETER (3 N W QUANm M LM (4 M W MM M NM NO. M SA (46-539 154 4 19 (30-46I 146-639 (64411 or (32-37f EX myg,s TYPE. AVERAGE MAXIMUM UMTS MINIMUM AVERAGE MAXIMUM UNITS num fg ,g SAMPLE . posy 3 t{ MEASUREMENT 3 3 ac =. o 3
- 7. 3 )
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,q g y g - PERMIT - . p u cy e e W' 3 3 . 0 .*b .D- *C70**. ) e ? -' } CIMUI fA3 REQUIREMENT
- e 3 .- c 7a; or m33 g y g r maw a s y T 4 ff C w ,
3Lio:' m
'3 SPENS *O SAMPLE MEASUREMENT nn% che m $ Mot) < gp ( 19 O [7 hg"
, 3 c, c h .3 gng ;Nn c
'{ ) g . PERMIT .
REQUIREMENT u n-e $ - teetote
- 20 ? 279*804 M' 100 YE MU DF 13y se mu '
47 3/3- B R T LY t M Y : **/T SAMPLE
;t t gyg ; g p3 n 3r33 E q r st -011 V UTH MEASUREMENT n933ei & ri a: T ? e C9 2CM 4{ g{ ( 19) Q '7, jg PERMIT . A0400L$ (5 1 S s ci 6 L 3 0 .M a & M :00 . E tt40 - 20 - Ik UKLT. EA3 N , n :. c e --w _ nm REQUIREMENT ceu & t y c; 'DartT>My eq/L gog *argp+gN* pL&F*
~ ,$ g y ,' 3 ', SAMPLE MEASUREMENT O,OC8 C. 6D E
/
- 33) &#CC*' ****** "****
O D *#W bb0 1 h .PER M . . REQUIREMENT Kgr yn:3 9
; WW ' i
-n n r g y .~ , y . .qn W M- MW W MYT M Y MI [S 77ryr4 + -nnqg y a t ni $43^
, SAMPLE MEASUREMENT PERMIT , REQUIREMENT , SAMPLE MEASUREMENT PERMIT REQUIREMENT , 4 SAMPLE MEASUREMENT PERMIT . . REQUIREENT T - 6 PMR EXECUTIVE N 4 CERTIFY UNDR PENALTY OF LAW THAT I HAVE PERSONALLY EXAMiteED AND AM FAMIUAR WITH THE NIFORMAhosi susMsTTED HERE100: AND BASED Oss /,i /
/! TELEPltONE DATE MY IIeOulRY OF THOSE ledOIVIDuALs IMMEDeATEiY REsPON90tf FOR / 1 David orndorp OSTAIIsleet THE mFORMATIOes, i SEUEVE THE sutamTTED iseFORMAftoes ts TRut. ACCURATE AmO cOMetET AM AWARE TWAT TweRE ARE s
^. /
' O /
Chenistry L4anager maner cA=T eE= Alms FOR suse E. eAtst meORMAnow. =ctuomo TTwo ' 412 393-5113 97 01 27 THE possouTY Or emE AmO surmisonMEnr. set is u.s.c. e iooi AmO s: / v.s.c. e iste. sReismise esisser mese sususse mer Aiemmin mese se se 870.000 S40 NATURE OF PRINCE *AL E ,,,, TYPED OR PRINTED sav er . . ' a sesween s maame e=W s peeras OmCER OR AUTHORIZED AGENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATICN OF ANY V'OLATIONS (Reference af etrschments herof
. EPA Form 3320-1 (OS-Stil Prowsous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAgg op I 00LU3/961003- M 34 1
__ _- - - _ _ _ - - _ - _ - - - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ _ _ - _ - _.- au . a. : - .. - - - . - _ _ . _ _._x .-
fL-#4 *w. .44 E- m
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,L -
m inperwork Reduction Act Notice- E ! 8
.a .
-, + ,
+ 1 PuHic reporting I urder. f r tids ccliection of inforuation is estimated to vary from a range of 10 hours as an > P ( : average per response fe s .me minor fxihties, to 110 hours as an avera'ge per response for sorne major facilities, e 1
' !with a wckhted avergen major and adnor facilitics of 18 hours per response / including time for reviewing , .
L linstnutions, hearchiny gi. ting data sources, gathering and maintaining the data needed, and completing and v
} ; reviewing tpcollectian of afornaticu_ Send cumnents regarding the burden estimate or any other aspect of
' this collection of iafmmtion, includmg suggetions for uducing this burden, to Chief, leformation Policy
- 13 ranch, PM-223, U.S. Environmentd Prote; tion Agency,401 M Street, SW Washington, DC 20460, and to the I Office of Information u.d Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. i
_g. .
'. General Instructions -
^
1.rlf form has been putially completed by preprinting, disregard instructions directed at entry of that information
> :already preprinted. J i
. ' 2.' "Enter " Permittee Name/Afailmg Addrext (and facility inmc/ location, if di!Terent)," " Permit Number," and . 1
, . fAuharge Numht r* w here indicated. (A sepamte form is required for each discharge.) <
r 1 l 3.. Enter dates beginning and ending "Alonitormg Period" covered by form nhere indicated. l
'4. Enter each'"Paramser" as specified in monitodng requirements of permit..
.l
- 5. Enter "Namp!c Marement" data for each parameter under " Quantity" and "Gredity" in units specified in pernut.
"herare" is normHy anthmetic average (geometric everage for bacterial parameters) of all sampic measurements '
iur exh parameta cbtamed dating "Alonitoring Perwd"; "Afaximum" and " Minimum" are normally extreme high i and low measurmats obtained during " Monitoring Period" (Note to municipals with recondary treatment ; , requirement: Ente: 3(bday asemge of sample measurements under "Awrage " and enter me.ximum 7-day avemge . of sunple measuremcats obtained during monitoring period tmder "Afaximum. ") 6/ Enter " Permit Reqwmmeni" for cach parameter under " Quantity" and "Guality" as spec;fied in permit. . 1
- '7. Ur$ der "No &" crer number of sample measurments during monitoring period that exceed maximum (and/or 4- ' minhnum or 7-day m crage as apptcpriate) permit requirement for each parameter. If none, enter "0".
] l
- 8. Enter " Frequency of Analysis" both as "Samp/c Meawrment" (actual frecuency of sampling and analysis used ,
daring monitoring period) and as " Permit Requirement" specified in permit. (e g., Enter " Cont " for continuous 1
-monitoring, "//7" for one day per weck, */60" for one day per month. "l/00" for one day per quarter, etc.) :
j i 9. Enter " Sample 7)p" both as " Sample Alcarurement" (actual sample type used during monitoring period) and as
" Permit Requirement " (e g., Enter;" Grab" for individual sampte. "Af#C" for 24-hour composite, "N/A" for
- continuous monitoring, etc.)
t ,
- 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective actions taken, and reference cach violation by date:
I 1. If"no discharge occurs during monitoring period, enter "No Discharge" across form in place of data entry. , . 12. Enter *Namemtle of Principal Executive ' Officer" with
- Signature of Principal Executive Oficer ofAuthorized Agent," " Telephone Number," and "Date" at bottom of ferm.
.13. Mail signed Report to 00 ice (s) by date(s) specified in permit. Retain copy for your records.
- 14. More detailed instructions for use of this Discharge Afonitoring Repart (DMR) foam may be obtained frorn Officc(s) specified in permit.
; , Legal Notice This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failuir to report or failure to report truthfully can res>lt in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation, or by impris4mment for not more than one year, or by both.
c o e EPA Form 3320d (Rev. OUd5) ns I{.
~ PEnemTTEE teAGE/ADOfESS WFmeby#mmvimmem(DWhmf 8sATIO88AL POLLUTANT DISCHANGE flameAfl088 SYSTOM MFDESJ FOfm ApprWVWd. ""
4 geagg DISCHARGE MONITORWee MPORT (DMR) CiEM, pgyn RETA10 g N* % -} 6 P ; 7 f ? VAI. LEY P3MEC 3IlTI39 (2-r at 117-72 . , AconEM p , ), g)g g ***'"*Te PERMIT NWWER l'9
- DecHAnu nuuuR (333t 35) M f
, eTr*; aure awoonr p ,
.pyggg i
' 'A 33IPPIwCP3kr a 1577' R40famweG reuOO '"J3E ! 4 LOCA N 3Pitd79 TaLLST POVP7 3 TAT!?M YEAR MO DAY YEAR MO DAY __ Fh0M 2% 17 9i TO 95, tt t1 309 v a a r e; C gsqqgg { c*6 j s v
- sr , s7yss 3o,sn~v tw211 122-23 124 20) (20-27) 120-201 1 M 311 NNN' W M M *'l* A >
PARAWTER is M W ML (4 Cwe W M CONCENTRATMM NO. *EOUENCf S
- tess 154-011 (Jo-est team tssat> or !
(32-37/ EX TYPE' ! aseALYess
- AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS seem ,,say a j SAMPLE a+ r 4
MEASUREMENT y33 cere;t9 aseSast ( 12) I t
\
es a g i 3 3 PERMIT '. es e
- t e - '
S e cr e t .o 1c t ..L -*ene w qEpaa?! n wic;/ 4Agg ! REQUIREMENT wee
- e. r v_ , , - 4 -n,e- y , vy t li v y e n t? Fai nton: no M14T N i l ; 3 t l y, , ya pp L SAMPLE c e ar s e e e 6 *- ar33 ss me n ( 14) l MEASUREMENT -
i11PR4C$D l , Os3S ( 3 '3 'PER C o g 5 p a: +r- teec? > .t 70 7 . ce39ec 3} 103- :1 WICC/ ;433q
.mc y0y REQUIREMENT
.,c,,%w n, 39 p y, y ~ ' p g p g,7 g gf7 y3y7g }
SAMPLE e e e r- o a, ( tIL AND 3REF3r MEASUREMENT eaetSS etec > ( 13) j 4 uun erra-M gv prTu
, 33 % s j ) 3 PERMIT - - 943eae : ee*pt -e *03 occace !$ 20 '
kIOg/ ; it A 3 l I r v, r9e 7) ;- ygtg7 REQUIREMENT met y a77' 'p e, y % 41/ L m ?g SAMPLE
'L3*l, IM '33001" 3F ( 3J) S3;tt00 cotr20e - :: 0 e
' dig Y ". ; T U V T PLANT MEASUREMENT yp p)h A I
; 3 n 'i O 3 n PERMIT c - 3 7 p p n e- e m ea r - c e t fa c e oc0057 etoca> #ct 1 .. E.C Q f STI54 }
-reta-A? ~q,tv yg(g, REQUIREMENT ,g n 4,9 hayg y z iy ,
433 See a SAMPLE MEASUREMENT [ l PERMIT . f REQUIREMENT * ' SAMPLE . l i MEASUREMENT [ s ' PERMIT - f REQUIREMENT SAMPLE i MEASUREMENT {; < PERMIT - , ! REQUIREENT : , - s MPM M M I CEftTTFY UNDEM PEBIALTY OF LAW THAT I HAVE , ....,.r k.LY ERAmmesED AMD AAA FAAMLIAR VUITH THE NfroplasATIO80 SUgemTTED MEREMt: ASED mansn oog , '/ - N DATE : j esY r* Quilty OF THOSE IIIOtVIOUALS itsesEDeATELY HE N POR '7 #, }
\ .h / ,
- DeTansee THE sarrostasAftoss, e SELtEVE TwE SugemTTED inspostasATtoes tS -
J / David Orndorf Taus. AccunATE AseD consatETE. Ann AvvAnE TWAT TwEsiE AaE y y , ,/7 ef - 90GBIIFICANT PEleALTTES FOR SLSAAf7TIIeG FALSE IIspopusATICIE. tHCLUDuse -v ' Chen19L17 MatiaRcr twe possesuTY Or rust AssD inspensossutNT. sEE tt U.S.C. 51001 AfED 33 -, O S 41 t 1^ 07 0i -^"7 I U.S.C. 91319. W%semmise esser shaus smessue nasr assessh mise ap es $70.800 88E*A M E N L TYPED OR POWITED miv er - - - ases===usae arass ese s nionensmiv s yseras orrecEn on aufgeosuEto neEOff hg NUtdBER YEAR MO DAY ! COMMENlt AND EXPLANATION OF ANY VIOLATIONS l Reference af strechmerres herof l ) 1 i k I b 1e A r u Le r-o EPA Form 3320-1008-914 Previous odetions may be used. tREPt. ACES EPA FORM T-40 WHICH sdIAY NOT BE USED.) PAGE OF: ;
- 0 3 1 0 ts / 9 5 1 0 0 3 @ fi 3 4 L
____-_~.__._.__..__._-_-.__._______..__,_..__...c
. l = . - ~ . - - - - _.- - - _ -. - . .
Paperwork Reduction Act Notice - L Pubhc repmting burden for this collection of infornution is estinated to vary fmm a rqe of 10 hotr' u u l *
; average per response for some rninor f acilities, to 110 hours as an average per response f or mne ncjor facHities. ;
l with a weighted average for nujor and minor facilities of 18 bours per response, including tarr fer rtyrewing l , instructions, t.earching exis, ting data sources, gathering and maintaining the data necdad, and coa.p.eting and
.,revicwing the collection of information. Send cornments regarding the burden e. stimate or my ch bpect of ,
this collection of information, including suggestions for reducing ths Omden, to Chief, Inf onuthm Policy l Branch, PM-223, U.S. Environmental Pratection Agency,401 M Street, SW Washington, DC 20450; and to the Office ofInformation and Regulatory Alfairs, O!Uce of Management and 13udget, Washingmn, DC 20503. l l General Instructions I If form has been partially completed by preprinting, disregard instructions directed at entry of that infonnation already preprinted.
- 2. Enter *Permittec Nameafaihng Address (and facilifv name/ location, if different)." " Permit Number," and
~ *Descharge Number" w here indicated. ( A separate form i., required for cach discharge.)
L
- 3. Enter dates bcginning and ending "Aluniformg Period" covered by form where mdicate<1
- 4. Enter cach
- Parameter
- as specified in monitoring requirements of penmt.
- 5. Enter *Sampic Alcamecment" data for cach parameter under "()uantity" and "(heahry'~ in unin spe cified in pernut.
"Awruge" is normally arithmetic average (geometric average for bacterial parameters) of aH icm:pl: mcaurements for cach parameter obtained during "Afonitoring Perio.P, "A4mmum" and "Ahmmum" are .mcmally extreme high and low meast rements obtained during '3/omtoring Permd.' (Note to municipah mt' semadary treatment requirernent; Enter 30-day average of sample measurements under "Arcrage " and enter nraimo n 7 day average of sampic measurements obtained during monitoring period under "Alarimum. ")
t
- 6. Enter
- Permit Requirement" for each parameter under " Quantity" and "(bahry" as specified in penait.
- 7. Under "No Er* cnter number of sample measurments during monitoring perioc! tha' cxeced maximma (anwm minimum or 7-day average as appropriate) permit requirement for each parameter. If r.one, enter *0"
- 8. Enter *Frequemy of Analyxi/ both as " Sample Alcarurment" (actual frequency of samphng aad andy sis used during monitoring p,7:od) and as "Pcrma Requirement" specified in penuit. te g., Enter t 'ont,' fcr continucus monitoring. "U7" for one day per weck, "Id(T for one day per month, "/60" for one day per quaner, etc.)
- 9. Enter
- Sample 7)pe" both as "Samp'e Afcasurement" (actual sample type used during monimring period) and as
" Permit Reginrement," (e g., Enter " Grab" for individual samp?c, "2.!#C" for 24-hour com;osite. "NW for continuous monitoring, cfc.)
- 10. Where violations of penuit req irements are reported, attach a brief explanation to describe cause and conecthe actions taken, and seference each violation by date.
I1, If"no discharge" occurs during monitoriag penod, enter "No Descharge" across form in place of data entry.
- 12. Entcr *No~ Titic of Principal Executoe Officer
- with " Signature of Principal Executive Cincer ofAuthorl:ed Agent,' ' + ne Number," and "Date" at bottom of fonn.
- 13. Mail signed Report to Office (s) by date(s) specined in permit. Retain copy for your records.
- 14. More detailed instructions for use of this Discharge Atumforing Report fDA/R) form may be obtained from OfLcce) specified in permit.
Legal Notice This report is reqmred 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 $25,000 pei day of violation, or by imprisonment for not nmre than one year, or by both. EPA Perm 3320-1 (Rev. 08-95)
PEnMITTEE NAE /ADDPCS#ashMeren#smeImame=(DWow) NATtONat POLLL' TANT DISCHARGE EUM888AT'ON SYSTEM [/ FOES) Forygg Approved. w,
"^* * ??Yr V e t i. ,! PSer9 3
- liI P YE '#
lt7N CM0??3i?" 9L0'.?,pMBNo.N W , Appm 05-h 48 ADORE::3p ,3 , 3)g a 5* *% "( 1 i 7 ( ;;! H e 55) *
.-ry.
2 1N,9 4,y y y a. s:- PERMIT NUMBE3 >ScHARGE NuMeER v
. . r. 7 y k ,u
;e!;TT9:raap "5 15t77 MONITORING PERIOD 5UU FACRITY qy # e 73j,7 og 3 ) .j - f pg77 ,
LOCAMN FROM r- t t i .1 TO +w v, 1! ete EO n;5C4 A r" H$ . s-. es :r, ,,<n. se > 420 29) 122-231 124-259 (26 271 128-29) 130k399 NOTE: Reed inetructione bet l :-l,.a 1He toe %. PARAMETER 13 ced osy QUANTITY OR LOADING 14 QW OnM OUANTITY OR CONCENTRATION wo, FRE M gg 14 & 531 154-691 13M51 14 & S 39 154-691 oF (32-377 EX mySit TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS em ,,#,,, ,,m
-t SAMPLE 3 e a- e
- s e e. e 3 y : n ; ; 3 ., ( 17 g MEASUREMENT
,gco j , s PERMIT 9 3 3 g 3 *e ** Mete 3 33 . , r; 9 0 0 0 0 0. 3. 3 . *: E R L i f RAS y, . Y-e 7 - . , , - .J . ,
, REQUIREMENT m y ,. 5 7 g 7 ,e n ., way5wg*- -"
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MEASUREMENT
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.- ;;3ee y 4 t, : r REQUIREMENT ,ns qq g ,r - pg m *y eq/t erter
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<l 3 79 9 PERMIT *te*?& A nn e n ;: Sy etecom ': r p 3 9 p ggpap; i e g ge L g - RA3 rrt3eer -.>,c r ., y : , r REQUIREMENT , , , g 9 gyn 3 3 7 gyy ,y 57ft
- L*'T-7L ?P*i, *3Til SAMPLE 37goe. e e e t s :. e y e e e a.
MEASUREMENT ( io)
; > t, g g a 9 PERMIT - eeemse *cet9% e .? : *e ? ? M ;
i ; 3p wp;q or,y; .r qg, yyr ., REQUIREMENT 7, 3 ,) 3 .g ' p g 7 g ' ,. y ,37t pyq;g
'l'J, I" ;* 3 ;f 7 0 { ? , SAMPLE i y 33sete ensany 9?ctet 4 3 ea7g?4/q _L(yi MEASUREMENT N (> '
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- 3 p PERMIT
- nSp; ar ege t . 9 % $ $ fj g t e ; ;t e g hecce r see , p ray ( y r; 7 [ g g
--tg. .e q99- y 5 r_. REQUIREMENT .y yy. ,.,,y vy , : -, ~ge a ae ,i g r r , r , v. 3. .
t < SAMPLE 3^ eye
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,3n . r, 5 PERMIT pece- See09e a -S t 4: S t W S 1. 5 t. 2 5 -
FE%I RAa
.n .r. . q yg,q REQUIREMENT ,at>
,3 yn 3yq {y37 qy m/L NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER I cERTtry uNoER PENAU. t CF LAW THAT I HAVE PERSONALLY EKAMMED AND AM FAMOUAR WITH THE INFORMATION SUBMITTED HEREfM; AND BASED ON /
- r. TELEPHONE DATE
/
MY INQUl8tY OF THOSE fNDIVIDUALS IMMEDIATELY RESPONSIBLE FOR f I.)a v id U rn d o r [ OSTAINING THE INFORMATION. I DEUEVE THE SUBMITTED INFORMATION It r e TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE StGNtRCANT PENALTIES FOR SUBMITTING FALSE eNFORMATION. INCLUDING
-I b &,.f)M$ ./
'12
+ 393-5113 97 0 'b h' 7 Ch tdril 8 L IVe !!a11 A RC T- THE POSSIStUTY OF FINE AND IM*RIS -,
u.S.c. s 1sie. IFunemee anne en ONMENT.essame mer SEEe te U.S.C. mete, newe 9100,1 AND 33 se R s70.000 SiONATURE OF PRINC8 PAL EXECUTIVE g TYPED OR PRWTED and er mashman L.1 : af terwowe e nwes and 6 yearsJ OFFICER OR AUTHOIT4 ZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refsrence s# ettschments heral AJu D r u h <; < e frn *
; 7a r = ;p 59u99;A 4 7 V I T 3 ' 7 '! P- T' IV ' f? i f r ';
9!TO?~ 05 JET '.AYfla."D7'T T J :- DJIL7 :*
- T I N I' s "O1 3rt? D a-d sur' 3;7.3 3u;[. ; (?1 ly, ,)
- i' . ) : '5/L. ("1[ LT9[7 IS .35 13/L $$ 1 D*TL7 MAX,)
EPA Form 3320-1 108-95) Previous editioris rby be used. (ftEPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
. _, - . _.-__.--.-_.__-_._____s-
1 5 I
' Paperwork Reduction Act Notice 4
' ^
, m l'
.*3 . ;
l j i%!ie n pbrting t-und . f4 c this collection of infunnetion is estimated to vary from a range of 10 houni as an
; averge pu response f- wme mmor' facilitics, to 110 hours as an average per response for some major facilities,
}- . with & weighted nyerep fer nujor .md minor facilities of 18 hotus per response, including time for reviewing ' l } imtructions, jarchiur anting data sourca, gathering and maintaining the data 'noeded, and completi g and , l ', { i miewing the collet.ti m of informatica. Scm! comments reprding the bwden estimate or any other aspect of l l ; tbrs en!!cction of infomnt:on, including suggep.tions for nducing this burden, to Chief, Information Policy i
. Branch, PM;223, U1 Environmatal Protection Agency,401 M Street, SW Washington, DC 2CC; arid to the '
i Office ofIrifornation ud Regulatory Affairs, Omce of Management and Budget, Washington, D' 1503, t { L. ..l c . . _ ._ . ____ ___ t
- General Instructions i
'l. If Ibrm has been :nnially completed by preprinting, disregard instructions directed at entry of that information already preprinted.
j
,2. Enter " Permittee Yme:Atailmg Address (and facility namellocation, if different)," " Permit Number, and '[
"Drsrhcrge Numba " 9 cre b indicated ( A separate form is required for cach discharge.)
- 3. 'EnMr dates begindog and ending "Alomformg Period" covered by form where indicated,
.4, Enter each "Param ter" as specined in monitoring requirements of permit.
i 5 Eder "Sn nplc Arcaa rrment' data for cach paramcter under "Guaniity" and "Guality" in units specified in permit "hroge" is nern Q anthmctic average (geomctric average for bacterial parameters) of all sampic measurements for each paramet r obtencd during "Alomtoring Permd'; "Afarm:nm" and "Almimum" are normally extreme high , and low measur< mnis obtained dming "Afoniturmg Period " (Note to municipals with secondary treatment reqms ement. Enae % day average cf sample measmcments, under " Average," and enter maxinmm 7-day average , of sample measursems obtained danng monitoring period under *Alarimum.")
^
- 6. Enter "Per mit Rep:rement" for cAch parameter under "Ommtity" and "guality" as specified in permit.
l 7 Under "No Er" A r number or sunple measurments during monitoring period that exceed nminmm (and/or minimum or 7-dnj m erage as appropriate) pcmut requirement for each parameter, if none, enter "0". j
- 8. Enter "fGrquerto V 4ra/ pia" both as " Sample k/eawrment" (actual frequency of sampling and analysis used !
d,: ring maratoring gnod) and as
- Permit Regwren.cnt" specified in pennit. (e g., Enter " Cont," for continuous !
monitoring. "IJ' ict ore day pc r week, "U30" for one day per month, "Isa" for one day p r quarter, etc.)'
- 9. Enter " Sample 7)re ' both as " Sample Alcawrement" (actual sample type tacd during monitoring period) and as
" Permit Require ment," (e g.,- Enter " Grab" for individual sample, "2,flIC" for 24-hour composite. "N/A" for continuous Inoniton ng. etC.)
'10. Where violations of pennit requirements arc reported, attach a brief explanation to describe cause and corrective actions taken and reference each violation by date.
I1. If"no discharge" occurs durir g monitoring period. enter "No Discharge" across form in place of data entry .
- 12. Enter "Namenitle viPrmcipal Executive O!11cer* with " Signature of Principal Executive ODicer ofAuthori:ed Agent," " Telephone Number," and "Date* at bottom of forrn.
- 13. Mail signed Report to Omcc(s) by date(s) specified in permit. Retain copy for your records.
.14. More detailed instructions for use of this Discharge A/omforing Report (DAIR) form may be obtained from Omce(s) )
, spe ified in permit. l 1
Legal Notice l i l This ' report is required by law (33 U.S.C.1318; 40 C.F.it 125.27). Failure to report or failure to report truthfully can ! result in civil penalties not to exceed $10,000 per day of violation; or in criminal penaltics not to exceed $25,000 per day I of violation, or by imprisonment for not more than one year, or by both. ; 1 1 l EPA Form 3320-1 (Rey,08-95) l
)
PEfte!TTEE 80AWlA000ESSIAmesd,Fershef Aram 't.essn=(W MATioseAL *0LLUTAmt DescMesteg M uhamaafgost WYST98 (APDfS) Form Appteved.
~
90AW
'4 E R V E R TILLET POWS 9 5flTI3V '2- N "AN -M NDEF3A?E 3L N DO,M No. M ,5ss e .*
AconEco p , 3, gg 3 - s s - , e: c * *n, r p :g g 35) u . 4 , O.S-31 .
*??N; M 71D Di1NDORP 1
PERMT N orscMAmoE muMem p . 77ggL I'4I PP T w ;P 3 R I PA 15077 mmm "P330 , PR%f2R 7hLLFY PO%9R 3?ATIJ" YEAR MO DAY YEAR MO DAY LOCAtiose FROM s t) nT TO ;A 1 11 MS *13 DIS 01AFCP t !'**e. (20'211 122-239 424 259 (20-27) (20-299 (30ustj NOTE.* M M 088MPI EGR9 % Y.
- T*vg n
- 11 7 1 a n w % 9 " n' PARANTER (3 M W NL MNN M NO.
-Te 5 Idd-5JF f54871 (39-457 (6 f544fL EX OF (3247; myget TYPE.
AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS mem Issaar tes-7tw
;;pHA2yyL SAMPLE egsee e ri p p a gegpp g igg MEASUREMENT 1113 PERWT. me egen q 3 ggggy g y; 1 3 ~; Aenege j a;n en e 3 3 REQUIREMENT
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SAMPLE MEASUREMENT PERMT-- I REQUIREMENT SAMPLE MEASUREMENT - PERMT ' REQUIREMENT SAMPLE MEASUREMENT
. PERMIT :
REQUIREMENT SAMPLE MEASUREMENT PERMT: ' REQUIREIENT S AMPLE . MEASUREMENT PERMT : ^ REQUIREMENT SAMPLE MEASUREMENT PERMIT .
- REQUIREENT , "
6 MAL M M l C5tTIFY UIsOER PfisALTY OF UnW THAT I MAVE . .mMY ENAMINED AMO AM FAMIUAR WITH THE IIeFOpInsATIOes SuttstTTED MEREIII: AfsD BASED Ost
/ TELEPHOSE DATE-MY IMOUlftY OF THOSE WIDiw4 DUALS pasasEDIATELY ftEEPOI8EIBLE FOR 7- 3 jf
, y j Daytd Ornderf OSTAINueG THE WePOfusATIOII. I SEUEVE THE SugestTTED INFOfDsATICII 15 TRUE. ACCtJRATE ASID ConsWLETE. B AM AWAflE THAT THERE AftE 3 .f.. '(,
'MQ A /
mesmeicAmr THE cOsseuryresA,LMS FOR SugamTTWs0 0 past Amo mannisownsesT.FALSE sEEWIPORMATICII. is u.s.c. e ioot lesCLUOese Asso as SpeetATUgit OF PRNICFAL E il ? P3-5L13 97 .l. l 27 TYPED OR PfWITED u.s.c. sav er. s isis. smanmMme E er asMar amwesa esse asemane s mensw w ayawe>neer.m Anse en se Ero.ceo OFFICER OII Atm00fu2ED AGEUIT h, 88URSER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (RefWence af errschments hers/ g 6 , u s.% , y, c din & A IT v- 400 A m FIA NMr?N TM ?' *"YT WP*ts p;3IOPT Oc sFi L
- Y '1 b . M e ^ D a 7 TM OAILY NA?!?UM FOR-5PT2 D T + 'l w 9Fe D I: ~ i U;D T (?4 an. ~MS.t: n / !, e (?dC I.rkrP T5 35 * ^, / L 1. < T MILY d'I.)
EPA Form 3320-1108-551 Prewoove odenotte may be used. IIEPLACES EPA FORM T-40 WeeCH allay 800T BE USEP 4 07 .PAGE OF
/3 00 4d3'4 j
i Paperwork Reduction Act Notice - l l 1 . , l .Public reporting burden for this collection of infonnation is estimated to vasy from a range of 10 kurf as an , l average per response for rome minor facilities, to 110 hours as an average per response far sons imjor facditics, ! l l with a weighted average for major and minor facilities of 18 bours per respanse, incluJmg time for n: viewing j , l instructions, searching existing data sources, gathering and maintaining the data needal, and competing and . l reviewing the collection of information. . Send comments regardmg the burden estimate or any mbcr aspect of I l this collection of information, including suggestions for reducing this burJen, to Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 20460; and to the l ; j j l Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503 j j l _ - 1 l General Instructions ! 1."If form has been partially completed by preprinting, disregard instmetions directed at entry of that information l already preprinted. ! 1
- 2. Enter *Permitter Name/Afailms Addrexx (and facility nameAccation, if difkrent)," " Permit Number " and l
" Discharge Number" where indicated (A separate form is required for each discharge.) i
- 3. Enter dates beginning and ending *Afonitormx Period"cmcred by form wbere indicated. j
'4. Enter each "farameter" as specified in monitoring requirements of pennit. l S. Enter "Nample Alcamrement* data for cach parameter under "Guantity" and "Guably" in units rpecified in pennit. i
' ' Average" is nornudly arithmetic average (geometric average for bacterial parameters) cf all mpb measuremrnis
~
j for each parameter obtained during "Afomforing Period"; "Afanmum" and "Abnimum* arc norrnally extreme high 4 and low measurcruents obtained during "Afomformg Period " (Note to municipals mth scavidarv treatment i rajuirement: Enter 30-day userage of sample measurements under "Averagef and emet masinen 7-day average ; of sample measurements obtained during monitonng per od under "Afarimum ") j i i l
- 6. Enter
- Permit Requirement
- for cach parameter under "Guantity" and "pmdsty" as specified m pernut l
- 7. Under "No &* cnter number of sample measurments during monitoring period th:it exceed maimum (and/or l minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "7
- 8. Enter " Frequency of Analysif both as %vnple Alcawrment" (actual frequency of sampling aad analysis used l
during monitoring per"od) and as
- Permit Requirement" specified in penuit. (c g, Emer 9 'ontf for continuous monitoring,"la" for one day per weck. "l/W for one day per month, "lNO" for one d n per quarter, etc.) ;
- 9. Enter "Wmple Type" both as "Samp/c Afeamerment" (actual sample type used during moni
- oring period) and as i i " Permit Requirement " (e g., Enter "Grah" for individual sample, "21//C" for 24-hour compostle. "N/A" for i conimuous momtonng, etc.)
1 i
- 10. <Where violations of pennit requirements are reported, attach a brief explanation to describe cause and conective l actions taken, and reference each violation by date.
I 1, If "no discharge" occurs during monitoring period. enter "No Discharge" across form in place of data entry. t i 12. Enter "Name/Dtle of Principal Secutive OJJicer" with "Signaturc of Prmeipal Secutive Ojpcer of Authori:cd l l Agent," " Telephone Number," and "Date" at bottom of form. l
- 13. Mail rigned Report to Office (s) by date(s) specified in permit. Retam copy for your records. l
! l l 14. More detailed instructions for use of this Discharge Afrmitoring Report (DAIR) form may be obtained from Office (r) i specified in pennit. l Legal Notice , This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or fadure to aport truthfully can i result in civil penalties not to excen.! $10,000 per day of violation; or in enminal penaltees not to exceed $25,000 per day l' of violation, or by imprisonment for not more than one year, or by both. EPA Forir 33204 (Rev. 08-95) l l
PEMMTTEE NAME/ADDRE2O(kshaFenhyhwieesasegroghms) i NATIC8W PORUTANT DISCMMt0E EUMesATION SYSTEM (MDESl -- ~" NtME t # % V! - i&LL%? 9 'l 4 E ? 3 ? A.
- I ] S DISCHARGE MONITOUWNG REPORT (DMAf (7-r si (t 7-t sj 30LK ?gML $M pgOP Form M M- '*"N '.~
ADOFEEIS;. , j . g3( , a* *
- 7 r. . 1c 4 - 1 5
{y;ga 3g) Approv{p 05-31-99 A ! T ?:; nsVI] 1RyDo9T PERMIT NUMBER DeSCHARot NuMsER c , ypjg 3 P I P T- t "; P V:
- Jf 119?' MOftfTORM PERIOD AJ3N N*N ,
w( S. V i 4 7 ALLEY PO4FB 3 f A I I ~) 'I YEAR MO DAY YEAR MO DAY LOCATION FROM a, I' i TO 9% ,
?I Se2 43 D T 3 C '{ A ? "; r ' )hl ?O&
a - F $. - ".?? ' 'D Y m in r (20 27J (22-23 124-251 (26-271 (28-281 (3G371 NOTE: Reed instruceene before eTesRP l oting eds feeh.
'# Cst onys QUANTITY M LOADMG /4 cerar W . QUANTITY OR CONCENTRATim go, h gg PARAMETER 146-52 154-671 (30-459 446-531 (64-619 OF '
(32-37; EX ANe$,s TYPE - AVERAGE MAXIMUM UNITS MtNtMUM AVERAGE MAXIMUM UNITS ass.es, ,,, g,j gg ,7g
.g SAMPLE a rcee*> 3fa%s. wq69- { g3 ,
MEASUREMENT S393 1 3 3 PERMIT aggtg e.3ec3* e .s . .,g g e + ,. e ;g3 3 m gy py 3
. c. r y n i- e r -a,-- .; e r ,, REQUIREMENT 33y 3 7 ,, p, ,.g pgg7yn, ;g
. ) i, [ D :; , [3 7f L SAMPLE o~o%** e. c r. 8 - y eacn> ( 1gg MEASUREMENT 15 pef 7?9
, 'N30 L 3 g PERMIT s e s s e.. so+ote e .s e astec; ;) gp j p M LT RAD
-~ng" REQUIREMENT '
r et g r y ? y i r ; r. . p ,, 3 ,9 ,FP D) T M *T -' / t
,7L a.c - > : n J f; SAMPLE g9 A** a n *
- a- y wewe3; { 1q a -- ;s egyp.czzy *P;a MEASUREMEm
. 9 t. " ;
{ 7 PERMIT ' nee:g&3 .Seecta r .gg pegete .$ 3 rs ;g n gg pg g- '
- r-.it ;e 13ec y7vy REQUIREMENT , . , .
g 7 pg777 ,,, z ,f SAMPLE LO, 's O r ;;!) ; 7 y MEASUREMENT O Oi g I I) S t M O *: M0ecy e. 3 e. 9 n g
-f r J 7ae37gey7 p g { ,; 7 i
;l !
- PERMIT yu p 3 O , ,* M*005 Mosco 9 p m~ " . , s**
O " L EEKLY n?** '"* r r r . ; ~ s. ;y,3r yq:gr REQUIREMENT y i.5 #V.- Beity .*r :n 3 0 ,.
- . ~~ '
SAMPLE MEASUREMENT PERMIT . I REQUIREMENT SAMPLE MEASUREMENT PERMIT . ! REQUIREMENT t SAMPLE MEASUREMENT i PERMIT REQUIREMENT c NAME1 TITLE PRNGCMAI. EXECUTfvE OFFICER e CERTIFY UNDen PENALTY OF law THAT e MAvE PERSONALLY ERAM18eED AND ' AM FAMOUAR IMTM THE INFORMATION SUSMFTTED MEREIN; AND SASED ON s. TELEPHONE DATE MY INQUIRY OF THOSE INDIVIDUALS IMenfDIATELY RESPO88919LE FOR [' [/ k osmN=o ME INFORMAN. I SEUEVE ME SUBMITTED INFORMAN IS / Davhi Orndor f TRUE, ACCURATE AND COMPLETE. 8 AM AWARE THAT THERE ARE mA/ - ChCI3i H 1. T Nanilqer StonesFICANT PENALTTES FOR SUOMITTING FALSE INFORMATION 18eCLUDiseG THE POSSieeUTY OF FftIE 3
' 1 a- 3' "
47
- 01 27 U.S.C. t tats. sRinemme anshrANO sneseIMPRISONMENT.
seems mer AiedusseSEEnnes 18 U.S.C. 9,1001 e se sfo. coo AND 33 880 NATURE OF PRINCIPAL EXECUTWE g TYPED OR PRINTED sw or merenum --- of terwesa 8 mensne sw s yeomJ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference af effechments hers/ Q b l S (.b c. q f EPA Form 3320-1 100-95) Prewous editions may be used. OREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) .,, PAGE OF _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ .4 ,_..s.,._ _ . _ _ . ~ _ . . _ _ _ _ _ _ _ . . _ _ _ _ _ . _ _ _ . __ -_ _ _ _ _ _ . _ __ _ . _ _ _ _ _ _ _
, o.
~, - -, .. --- . .
*. . t
) pubhc reperting i urd , S r thh colledion of mforuation is estinuted to vary from a range of 10 hours as an m rye fa sem i , u me mhwr Lahties, to 110 bours as an average per response for some major facilities, with 2 weighted aver, s for myratad udnor f acilities of 18 hours per response, meluding tima for reviewing l mitmctmns. teardun; i ung data somces, gathering and maintaining the data needed, r.ad compleMng and
! re3i ewing du col! edin d inimmaion. ScoJ comments regarding the burden estimate or any other aspect of ths wlbetion of mfe: Loo, im htdiry suggestions for reducing this burden, to Chief, Information Policy Branch, PM-223, US Ermronmental Pmicetion Agency, 401 M Street, SW Washington, DC 2040; and to the
' Office of Infonration nd Regulaimy Af fairs, Office of Management and Budget, Washington, DC 20503.
General Instructions
- 1. If form he been pitLdly completed by preprinting, disregard instructions directed at entry of that information already preprinted.
4
- 2. Enter "Perimitce Xamc/Mading .iddress (and facility name/ location, if different)," " Permit Number," and "Dmharge Numb. r where indicated. ( A separate form is required for each discharge.)
- 3. Eraer dates begim mg ; t d ending "Monitorrng Perm./" covered by form where indicated.
- 4. Emcr cath "Paramar ' as specified in monitonng requirements of permit.
- Entt "l,cmpi Mw a more data kr cath paramcier urder "Quantety" and "puolity" m units specified in permit.
" h cry " s nem ,4 antometk merage (ycometric lacrape for bacterial parameters) of all sampic measurements for en n pnun.ct " cht .icca danng "5lorirvring Powd"; " Maximum" and " Minimum" are normally extreme hsch and law meaeurri , nh obtaiord danng "Homformg Permd." (Note to municipals with secondary treatment reqmrement: Enu Me averve r.f s:unpic measuitments under " Average." and enter maximum 7-day average of sample measulmun obtained durmg tuonboring period under "Mmimum,*)
0: Emcr " Permit Res m mnt* fer each pwuncter under "Quantay" and " Quality" as speciEJ in permit.
- 7. Unde: "No Er" u.r rurnber of umple rocasurmens during monitoring period that execed maximum (and'or minimum or 7-de a erage as sppropriate) pctmit requirement for each parameter. If none, enter 41".
- 3. Enter "Frcqwmy '
alpis" kah as " Nam;>le Measurmen/* (actual frequency of sampling and analysis used irine, nmmionng pend) and as */'ermit Rafwement" specified in pennit. (e g., Enter " Cont " for continuous monitcring, "/m ?,, to e d.ty per week */W!" for one day per month, */M1" for one day per quarter, etc.)- r 9 Enter "Samp!c 'y;," l both as "Sumple Measurement" (actual sample type used during monitoring period) and as
" Perma Requiremerf * (e g.. Eraer "Grah" for indriidual samp!c, "NHC" for 24-hour composite, *NOf" for continuous momtonng, Ctc.)
- 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 Dacharge" across form in place of data entry.
t
- 12. Enter "Name'7'ule ofI'rmapal Executive Officer" with " Signa:ure of Principal Erecutne Oficer of Authorced Agent." '7elephone Number " and "Date" nt bottom of form.
- 13. Mail signed Report to Omce(s) by date(s) specified in permit. Retain copy for your records.
- 14. More detailed instructwns for use of this Dacharge Monnoring Report (DMR) fonn may be obtained from Office (s) spesified in pernnt.
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 not to exceed $10,000 per day of sin!stion; or in criminal penahies not to exceed 525,000 per day of violation, or by imprisonment for not more than one year, or by both. EPA Form 3320-1 (Rev. 08-95)
l $ FEnemTTEE NAhEEIADDRESS 0=weFaderm=.1 ewsm pWous mATIO=AL POttutANT oeSCHARGE EUMMATION SYSTEM (NPDESf Form Approved. NAME DISCHARGE MONITORWG REPORT (OMR1 l hM%iE9 7%LLLY D3W?O 'I ? A
- I. ~14 (2-7"" (77-781 1 M i, " l ;EEEI9 3LWgg m . & -
~
mm n 7, 437 a n.,,wc*c .,. , {qg3p 3s) ^5 Prot'%f!**,C&31-98
=.
- T N ; 91/1 f) 3 NDn,p PERMIT NUMBER DISCHARGE NUM8m p .,y{ygg l 3 PIPPI 9IP3PT i' 2 15'77 MONITORING PERIOD #33 \
FA N ,gggy9 ykLLg7 pggqa 7 ;. g 7 I l h
- YEAR MO DAY YEAR MO DAY LOCAT m FROM 1/ +, TO v *,
NOTEDIZir Reed M &gaJM g y ;p g y pcS %. I 4 ', 1 si Cte s ') s* v3 , 5 y r ", 3r- ,1> 120u211 122-231 124-251 126-279 (28-29) (30'311 PARAMETER 13 Cerd crwyl OUANTITY OR LOADING d4 Card on/yl QUANTITY OR CONCENTRATION NO. mEM gg 146-539 154-6 t9 (30-461 146-63) (5Hil or (32-37; EX ANALysrS TYPE. : l AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,s2 43, fe m fggyo, ( 1 SAMPLE e. 3 n s $ s we~;; *t500+
. ); 3r ,, 737s; MEASUREMENT ( ] ') )
,, : n.r m e. cn 5. , n 1 -} g a n 1 3 3 PERMIT , e. c a. d e a
r r- c e as; 9 : Sy otteet 39 100 , eMLy GAB i gei qc . -. , , - .g 3 ; , REQUIREMENT .33 v3 gy , p qy p .sy 3 :p(
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- 0 'J I T .N . SAMPLE f 1., )
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PERMIT g333p mg g , .* , "' ~ ,~ l ' S ' . .,1 i S 4 7,y 9 7 p p g 7, y - , ' w ?slI STIS3
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an , . 937te 1r gg3 ' SAMPLE i MEASUREMENT PERM!T REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT ' REQUIREMENT SAMFLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRINCIPAL EXECUTIVE OFFICER ' I CERTIFY UNDER PENALT OF LAW TH AT I HAVE PERSONALLY ERAMfMED AND TELEPHONE DATE AM FAMfuAR WITH THE INFORMATION SUSMITTED HEMUN; AND BASED ON MY INQUIRY OF THOSE fMD8VfDUALS sMMEDIAI ELY RESPONSr8LE FOR [z , / t[ IJ aV id U M d O I. cL OBTAJNING THE INFORMATION, t eEUEVE THE SUDMfTTED INFORMATION IS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT TME8G ARE /
,@ , e Av ff
- / V f.
p L. .neniat ry ilattor.c r 3 RIG pos PENALTIES FOR SUBMtTTING FALSE INFORMATION. INCLUDING -- - - - ' 73,MRCA,N,T,uTY u.S.C. n isie. sRwee. ==w OFv Fat.ANo maFouSO.N. MENT. sEEstoMATwE
,=,m.F m em .,sesro. coo to u.S.C.OFePueCsPAL tooi A4 33 EXECUTIVE
;i, w7-5113 o7 ti1 27 TYPED OR PRINTED and er ==r*=m : n .: or aerween s manens .ne 4 ms AREA NUMBER OFFICER OR AUTHORIZED AGENT CODE YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Retsre;ee s# etteChments heref l& D i q i- + y a e EPA Form 3320-1(06-951 Previous editions may be used. IREPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE 37y 4 gg3,gg3 ( OF
4 : __ .- ..- - _. 1 ..,_aL.-- _ y Paperwork Reduction Act Notice '
.. . ! o IP.ublic reporting burden for this collection of iriformation is estimated to vary from a anse of 10 hours as an - ! .
iaverage per response for some minor facilities, to 110 hours'as an average per response far some major facilities, l with a weighted average for major and. minor facilities of le hours per response, incluihng time'foc reviewing ! instructions, searching existing data sources, gathering and maintaining the data needed, and completing and _ ireviewing _the collection of information.. Send comments regarding the burden estimat.: or arc, othe.t aspect of this collection of infonnation, including suggestions for reducing this burden, to Chief, InfonnationjPolicy Branch, PM-223, U.S. Environmental Protection Agency,401 M Street, SW Washington, DC 2M60; and to the Office ofInfonnation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503, _p _ _ . . . . _ _ - _ . - _ _ _ - . . . - General Instructions '
- 11. If form has been partially completed by paprinting, disregard instructions directed at entry of (Sat information
.. -already preprinted 1
- 2. Enter " Permittee Name/A/m/ing Address (and facility name/locatien, if different)," " Permit Number," and
" Discharge Number" where indicated. (A separate form is required for each discharge.) ;
- 3. Etter dates beginning and ending " Monitoring Period" covered by form where indicated
- 4. Enter eacn " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample Measurement" data for each parameter under Quantity" and "Quahty" in unns sp=ilied in pennit?
" Average" is nemtally arithmetic average (geometric average for bacterial parameters) of all umple measurements for exL parameter obtained during "Monitonng Period"; "Maumum" and "Mmimum" are normally extreme ldgh omd low measurements obtained during "Afomtonny Permd" (Note to municipals with secoadary treatment t- . regmrement: Enter 30-day average of samp!c measurements under
- Average " and emer maximum 7xiay average of sample measurements obtained during rnonitorinf; period under " Maximum. ")
.6c Enter " Permit Retjuirement" for each parameter under " Quantity" and "Guahty" as specified in permit; e 7.'Under' *No Er" 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 " Frequency of Analysis" both as " Sample Memurment" (actuai frequency of samplir,g and analpis used daring monitoring pwod) ;md as " Permit Requirement" specified in pernut. (e.g , Enter " Cont," for contimmus monitoring, "//7" for one day per week, "//30" for one day per month, "130" for one day per quarter, etc.)
.9. Emer 'bmple 7)pe" both as "Sanp/c Memurement" (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. I1. If"no discharge" occurs during monitoring period, enter "No Discharge" across fonn in place of Atta entry. f
.12. Enter "Name/ Title of Principal Executive Officer" with
- Signature of Principal Executive DJJicer of Authori:cd ,
l Agent."
- Telephone Number," and *Date* at bottom of form.
- 13. Mail signed Report to Office (s) by' date(s) specified in pennit. Retain copy for your records.
*14. More detailed instructions for use of this Discharge Momforing Report (DMR) form may be obtaiacd from OfTice(O specified in pennit.
e Legal Notice Thisieport is required by law (33 U.S.C.1318; 40 C F.R.125.27). Failure to report or failure to report truthfully can
)
result in civil penalties not to exceed $10,000 per day of violation; or in enrmnal penalties not to exeecd $25,000 per day l of violation, or by imprisonment for not more than one year, or by both. l
)
i l I EPA Form 33201 (Rev. 08-95) l
PERMITTEE NAME/ ADDRESS (t=bdeFaeryNeuvLorenes(D@unt) NATIONAL POLLUTANT DISCHARGE EUUltdATION SYSTEM (MPDESf Form Approved. ._ ; DISCHARGE MONITORING REPORT (DMR/ NAME
--t F A V 2 a V I L L E Y PosEM'3*%;I]i 12-f 61 (17-1s1 IP!A<L SCPerH HACM, h N '~
ADDRE33 p . 3, q3y ** "*** *b '*'
- p f) D R J ';)
, 'f'"
t s ns; :uvn m.oyy PERMINMBER OtSCMMGE NUMBER y , 7y q( J
- M!PPTN3?M? PA I577 MONITORING PERIOD "#33 e .
~ E A '18; a V4LL"f P 3W " iT&TIJt YEAR MO DAY YEAR MO DAY _
l LOCATION FROM - , !/ ; TO -r % 1/ tt W F3 DtSCHxPG" l CCa- g
>rt. ptyin 3 a s nw 7 (20219 122-23) 124-251 120-211 128 29s 130 31) NOTE:
Reed inetructbone before%l _ . PARAMETER '3 Cd Ontri QUANTITY OR LOADING f4 Ceruf Omtrf OUANTITY OR CONCENTRATION NO. FREoutNcY SAMPtX (46-53) (54-691 (3H51 946-631 (54-691 OF (32-371 EX angyg,$ TY'El AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS nse fa,_ast (6sa L O 3, Is 'JN3)[T ') p SAMPLE *
^y 0 $ ? r- e t ONa t e $ Wcy f
<gon ;n p73r .? p g g p; y MEASUREMENT ggg ggyg C 7 g gl
,ger- 1, 7 7 PERMIT at.yp p e n rpp y e t.p o e cueec t ee s e n i 3p t 73ty .py g g
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32 73 t.3 y REQUIREMENT g , , , ng 7g y .,, gg SAMPLE MEASUREMENT
- PERMIT REQUIREMENT SAMPLE MEASUREMENT g PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT SAMPLE MEASUREMENT PERMIT REQUIREMENT NAME/ TITLE PRWCFAL EXECUTIVE OFFICER I CERftFV L*# DER PENA 6TY OF LAW THAT 1 MAVE PERSONALLY EXAMINED AND TELEPHONE DATE AM FAMlUAR WITH THE INFORMATION SUSMITTED HEREIN; ANO SASED ON ~
MY tNQUIRY OF THOSE INCtVfDUALS IMMEDIATELY RESPONSrBLE FO t .
"<O .'
/
OSTAINING THE INFORMATION. I BELtEVE THE SUBMITTED INFORMATION t$ ~I g/ Je.sv d b.nderi TRUE. ACCURATE AND COMPLETE. I AM AWARE TMAT THERE ARE '
' - ,-# M"7.h* '
g['l__._ SIGNRCANT PENALTTES FOR SUDMITTING FALSE INFORMATION. INCLUDING
,,'..,,' THE POSSIBsLITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 91001 AND 33 G1 5.1 1 'I O7 "* ?
g' - u.S.C. e 13to. penemme ener w senses mer siebsw anos up so s70,000 --S40 NATURE OF PRINCIPAL EXE' C' UTIVE --
- 0I TYPED OR PRWTED man or maremen u - - ro seewe.e s meetne ans a resro OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY CODE COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference s# strechments herel EPA Form 3320-1 (OS-SM Previous editioris may be used. (REPLACES EPA FORM T 40 WHICH MAY NOT BE USED.) PAGE OF 3g33 7g ggy,9 3g y
, e
. - = 7 Public reposting burden for th;s collectmn of iriformation is estimated to vary from a rage of 10 ' tours a ar, ,
average per regense for wmr. rninor facilities, to I10 hours as an average per respone fqr wme nuior facihtics, l with a weighted average for major and miner faci' ides of 18 hours per respanse, includmg time fot rtviewing ; , instrations, searching exicting data sourecs, gathering and maintaining the data needed, and completing and reviewing the collection of information. S:nd cornments regvding the burden estimate or any othes aspect of this collection of information, inclu6ny suggeshons for reducing this bunlen, to Cluf, Infonration-Policy Branch, PM-223, U.S. Environmental Protection Ager>cy,401 M Street, SV/ Washington. DC 20460; and to the Office of Information and Regulatory Af fairs, Office of Management and Budget, Washington, DC 20$03. l I _ . _ _ __ _ _ _ . _ _ . _ _ _ . _ . _ . _ _ _ _a General Instructions 11If form has lun partially completed by preprinting, disregard instructions directed at entry of t* tar information already preprinted. -
- 2. Enter *Permitter Name/Afailmg Adduss (and facility namc! locution, if di'ferem)l " Permit Number l und "DiA< Aarge Number" where indicated. (A separate form is required for cach discharge.)
- 3. Enter dates leginning and ending *Afonnoring Period" covered by form where mdicated
- 4. Enter cach " Parameter" as specified in monitoring requirements of permit.
- 5. Enter " Sample Afcasurement" data for each parameter ander *Guantity* and "Guality" in unh ; spa;ified in perndt.
" Average" is normally arithmetic average (geometric ascrage for bacterial parameters) of alt tamp 1: n casurements for cach parameter obtained during "Alamformy Fermd"; Afaumum" and "Alimmum" uc rornudly cureme high and low measurements obtained during *Afomtoring Penod' (Note to municipals vcith seccadary treatment reqmrement: Enter 30-day average of sampic measurements under " Average." and enter muimum 7-day average of sample tucasttreinents obtained during monitoring period under "Afarimum. ")
- 6. Emer " Permit Requirement" for each parameter under "guantuy* and *Guahty" as specified in penniti
- 7. Under "No Er* cnter number of sample measurmen:s during; monitoring perkx! that exceed maximum (and/or minimum or 7-day average as appropria:c) permit requiremer,t for each pararneter. If rone, enter '0".
- 8. Enter 'Frequeng of Analysis" botS as "Nample Afeaxurment" (actual frequency of sampling aad analysis used during monitoring per od) and as "Penmi Requirement" specified in permit. (e g , Enter Tont for continuous >
monitoring, "l/7" for one day per wech, *l/.W' for one day per month. "l/90" for one day per quarter, etc.)
- 9. Enter " Sample 7)pe" both as " Sample Afrasurement" (actual simiple type used during monitorirg 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 descnbe cause and corrective actions taken, and reference cach violation by date.
- 11. If 'no discharge" occurs during monitoring period enter "No Dist harge" across form in place of data entry .
F
- 12. Enter *Name/Dile of Principal Executive Oficer" with " Signature of Principal Erecutive OLHcer of Authorired Agent " Telephone Number
- and "Date" at bottom of form. ,
I
;13. Mail signed Report to Ofnce(s) by date(s) specified in permit Retain copy for your records.
- 14. More detailed instructions for use of this Discharge Afonitoring Report (DAfR) form may be obtained froin OfDec(r) +
specified in perndt Legal Notice l l This report is required by law (33 U.S.C.1318; 40 C.F.R.125.27). Failure to report or failum 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 1 of violation, or by imprisonment for not more than one year, or by both. EPA Fortn 3320-I (Rev. 08 95)
. _ . . _ . - _ _ _ _ _ _ _ _ _ _ . - - _ _}}