VH.j:C3H.j; 1 RIDS SYSTEMA Pennsylvania Power 8 Light Company Two North Ninth Street ~ Allentown, PA...
Transcript of VH.j:C3H.j; 1 RIDS SYSTEMA Pennsylvania Power 8 Light Company Two North Ninth Street ~ Allentown, PA...
~, .4 ~
VH.j:C3H.j; 3." 1(ACCELERATED RIDS PROCESSING)
REGULATORY INFORMATION DISTRIBUTION SYSTEM (RIDS)
ACCESSION NBR:9408020198 DOC.DATE: 94/06/30 NOTARIZED: NOFACIL:50-387 Susquehanna Steam Electric Station, Unit 1, Pennsylva
50-388 Susquehanna Steam Electric Station, Unit 2, PennsylvaAUTH.NAME AUTHOR AFFILIATION
FIELDS,J.S. Pennsylvania Power 6 Light Co.RECIP.NAME RECIPIENT AFFILIATION
DOCKET0500038705000388
P
SUBJECT: "Susquehanna Steam Electric Station Discharge MonitoringRept June 1994."
DISTRIBUTION CODE: IEZSD COPIES RECEIVED'LTR L ENCL L SIZE: /TITLE: Environmental Monitoring Rept, (per Tech Specs)
NOTES:
0
RECIPIENTID CODE/NAME
PD1-2 LAPOSLUSNY,C
INTERNAL: ACRSRE~'XLR 01
FILE 02
EXTERNAL EGE(G AKERS I D
COPIESLTTR ENCL
3 31 1
1 11 11 1
1 1
RECIPIENTID CODE/NAME
PD1-2 PD
NRR/DRSS/PRPB11RGN1 DRSS/RPB
NRC PDR
COPIESLTTR ENCL
1 1
2 ~ 21 1
D
0
C
U
NOTE TO ALL"RIDS" RECIPIENTS:PLEASE HELP US TO REDUCE WASTE! CONTACTTHE DOCUMENTCONTROLDESK, ROOM Pl-37 (EXT. 504-2083 ) TO ELIMINATEYOUR NAME FROMDISTRIBUTIONLISTS I'OR DOCUMENTS YOU DON'T NEED!
TOTAL NUMBER OF COPIES REQUIRED: LTTR 13 ENCL 13
A
Pennsylvania Power 8 Light CompanyTwo North Ninth Street ~ Allentown, PA 18101-1179 ~ 610/774-5151
July 26, 1994
Ms. Kate CrowleyWater Quality Regional ManagerBureau of Water Quality ManagementPennsylvania Department of Environmental Resources90 East Union Street, 2nd FloorWilkes-Barre, PA 18701-3296
FILE R9-8A
SUSQUEHANNA STEAM ELECTRIC STATIONDISCHARGE MONITORING REPORT - JUNE 1994NPDES PERMIT NO. PA 0047325CCN 741326PLE- 17929
Dear Ms. Crowley:
Pursuant to Part A, 3.b.(1) of NPDES Permit No. PA 0047325, enclosed is theSusquehanna Steam Electric Station discharge monitoring report for June 1994. Alsoenclosed is Pennsylvania Department of Environmental Resources'onthly FacilityReport Form (01-112).
There were no noncompliances in June.
During the week of June 20, 1994, annual maintenance was conducted at the RiverIntake Structure. Screen wash water normally processed by the river intake debrisremoval system was discharged back to the river to allow for removal of sediment fromthe intake bays. Once maintenance was completed river water was once againprocessed by the debris removal system prior to use as station make-up water.Sediment removed from the intake bays was disposed of onsite.
Pgt.'0 gp 7/
I 9408020g98'qDOCK 940~3'0
P IC 050003'87PDR
8(
July 26, 19941
CCN 741326 FILE R9-8APLE-17929To: Ms. Kate Crowley
Ifyou have any questions, please call me at (215) 774-7889.
Respectfully yours,
+9'rome
S. Fieldsnior Environmental Scientist - Nuclear
Enclosures
Copies to:IVls. I. Worrell,-EPA-Region.lll
FNRC Document'Control-Desk~NRC Region I
Mr. C. Poslusny, NRC Project Manager
Jsf/ltf3216o(26)
Ul-l.12
ATTACHMENT
PA Ota ARTHEHT OF ENYIROHHENTAL RESOURCES Hoetn JU.KHONTHLY FACILITY REPORT Date Prepared +
2400994faci l i ty Name Sus uehanna Steam Fleet ic Station PWS ID HO.P.O. 8ox 467
'acilityAddress Berwick PA 18603 HPDES Permit Ho. PA 0047325
Municipal i ty Salem Townshi
Co„nty Luzerne
Incinerator Permit Number(s) N/A
Telephone Number (717) 542-1879
Person Comple ng Form Curtis H. SaxtonPrint Name
Signature
Title Environmental Scientist
1. Total Hours Incinerator Operated
2. Type of Fuel
3. Total Fuel Osage
4. Supplier of Fuel
N/A
N/A
N/A
N/A
5. Estimated Atnount of Sludge Incfnerated
6. Incinerator Ash Dfsposal H/A
(a) How Huch (Tons)(b) Where(c) When (Last ccurrence(d) Hauler(e) Receipts: Yes
8. Other Wastes (Grfts, Barscreenfng, etc.)
(a) How Huch (Tons)(b) Where(c) When (Last ccurrence(d) Hauler(e) Receipts: es Ho
S. Septic Tank Haste Accepted: Yes Noa
N/A
7. Sludge Ofsposal Water Treatment
(a):.':(b)
(c)(d)(e)
Hm,Huch (Tons)4%leres»'Nen .{ t OccurrenceHaulerRecefpts: Yes Ho
+ Id:PM.L)IIC. CAV)VG<~~ag+) Q)Q~HaKSa, I)A
10. If yes:(a) Volume(b) Hauler(s Percent (X) Hauled
11. Analysis Performed to ensure tank waste contafns no fndustrfal waste(a) Yes No(b) If yves, requency
12. Addi tional Comtents: I 0
dR 0 Ifdat i-I ze.(
PERMITTEE NAMc/ADDRESS ((nelttdcFaculty /(arne/Local/c>n Ifdiffcrcnt/
i'UK3U'ACILITY
LOCATION
I. ~ ~ 0 TY SUPV OPEfi TECHNOL
PERMIT NUMBER OISCHAIICE NUMaER
MONITORING PERIODYEAR MO
FROMDAY YEAR MO DAY
TO
(20-2// (22.25/ (26.25/ / (2 ~ / ( /
NAYIDH*LPOLLUTANTDISCHARGE ELIMINATIONSYSTEM (((PDE5/DISCHARGE MONITORINGREPORT (DI/R/
2 I6 I7./9 H A~ oR Form Approved.(SU BR 02) OMB No. 2040-0004.
FI N AL Approval expires 6-30-91. ~
COOLING TOi(ER BLOMDOi(N
NO DISCHARGENOTE: Read instroctions before compietiIIII<his form.
PARAMETER
(5M7) AVERAGE MAXIMUM
(5 Card Only) QUANTITY OR LOADING(61M/) (5A$I)
UNITS
(6 Card Only)(5(L65)
MINIMUM AVERAGE MAXIMUM
QUALITYOR CONCENTRATION(6645) (546/)
UNITS
NO. FREDUENCYOF
ANALYSIS
(6648)
SAMPLETYPE
(69r70)
OOII00 1 0 0C
LINCa TOTAL(AS ZN)01092 1 0 0
SAMPLEMEASUREMENT
: 'PEAMlTRKQUIAEMKNT
SAMPLEMEASUREMENT
'ERM I'rREQUIREMENT
'Ie VV e'V'e
1 VACVVC A ~ AJ AA'e VVV e ~
J AAA~ V ~
ec AAA
56 4vv
6CO,
AAAJ AA~ 'V r'V ~
AAAA'QJ)
0 JZ
(12) g
( 19)
05P.
FLOP, IN CONDUIT ORTHRU THEATNE.IIT PLAN50050 1 0 0
CHLORINE, FREi.AVAILABLE5006(I 1 0 0
SAMPLEEASUREMENT
PERMIT-RKQUIREMENT
SAMPLKMEASUREMENT
PKAMST.RKC}UIRKMENT.
REPORT>
en C:vtetv
AgAAJc
r~g ~~ ( 03)
-REPORT.
0AJ AAAvvvv ec
J>AJ A erVVVVVV
AAAAAPVV ~ V
'Q ~tvrnsei
~ V r'V
( 19)
DAXLY-RCORD
SAMPLEMEASUREMENT
. PKAMTTREQUIREMENT
: -'V
SAMPLEMEASUREMENT
PERMIT.RKQUIREMENT
SAMPLEMEASUREMENT
PKIVlIT.REQUIREMENT
NAME/TITLEPRINCIPAL EXECUTIVE OFFICER
R.( * Gyv(L~ Sr. V. P.
TYPED OR PRINTED
I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINEDAND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AND BASEDON MY INQUIRY OF THOSE RIDIVIDUALS IMMEDIATELY RESPONSIBLE FOROSTARONG THE INFORMATION. I BELIEVE THE SUSMITIED INFORMATIONIS TRUE. ACCVRAYE AND COMPLETE. I AM AWARE THAT THERE ARE SIG.taFICANY PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDINGTHE PDSSIS>LIIY OF FINE AND IMPRISONMENT SEE 18 V5C I 1001 AND33 USC 5 1319 tyrnatt>rv unarr them ttatvtra mar >nrludr />nrv vp te> Stun>mand eer mat>mane >mpneemmrnt u/hrturrn 6 me>nthv and 6 Srarv I
SIGNA U E O PRINCIPAL EXECUTIVEOFFICER OR AUTHORIZED AGENT
TELEPHONE
7( Wu2220NUMBER
DATE
7 4/YEAR MO DAY
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Itr(rrrnrc ull uuuchrnrnts hrrr) 0'1 E- ("<icr(I~(= >S ~~~-I C-:liSLG~-I', ~~C l iSL 0~I tl I-I(,~~FREE AVAILABLE CHLORINE SHALL BE TAKEN DAILY BY GRAB DURING CHLORINATION~
EPA Form 3320-I (Rev. (HIS) Pwvlous editions may be used. (RCI'LACES CI A IFORM T 60 WHICH MAY NOT SC VSCO.)00464/940307-1015
PAGE OF
PERMITTEE NAMEIADDRE55 f/ncI44dcFac43 ty //omc/Loaallon lfdlffcrcnl/~NME ~4 chil~ f 'IUU4
ADDRESS~~Cui BLI/E.'LILMUKZJ
FACILITYI OCATION
riis R.. DOTY SUPV OPER TECHIIOL
PERMIT NUMBER olacHAkoc N44msck
MONITORINC PER IODYEAR MO OAY YEAR MO OAY
FROM TO
/ze.zl/ /22.2J/ /242s/ / 6 / /2 ~ / / /
NATIONALPOLLUTANTOISCHARO>5 ELIMINATIONSY5TEM ///PDES/DISCHARGE MONITORING REPORT /D/dR/
2-/6 /7./9 fIAJOR Form Approved.(SU BR 02) OMB No. 2040-0004.
FI H A L Approval expires 6-30-91.
SERV AHD ADNIH BUILDIHG SU!IP
HO DISCHARGENOTE: Read instructions before comI)letiIIIIthtsforrrL
PARAMETER(SZnry) AVERAGE MAXIMUM
(S Card r/nty) QUANTITY OR LOADING(666/) (S64/)
UNITS M IN I MUM AVERAGE MAXIMUM
(6 Cord Only) QUALITY OR CONCENTRATION(/ILES) (ASS�) (S46/) FREOUENCY
OFANALYSIS
SAMPLETYPE
6M3) (6648) (dIL70)
SAMPLEMEASUREMENT
r J4'V ~ rn >rn >rn
00/IOO 1 0 0
SOLIDSF TOTALSUSPEHDED00530 1 0 0
PERMITnRKOUIREMKNT
SAMPI.EM EASU R E MENT
'ERMITRKqUIREMEIET
AHA>rA
A >cA >>>P -'
AJ AQg
j $$ .4o-p HJ J 4>>v''4 >
~ A4 A%A~ %' >
V'»4>r qg
. 30 ~
0'SO," .
( 19) 0 lid>ONCZ44/ 4 O'RAB ."'.
OIL AHD GREASEFREON EXTR GPiAV MET00556 1 0 0
SAMPLEEASUREMENT
PERMIT .
EGUIREMKNT
I> +4> r Ar I>CA» rcr ~
r O'I>r/F44(/r>C:; $$ ' 0." 2090'O.q9 0.0s
ONCE/f 'RAS
FLOII F IH COHDUIT ORTHRU TREATBEHT PLAH50050 1 0 0
SAMPLE/6EASUREMENT
. PERS/5T-RKqUIREMENT,
( 03) A4 Mr aw>r rn'v~/</4 i ~BD
DAI,IY ESTX5
SAMPLEMEASUREMENT
PERMrl'KGUIREMKNT
SAMPLEMEAS U R EM EN T
PERMITRKGUIREMKNT
SAMPLEMEASUREMENT
PERM ITRKQUIREMKN'T
NAME/TITLEPRINCIPAL EXECUTIVE OFFICER
P.C. pr"~ Sr. U.
TYPED OR PRINTED
I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAM4HEDAND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AHD BASEDON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOROBTAIN>HG THE IHFDRMATIO!a. I BELIEVE THE SUBMITTED INFORMATIONIS TRUE, ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG.taF4CAHY PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDINGTHE PDSSIB>LITY OF FINE AND IMPRISONMENT SEE IB USC 5 IDOI AND33 Use 5 4319 ryrnalr>ra unarr 4hr>r alalatra may >aria>lr />nra ap lr> ilail»>4and»r mammrm >mpn»mmrnr»/hrlarrn 6 mnnlha and $ !rara >
IGNAT R OF P INCIPAL EXECUTIVEOFFICER OR AUTHORIZED AGENT
TELEPHONE DATE
NUMSER YEAR MO DAYCOMMENT AND EXPLANATIONOF ANY vloLATIGNB (Rc/crcncc all «rlachmcnlc herc)
FLOli AHD PH SHALL BE MEASURED DAILY ifHEH DISCHARGIHG ~
EPA Form 332()-t (Rev. 048) Pnrvious editions may be used. IREPLACLr5 EPA FORM TWO WHICH MAY NOT BE VSEO.IOOII67/9/I0307-1015
PAGE Of
PcRMITTcK NAMc/ADDRE55 (/ne/ttdeFee//I'ty )(arne(Locotbn lfdifferent)
ADDRESS~~»~i ~tlZii METES~'UiXQRh ~~UU
FACIUTYLOCATION
Ii- R ~ ~ DO'UPV OPER T CHNOL
PERMIT NUMBER DIacHARCE Nvmacn
MONITORING PERIODYEAR MO DAY YEAR MO DAY
FROM(3 TO
(20.2)) (22.2// (24.26) (26 / (2 ~ / ( /
NATIONALPOLLUTANTDISCHARGE ELIMINATIO>I5YSTEM ()VPDES/I)ISCHARGE MONITORINGREPORT ID)t(R)
2./6 ly./9 HAJOR Form Approved.~SUBR 02'MBNoe 2040-0004.F - FINAL Approval'expires 6-3'0-91...II1 TURBINE BLDG IIASTE QUIP
NO DISCHARGE I INOTE: Read instructions before compietIIIII~his foll(L
PARAMETER
(lMT)
00400 1 0 0~ e
SAMPLEMEASUREMENT
; I ERMIT.REK(UIREMENT
AVERAGE MAXIMUM
4 AtvJ e 4~ ~
4 4 4AJ Je
q JveL4(4 Ler
(4 Cord Only) QUANTITY OR LOADINQ(d(Wl) (SAfl)
UNITS
S.4 L4 4 >L
(d Cord Only)(/(L4S)
MINIMUM
0AVERAGE
4 4 4 4 4~ n n n n 'll
MAXIMUM
8.oe9 ~ 0
QUALITY OR CONCENTRATION(4$N) (SArl) NO.
KXUNITS 62~))
(12) g
FREDUENCYOF
ANAI.YSIS
(6448)
SAMPLETYPE
(69-70)
SOLIDS F TOTALSUSPENDED00530 1 0 0
OIL A )ID GRKAS E
FREON EXTR-GRAY rlET00556 1 0 0
SAMPLEMEASUREMENT
- PERMITIIKEQLIIREb(ENT
SAMPLEEASUREMENT
PERMIT'.'QUIRI94ENT
4 J 4 4 J Jn n nn 8'n en
J eL4 )>'hg)>1,
4 4 4 4 4 4'v n ~
Jv4 e 4
AQg.fQy-
~ 4 4n ~ Y'
et 4 J
Jy g Je 4
4 4 4
Q+~4.+4"e
'JJJeLJn"p ~ n n
e'30i0
Q ll15o0 e "'
~
1,00 a 0„".'".
O.ll
( 19)O
(19) Q
NCK/ "
'leo
GRAB "
FLOIIF IN CONDU1l ORTHRU TR"ATHLNT PLAII50050 1 0 0
SAMPLEEASUREMENT
PCRb(IT:.'REQUIRKIEENT.
g) gyp' 03)
- REPORT-
+JIJ 4 4 4
Q)t(no(r)e(gt
4 J 4 4 A4 en n
SAMPLEMEASUREMENT
PERbllT .
.R EQUI R KblKNT
SAMPLEMEASUREMENT
SAMPLEMEASUREMENT
PERMIT'EQUIREMENT
NAME/TITLEPRINCIPAL, EXECUTIVE OFFICER
Itra.IYI Sl
6 rrfl lsTYPED OR PRINTED
I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINEDAND AM FAMILIAR WITH THK INFORMATION SUBMITTED HEREIN. AND BASEDDN MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOROBTAlttlNG THE INFORMATION. I SKLIEVE THE SUBMITTED INFDRMA'TIDNIS TRUE, ACCURATK AND CDMPLETK I AM AWARK THAT THERE ARE SIG.MFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. VICLUDINGTHE POSS>B>LITT OF FINE AND IMPRtSDNMKNT SEE 18 USC I IDOI AND33USC I )319 tprnah>re u>utrr threr ttatntre mav mrledr /enrn up tn rtogrna>«t e>e manm un> >mpne>mmrnt n/ hvtuvrn 4 m >nthn andS hearn I
SION U E 0 RINCIPAL EXECUTIVEOFFICER OR AUTHORIZED AGENT
TELEPHONE
NUMBER YKAR
DATE
7 2/MO DAY
COMMENT AND EXPLANATIONOF ANY VIOLATIONS (Rr)rrrnee uu uuurhmrntr here)
FLOiI AND PH SHALL BE iiEASURED DAILY i(HENDISCHARGING'PA
Form 332()-t (Rev. 048) Ptev(ous editions may be used. (RcPLAccs KPA FQRM T 40 vrHlcH MAY NDT sc UEKD.I00470/940307-1015
I'AGK OF
I'cRMITTcc NAME/ADDRc55 (lnctttdcFacdtty J(amc/Loartbtt IfdiffcrcnlJ
eADDRESS~~~~~ee L~~e~eeieForm Approved.
(SUBR 02) OMBNo.2040-0004.F — FI NAL Approval expII'es 6-30-91.
k2 TURBINE BLDG MASTE SUNP
PERMIT NUMBER DISCHARGE NUMacn
MONITORING PERIOD
NATIONALIeOLI VTANTDI5CH*RGE ELIMINATIONSYSTEM (J(y()ES)DISCHARGE MONITORING REPORT IDJIIRJ
2 16 17.19 GATOR
FACIUTYLOCATION
eg PER TECHNO
YEARFROM
MO DAY YEAR MO 'DAYTO
(Ze-ZJJ (22.231 (26.2SJ (26 1 (26.291 ( J
NO DISCHARGENOTE: Read instructions before completil(g1IIis form.
PARAMETER
(3247) AVERAGE MAXIMUM
(3 Card Only) QUANTITY OR LOADING(dt543) (3641 )
UNITS
(6 Card Only)(3SAS)
MINIMUM AVERAGE MAXIMUM
QUALITY OR CONCENTRATION(6643) (Sddtl)
UNITS
NO FREOUENCYOF
ANALYSIS
6249 (drat)
SAMPLETYPE
(d9-70)
PH
00400 1 0 0V 0
SOLIDS, TOTALSUSPENDED00530 1 0 0
C
OIL AND GHEAShFREON EXTR-GRAY HET00556 1 0 0
'
I
SAMPLKMEASUREMENT
.I KRlllT.REQVIREMKNT
SAMPLEMEASUREMENT
PERMITREQUIREMENT
SAMPLEEASUREMENT
PERlal1 i;RKQVIRKMKNT
AA
A AAg4 III..
AAAAAJ~ v'I 'N ~
J AAAA
AAJ AAe 'YW II ~
AAAJ AArn i r
A A AJ Ie0gee
AJ AAAA~ &eeerr
+e OAJ AA
JI AAge gJ A
AJ JyAg
,;30aO
;i550":
09ia0 ',':-'...
20+0
( 12)
0 '/zoONCE/
RA
8'„."'LOW
IN CONDUIT ORTHHU THEAT?IENT PLAN50050 1 0 0
'e e
PERMIT .'EQUIREMENT.
REPORT
tleeeVREMCNT Q.Olc,g Q g)Pg ( 03)
REPORT":,
e AAAAAie r~~'W i
A ~/8tDAXLY
SAMPLEMEASUREMENT
PERMlT'l
KQUlR KMENT
SAMPLKMEASUREMENT
PKRMIT-RKQVIRKMENT
SAMPLEMEASUREMENT
PERMIT .
REQVIRKMKNT
NAME/TITLEPRINCIPAL EXECUTIVE OFFICER
TYPED OR PRINTED
I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINKDANO AM FAMILIAR WITH THE INFORMATION SUBMITTED HERON. ANO BASEDON MY INOUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOROBTAIHVIG THK IHFORMATIOeL I BELIKVE THE SUBMITTED INFORMATIONIS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG.taFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDINGTHE POSSRVLITY OF FINE AHD IMPRISONMEH'T SEK 18 USC f IOOI ANO33 USC 5 13I9 tyinatteis asuri thrsr statstrs may tatladr /iars ap r» stuJsstand eer mammam empnsemmreet s(terraria 6 aerinths and 6!ram I
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rr/crrncc uu attachments hare)
FLOW AND PH SHALL BE HIEASURED DAILY MHEN DISCHARGING~
GNATV E OF RINCIPAL EXECUTIVEOFFICER OR AUTHORIZED AGENT
TELEPHONE DATE
NUMSER YEAII MO DAY
EPA Form 3320-1 (Rev. 948) Previous editions may be used. (RcI'LAGE5 cPA FDRM T ao vrHIGN MAY NDT Bc v5co.l00473/940307-1015
~ AGC OIi
PERMITTcc NAMclADDRE55 /IncfttdcFactrlty J/amc/Locolk)n Ifdlffcrcnl/
~~sXSLU~JLmU~Q'ERMITNUMSER ota»HAttoc NUMactt
MONITORING PERIOD
NATIOHALPOLLUTANTDI5CHARGE ELIMINATIONSV5TEM IJIPDESIDISCMARGE MONITORING REPORT IDJ)IRJ
2.I6 /7./t/)4
5AJOR Form Approved.(SUER 02) 0MB No 2040-0004
F — FINAL Approval expires6-30-91.'EIIAGE
TREATtiENT EFFLUENTO'ACILITTLOCATION
~ >)I u T SU V 0 ER ECHH
YEAR MO DAY YEAR MO 'DAYFROM TO
I20.2I/ /22 25/ /26-25/ /26 I /2 ~ I I J
HO DISCHARGE ) ) ¹¹¹.,NOTE: Read instructions before complstllliItIItsform.
PH
PARAMETER(5241)
SAMPLEMEASUREMENT
AVERAGE MAXIMUM
A AAAAA5 ~
AAJ AAJ>ann% r
(5 Card Only) QUANTITY OR LOADING(6645) (5ddII)
UNITS
(6 Cord Only)(5(L65)
MINIMUM AVERAGE
¹¹¹¹¹-">IMAXIMUM
77C
QUALITY OR CONCENTRATION(6645) (546l) FREQUENCY
OFANALYSIS
SAMPLETYPE
6245) (6648) (de-re)
) BO> ~g00400 A 0 0
~ D ~ ~
SOLIDSF ZOThLSUSPENDED00530 A 0 0
I ERMITREQUlREMKNT
SAMPLEMEASUREMENT
REQVIREMKtlT
J AA¹J ¹.
20 »'00
AAAAAA
AAAAAA
J AJA¹AJ
( 26) ¹AA¹ >IA
¹yjA&gi
¹¹¹¹"¹ 9»0 ..
J AAJ
q¹g>M¹ L
( 19)
'. -,- ONCEJ'f = OHP-.-'
LOit F IH CONDUIT ORTHRU TREATtlEI(T P LAH
50050 A 0 0
SAMPLEtM EASUREMENT
PRRlllT „REQVlREMKNT
0»08
(>) gZ i( 03)
-REPORT
LAAJ>AAnn~ rtn J ~> AAAJ A'r( SO(ao f4or
MILD.-FLOXH
CHLORIHEF FRi,"EAVAILABLE50064 A 0 0
SAMPLEMEASUREMENT
PER»(lT.REQUTREMEtlT.
AJ AJ AAn >r nn n> ~
A~g¹Jn(:"„¹
AJ AA ~Innnnc
¹¹¹¹¹~~ ~ J AAAAAA
8 )0 Q.Z3 (19) q (COLIFORtia FECALGENERAL74055 A 1 0
BODF CAROOHACEUUS05 DAY, 20C80002 A 0 0
SAMPLEMEASUREMENT
PERMITKQUIR KMKNT
SAMPLEMEASUREMENT
PERM lTREQUIRRMRNT
AAAJn n > n 9"n
},2A¹A¹AA
AAAAAA»I t J>reer
AAAA~ V'
26) AAAAJ J
Q-O200
0
¹¹J AA
A¹¹ ~ A
¹¹¹¹¹¹
( 13)
ONCE/ GRAB
'/SO
CO
ONCE/ CONP-
SAMPLEMEASUREMKNT
PKIUl IT'EQUIRKMCN'r
NAME/TITLEPRINCIPAL EXECUTIVE OFFICER
0 G y Vn.rq St" V
, (teGIQTYPED O PRINTED
I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMtNEDAND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AND BASEDON MV INCWtRV OF THOSE INDtVIDUALS IMMEDIATELY RESPONStSLE. FOROBT>UNtNG THE atFDRMATtON. I BELIEVE THE SUBMITTED fNFORMATIDNIS TRUE. ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG.toctCANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDINGTHE POSS>B>Ltlv OF FtNE AND IMPRISONMENT SEE IS USC I 1001 AND33 USC 5 I3IS tprnolnrr unorr thrrr rtotutrr moy >nrludr />nrr up tn Stolrrtond ur mor>mum tmpnammrnt >d hrturrn 6 munthr and.I lrom t
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rclcrcncc all anachmcntr herc)
IGNAT E OF PRI CIPAL EXECUTIVEOFFICER OR AUTHORIZED AGENT
TELKPHONE
NUMSER YEAR/7 5'/Z- Z
DATE
DAY
EPA Form 3320-1 (Rev. IH)8) Prev/ous editions may be used. (RCPLACC5 CPA fORM T CO WHICH MAY NOT SC USCD.I00476/940307-1015
PAGE Of
PcRMITTEE NAME/ADDRc$5 (JnttodrP'on7(ty //omc/Locotbn Ifdtffctent/
ADDRcm~ I1Li/~i~I'~~Li1Ef~~L(liLR ~MMU
O'ACILITY'OCATION
AT N: R ~ L ~ f/OTY SUPV OPER TECHNOL
PERMIT NUMBER OITCHARCC HUIISCR
MON ITOR IN6 P E R I0 DYEAR MO OAY YEAR MO OAY
FROM(J TO
(Ze 2/J (22.25/ (26.25/ (2 ~ / (2 ~ / ( J
NATIONALI OLLVTANTOI5CHAROC ELIMINATIONSYSTEM (J(PDE5/DISCHARGE MONITORING REPORT IDHRJ
2-I6 /7 /9 MA~OR Form Approved.(SUBR 02) OMBNo.2040-0004.
FI g A L Approval expires 6-30-91.
RADMASTE TREATMENT EFFLUENT
NO DISCHARGENOTE: Read inrtruCtions before completlIIjthis form.
PAR A M ET KR
(/My) AVERAGE MAXIMUM
(5 Cord Only) QUANTITY OR LOADING(4645) (564/)
UNITS
(6 Cord Only)(/IL65)
MINIMUM AVERAGE MAXIMUM
QUALITY OR CONCENTRATION(6645) (546/)
UNITS
NO,
62J5/)
FREOUENCYOF
ANALYSIS
(6'>S)
SAMPLKTYPE
(69-10)
SOLIDS F TOTt(LSUSPENDED00530 1 0 0
SAMPI.EMEASUREMENT
PFRM IT,REQUIREMENT
J J J J JY"n J'v J n J J JvJ J'J ~ ~ Yn nr
JIJ>J J J gJ JvJ JI J ~
J Jv ~ J J J
30s0g g (.19)
100 ~ 0
FLO)l F IN COiVDUI'1'RTHRU TffEATHENT PLAN50050 1 0 0
SAMPLEEASUREMENT COZ 0OI 4
REPORT 'EPORT'03) JvJQJgJ J QJ QJ vv
"Iv54tp-rn m-—
z/go
SAMPLEMEASUREMENT
PERMIT.'EQUIREMENT
SAMPLKMEASUREMENT
PERSIIT.—REQUIRKMENT.
SAMPLEMEASUREMENT
PER MTTRKQUIRKMENT
SAMPLEMEASUREMENT
PERM lTREQUIREMENT
SAMPLEMEASUREMENT
-
PERMIT'EQUIREMENT
NAME/TITLEPRINCIPAL EXECUTIVE OFFICER
R G yrD~ S'r V
TYPED 0 PRINTED
I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINEDAND AM FAMILIAR WITH THE WFORMATIDN SUBMITTED HEREIN. AND BASEDON MY INOVIRY OF THOSE INDIVIDVALS IMMEDIATELY RESPONSIBLE FOROBTAINING THE INFORMATION. I BELIEVE'HE SUBMITTED INFORMATIONIS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG.taFICANT PENAI.TIES FOR SUBMITTING FALSE WFORMATIDN. WCLVDlttGTHE POSSe>LITY OF FWE AND IMPRISONMENT SEE IB U5C I IOOI AND33 VSC l 1319. IPrnatt>rv vnarr thrrr ttatvtrv mav tnrlvdr />nrv vp tn litt!vvtand»r manmvm >mpnvvnn>r»t v/ hrtvvrn 6 mnnthv and 5 Pram I
IGNAT E F PRINCIPAL EXECUTIVEOFFICER OR AUTHORIZED AGENT
TEI.KPHONE
'rlt" - 2NUMSER YEAR
OAT E
7 +/>
MO DAYCOMMENT AND EXPI ANATION OF ANY VIOLATIONS (Rr(rrrnrr oil vttvrhmrntt hrrr)
FLOM SHALL BE MEASURED DAILY 5lHEN DISCHARGING~
EPA Form 3320-1 (Rev. 948) Pattlous editions may be used. (RCPLACC5 CPA II'ORM T 60 WHICH MAY HOT SC USED.)00479/940307-1015
I'AGE OF
I'ERMITTcKNAMEIADDRE55 (JncfttdaFacttity Noma (Localbn lfdij/crcntJ~~ME ~ '~maui au~ADDRE
I ACILITYLOCATION
TN ~ P ~ L ~ DOTY SUPV OPER TECIINOL
PERMIT'UMSEIt otacnnttcs NUMocn
YEARFROM
MONITORING PERIODMO DAY YEAR MO DAY
TO
(20 ZlJ (22 23J (26.2'26. J (2 .29J ( J
NATIONALPOLLUTANTOISCHAIIOS CLIMINATIONSYSTCM (f(PDESIDISCHARCE MONITORINC REPORT (DI(JIJ
2(6 l1.l9 MAJOR Form Approved.(SUB'2) OMB Nor 2040-0004.
Approval expires6-30-91.'ASTE
FILTER BYPASS
NO DISCHARGENOTE: Read instructions before co Pieti)llthls forrlL
PARAMETER(3M1) AVERAGE MAXIMUM
(3 Cord Only) QUANTITY OR LOADING(6643) ($641 )
UNITS
(6 Cord Only)(3)L63)
MINIMUM AVERAGE MAXIMUM
OUALITY OR CONCENTRATION(6643) (SAfl)
UNITS
NO FREQUENCYOF
ANALYSIS
6243) (66a)S)
SAMPLETYPE
(69-10)
SOL1DSa TOTALSUSPENDED00530 1 0 0
(
SAMPLEMEASUREMENT
PERMITaREOS)TREMENT
AP AAAAnr r 'I 'snrn'r'~Atr v:trn.
AAAA~ AYAu Arn
ntv'AAAAAnr n r' rr'v
drtgf@ggtg 3060 3,00tr 0
( 19)HACK/
GRAB..
OIL AND G R EASEFREON EXTR-GRAIi MET00556 1 0 0
SAMPLEEASUREMENT
'4 AA AII n
QILqAAQ ~ AII A
AA4 AA
S),'@A~yr+A,, 15» 0, . 20i0
( 19)
GRAB.,"
FLOI, IN CONDUIT OHTHRU TREATMENT PLAN50050 1 0 0
SAMPLEEASUREMENT
PERM)sREC)u)RKMENT
( 03) AAAAPArnn'I
n nA rn nr~ . „-.: m rrrv~~nr DAXL'Y"FLOXH
SAMPLKMEASUREMENT
PERM ITREGUIREMENT.
SAMPLEMEASUREMENT
PERbl)T .
SEC) UlR KblENT
SAMPLEMEASUREMENT
PERMITRKGU)REMKNT
SAMPLEMKASUREMKNT
PERM!tRFA}UIREMKN't
NAME/TITLEPRINCIPAL EXECUTIVE OFFICER
P 6 l3y~ppr Sr
TYPED OR RINTED
I CKRTIFY VHDKR PENALTY OF LAW THAT I HAVE PKIISONALLY KXAMINKDAND AM FAMILIAR WITH THK INFORMATION SVBMITSKD HKRKIN. AND BASKDON MY INQUIRY OF THOSE INDIVIDUALS IMMKDIAYKLYRKSPONStBLK FOROBTAINING THE INFORMATION. I BKLtKVK THE SVBMITTLD tNFORMAYIONIS TAVE. ACCURATE AND COMPLETE. I AM AWARK THAT THERE ARE SIG.taFICANT PKNALTCS FOR SVBMttttHG FALSE INFORMATION. INCLUDINGYHK POSSIBILITY OF FINK AHD IMPRISDHMKHT SKK IB VSC f IDDI AND33 USC 5 13 I 9 tyrnattira aniri r thrar atatotra mav inrladr finra ap tii Slufamoiid nr maaimom impnaimmrrit Id hrtovvn 6 mnntha ond Shrarnt
SIGNAT E RIN IPAL EXECUTIVEOFFICER OR AUTHORIZED AGENT
TELEPHONE
1I 7 qg-32ZONUMBER YEAR
DATE
7MO DAY
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rrfrrrnrr oll uuuchmrnts hrrr)
F LOM SHALL BE tlEASU RED DAIL Y IiHEN DISC HARG ItiG ~
EPA Form 3320-1 (Rev. 948) Previous editions may be used. (RCPLACC5 CPA FORM T 60 SrrHICM MAY NOT BC V5CD.)00482/940307-1015
PAOC OF
PERMITTEE NAMctADDRE55 ffnetttdeFacility 1/atnefLoottbn tfdiffcrentJ
ADDR SS~~UiXL13itL ~~LLlL PERMIT NUMBER OISCHARCE NUMattl
MONITORING PERIOD
NATIONALPOLLUTANTDISCHARGE ELIMINATIONSY5TEM t//PDE5JDISCHARGE MONITORING REPORT /Dtt(RJ
2.16 11-19 M A0 OR Form Approved.(SU BR 02) OMB No. 2040-0004.F - FIHAL Approval'explres6-3'0-91.
NEUTRALI'lATION BASIH DISCHARGEFACILlTYI OCATION
'0'sX 0 It V OPER TECHNOL
YEAR MO OAYFROM
YEAR MO OAYTO
120 21J /22.23/ (26-25J 126- 1 (28 J 1 J
HO DISCHARGENOTE: Read instructions before comptetilltIthis form.
PARAMETER
(3M7)
SOLIDSF TOTALSUSPEtiDED00530 1 0 0
SAMPLEMEASUREMENT
PERMITnREOUtREM ENT,
(3 Card Only) OUANTITY OR LOADINO(6643) (Sddtt)
MAXIMUMAVERAGE
AAAAAA~ 'vn I rn J AAAA1nrnrr
AAAA AArw rwYv A+A A g
UNITS
AAA~ 'V 'p
AAal Ar
v'INIMUMAVERAGE
B.GMAXIMUM
.Q I.Q
3090 ',$ 00 0(
(d Cord Only) OUALITYOR CONCENTRATION(38-65) (6683) (SAfl)
UNITS
( 19)
NO.
6M3)
FRECUENCYOF
ANALYSIS
(66ats)
SAMI'LETYPE
(69-10)
OIL AND GREASEFREOtt EXTR GRAY klET00556 1 0 0
FLOM IH COtiDUIT OttTHRU TREATtIDNT PLAN50050 1 0 0
SAMPLEEASUREMENT
PERMIT,RKEIUIRKMENT
SAMPLE[MEASUREMENT
AAAAAr ~ -rn Y AAAAAA
QILJ A A)st
'PKRMtT - - REPORTEOUtREMENT
Ci.0gl O.b150
A 4Ar rnII rl
( 03)
yIAAAAJg
AAAAAr' 'err
Qtsttr4!Q st
hAJttl AA .r trn On-
Ag)CA+A' gy8trrJ AQ
Qo 8 O,-'15a 0
( 19)
DAILY...'AB.'STXH
SAMPLKM EA SU R EM ENT
PERMIT;,RK(tUIREMKitT,
K
SAMPLEMEASUREMENT
.. PERBIITRKCIUIRIQlKNT
SAMPLEMEASUREMENT
PERMITREOUIREMKNT
SAMPLEMEASUREMENT
KRMIT .REE)UIREMKNT
NAME/TITLEPRINCIPA! EXECUTIVE OFFICER
6 It) r6t.Pit Xr. U. P-
.IA tOCCTYPED R PRINTED
I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY EXAMtNEDAND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AND BASEDON MY INQIXRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOROBTAINatG THE INFDRMATlDN. I BKLIEVE THE SUBMITTKD INFORMATIONIS TRUE. ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIGtaFICANT PENALTtES FOR SUBMiTTING FALSE INFORMATtDN, INCLUDINGTHE POSSIBILITY DF FINE AND IMPRtSDNMENT SEE IS USC I 1001 AND33VSC $ 13I9 tPrnaturs snare thrsr ~ tarstrs mav snrtsdr /mrs ap ts> Stufrmand ar mammam smpnummrntnrh tuvrn 6manths andS srars.t
IONAT R OF PRINCIPAL EXECUTIVEOFFICER OR AUTHORIZED AOENT
TELEPKONK
NUMBER
DATK
YEAR MO DAYCOMMENT AND EXPLANATION OF ANY VIOLATIONS (Re/erenee utt uttvehmentt here)
FLO|l SHALL BE tlEASURED DAILY IIHEN DISCHARGING''TEtt~ FLOit SHALL BE tiEASURED DA'ILYHEN DISCHARGIHG ~ THERE SHALL BE N",DISCHARGE Of POLYCHLORINATED BIPH>ttYL CONPOUNDS ~ SEE PERIIIT FOR'OTH
EIPA o } Pnrvious editions may be used. (REPLAcE5 EPA FoRM T 40 wHIcH MAYNDT BE U5ED.I00485/940307
PAGE OF
PERMITTcc NAMc/ADDRc55 //nc/udcFoomty 2/omcjlocotlon lfdiffcrcnlJ
-~BQlUUULAADDItESS~>
~MMU PERMIT NUMBER OlaCHARGC NUMSCR
MONITORING PERIOD
NATIONALPOLLUTANTDI5CHAROE CLIMINATIONSY5TCM /J/PDES/DISCHARGE MONITORING REPORT /DJI/RJ
2./6 /7./9 tiAD OR Form Approved.(SU BR 02) OMB No. 2040-0004.F - FINAL Approvel expiree
6-30-91.'tASTE
FILTER EFFLUENTFACILITYLOCATION
~ 0
PARAMETER(3247)
tiO DISCHARGENOTE: Read inrtruCtiOns befO 8 COIniNeti)IIIthis fOrm.TECH ' /10-2lJ /22.25/ /2d.25/ /26. J /2 ~ J / J
(d Cord Only)(3/hd5)
(3 Cord Only) OUANTITY OR LOAD)NO(d643) (5'/)
DUALITYOR CONCENTRATION(d643) (546/) FREOUENCY
OrANALYSIS
SAMPLETYPE
(6/L70)AVERAGEAVERAGE MAXIMUM UNITS M IN I MUM MAXIMUM
6243) (6dder)
YEAR MO OAY YCAR MO DAYFROM TO
SOLIDSF TOTALSUSPEiiDED00530 1 0 0r"OIL AND GREASEFREOts EXTR-GRAI/ tIET00556 1 0 0
4
SAMPLEMEASUREMENT
SAMPLEEASUREMENT
Q rn n >J>tnJI
r +i~~C'4
J J J 4 J>J~ n rt em'
' rv'wn
J>avJ J gQ
~ J J J J Jv
nr'Tc /43I tg Q
J 4 J
J +J JIJVJ
J J J>J Jn
. QJ'vt5+ev 4> 15 0.n4
100u0 - ','
20400
( 19)
( 19)
HCE/
:, ONCE/'; 6MB.;"
FLOV c IN CONDUIT ORTHRU TREATMENT PLAti50050 1 0 U
SAMPLEEASUREMENT
MIT-'CIVIREMENT
REPORT
( 03) JJJJsvt'o'Yn J v
. J J Jr gQ Je
Ip C=nYIp n-"
.'" DhILY FLOItiI
SAMPLEMEASUREMENT
'KRhtIT e.. RECIVIREMENT.
';e
SAMPLEMEASUREMENT
PERMIT,IIEOUlR KMKNT
SAMPLEMEASUREMENT
PERMITRKOVIREMKNT
SAMPLEMEASUREMKNT
PERMITRKQUIRKIIENT
NAME/TITLEPRINCIPAL EXECUTIVE OFFICER
f G y'I"AdTI S/- V
TYPED R PRINTED
I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLV EXAMINEDAND AM FAMILIAR WITH THE INFORMATION SUBMflTED HCREIN. AND BASEDON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOROBTAINutG THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATIONIS TRUE. ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG.tuFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDtNGTHE PDSSIB>LITT OF FINC AND IMPRtSDNMENT SEE 18 USC I IDDI AND33 USC 5 I 319 IPrnalt>rs unarr thrsr statstrs mav enrlsdr /enrs ap te> Slulstuand 4» waN>nsw e>npneun>nrnt <e/hrtuvrn 6 me>nths and S crass I
SIGNATU E OF PRINCIPAL EXECUTIVEOFFICER OR AUTHORIZED AGENT
TELEPHONE DATE
NUMBER YEAR MO DAYCOMMENT AND EXPLANATIONOF ANY VIOLATIONS (Rr/crcncc ull uuuchmcnts hare)
FLOM SHALL BE iIEASURED DAILY It HEN DISCHARGING ~
EPA Form 3320-t (Rev. (HIS) P/sv/ous editions may be used. IREPLAcc5 cPA FoRM T 40 wHlcH MAYNoT Bc USED.I00488/940307-1015
PAOC OF
PERMITTEc NAMcrAooRE55 (IncludeFeelrity Ironte/Locotlon IfdlffcrentI~NM —~ *
ADDIICSS~n SII~<~~V'iIIL~r.I~I~~~LQ3
FACILITYLOCATION
TTN- iia ~ DOT SUPV OPER ECHNOL
PERMIT NUMBER OISCHAROE NUMacn
MONITORING PERIODYEAR MO OAY YEAR MO 'OAY
FROM TO bIZO-ZII IZZ.ZII (zd 5I I I 12.2I I I
NATIQNALPDLLUYANTDI5cHARGE ELIMINATIQNBY5TEM IIIPDE5IDISCHARGE MONITORING REPORT IDSIRI
2.16 I1.19 MAJOR Form Approved.(SU BR 02) OMB No.20404004.
F - F INA L Approval explree 6-30 91.
571 CIRC MMATER PUNPHOUSE SUMP
NO DISCHARGE I lNOTE: Read Instructions before completilIIIihis forlIL
PARAMETER
(5241)
SOLIDSF TOTALSUSPENDED00530 1 0 0
SAMPLEMEASUREMENT
I EAMITREQUIREMENT
AVERAGE MAXIMUM UNITS
~hv hAr AAd hAAYW
~ AAA
(5 Cord Only) QUANTITY OR LOADINO(6IM5) (5441)
(6 Cord Only)(IS45)
MINIMUM
hhhhP ~
AVERAGE MAXIMUM
30 0 100 ~,0
QUALITY OR CONCENTRATION(4645) (5641)
UNITS
( 19)
NO. FREQUENCYOF
ANALYSISSAMPLE
TYPE
(6648) (6SLro)
'lx> $6
OIL AND GREASYFREON EXTR-GRAY MET00556 1 0 0
FLO!4 F IH CONDUIT OHTHRU TREATMEIIT PLAti50050 1 0 0
SAMPLEEASUREMENT
'ERMITRKOUIREMKNT
SAMPLEEASUREMENT
= PKRMIT '.-COUIREM KNT
AAAr'hhh
REPORT
AAd AYh
Ahh4 AQ
( 03)
404"c: '5'0 '
AAmhhh'IP
2090' ":"
4trt44:4
( 19)Q 'leo GC
PLOIM
ICZ/ GHAB;"-
SAMPLEMEASUREMENT
PERMIT . "
REOU IAKMEIIT.
SAMPLEMEASUREMENT
PERMIT .
AKQUlIIEhl KNT
SAMPLEMEASUREMENT
PERMIT'EQUIREMENT
SAMPLEMEASU R EMKNT
PERMIT ..R EAU IREM KNT
NAMK/TITLEPRINCIPAL EXKCUTIVE OFFICER
TYPED 0 PRINTED
I CERTIFY UNDKR PENALTY OF LAW THAT I HAVE PERSONALLY EXAMuIKDAND AM FAMILMR WITH THE INFORMATION SUBMITTED HKREIN. AND BASKDON MY INQUIRY OF THOSE INIXVIDUALS IMMEDIATELY RESPONSIBLE FORQBTAINIHG THE INFORMATION. I BELIEVE THK SUBMITTED INFORMATIONIS TRUE. ACCURATE AHD COMPLETE I AM AWARE THAT THERE ARE SIG.NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDINGTHE PDS&&LITY OF FINE AND IMPRISONMENT SEE IS USC I 100'I AHD33 USC S 13IB trinaturv anarr thrrr ~ Iatvtrv may Inrtvdr rtnrv vp nr rturanand nr manmvm Impnnmmrnt vr hrtvrrn 6 mvnthv and.Shrarv.t
IONAT R OF INCIPAL EXECUTIVEOFFICER OR AUTHORIXEO AGENT
TELEPHONE
7r'? 2- XZZgNUMSER
DATE
q( 7 M/YEAR MO DAY
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rerrrenee oll unuehmentt here)
FLOM SHALL BE MEASURED DAILX MHEN DISCHARGING~
EPA.Form 3320-t (Rev. 948) PrevIous editions may be used. IREPLACC5 CPA FORM T.oo WHICH MAYNOT SC USCO.I00(I91/940307-1 015
PAGE OF