ACCEI ERA D DOCUMENT DIST UTION SYSTEMREGULA< Y INFORMATION DISTRIBUTI SYSTEM (RIDS)
,4
ACCEc3sjON NBR:9308230147 DOC.DATE:.93/08/16 'NOTARIZED: NO DOCKETFACIL:50-387 Susquehanna Steam Electric Station, Unit 1, Pennsylva 05000387
50-388 Susquehanna Steam Electric Station, Unit 2, Pennsylva 05000388AUTH.NAME AUTHOR AFFILIATION
FIELDS,J.S. Pennsylvania Power & Light Co.RECIP.NAME RECIPIENT AFFILIATION
CROWLEY,K. Pennsylvania, Commonwealth of
SUBJECT: Forwards "NPDES Discharge Monitoring Rept for Jul 1993...."& PA Dept of Environ Resources monthly facility rept. Informsthat during month of Jul,sewage treatment plant Outfall 079total suspended solid sample exceeded monthly average.
DISTRIBUTION CODE: IE23D COPIES RECEIVED:LTR I ENCL ] SIZE:TITLE: Environmental Event Report (per Tech Specs)
NOTES:
RECIPIENTID CODE/NAME
PD1-2 LACLARKgR
INTERNAL: ACRSNRR/PMAS/ILRB
EG FI% Ol
EXTERNAL: NRC PDR
COPIESLTTR ENCL,3 '
1 1
5 51 11 1
1 1
RECIPIENTID CODE/NAME
PD1-2 PD
NRR/DRSS/PEPBOGC/HDS2-RGN1
NSIC
COPIESLTTR ENCL
1 1
1 11 11 1
1 1
NOTE TO ALL"RIDS" RECIPIENTS:
PLEASE HELP US TO REDUCE WASTE! CONTACT THE DOCUMENT CONTROL DESK,
ROOM Pl-37 (EXT. 504.2065) TO ELIMINATEYOUR NAME FROM DISTRIBUTIONLISTS FOR DOCUMENTS YOU DON'T NEED!
TOTAL NUMBER OF COPIES REQUIRED: LTTR 17 ENCL 17 gj~/
0 ~ ~
August 16, 1993
Pennsylvania Power 8 Light CompanyTwo North Ninth Street ~AIlentown, PA 18101-1179 ~ 215/774-5151
Ms. Kate CrowleyWater Quality Regional ManagerBureau ofWater Quality ManagementPennsylvania Department ofEnvironmental Resources90 East Union Street, 2nd FloorWilkes-Barre, PA 18701-3296
SUSQUEHANNA STEAMELECTRIC STATIONDISCHARGE MONITOMNGREPORT - JULY 1993
NPDES PERMIT No. PA 0047325CCN 741326 FILER9-8APLE- 17125
Dear Ms. Crowley:
Pursuant to Part A, 3.b.(1) ofNPDES Permit No. PA 0047325, enclosed is the SusquehannaSteam Electric Station discharge monitoring report for July 1993. Also enclosed is PennsylvaniaDepartment ofEnvironmental Resources'onthly Facility Report Form (01-112).
There was one noncompliance in July. During July, the Sewage Treatment Plant (Outfall 079)total suspended solid (TSS) sample exceeded the TSS monthly average of30 mg/1. This TSS
sample was recorded at 38 mg/1. Normally, additional samples for TSS are taken in order to meet
the monthly average. To ensure compliance procedures are being developed to ensure collectionofadditional samples when necessary to meet the monthly average TSS limitof30 mg/1.
Ifyou have any questions, please call me at (215) 774-7887.
Respectfully yours,
iJ P~J ome S.FieldsS 'or Environmental Scientist - Nuclear
Enclosures
<300 ~gCopies to:EPA Region IIINRC'DocumentControLDeslaNRC Region IMr. R. J. Clark, NRC Sr. Project Manager
9308230i47 9308ih)~tr32t~g6) PDR ADOCK 05000387-~R PDR
I01-11?
t ATTACHMENT 1
PA OEPARTMENT OF ENVIRONMENTAL RESOURCES Month July 1993
MONTHLY FACILITY REPORT pate Prepared 8/17/93
Facility Name Sus uehanna Steam Electric Station PWS IO NO. 24pp994. Box 467
Facility Address Berwick PA 18603 NPOES Permit No. PA 0047325
Municipality Salem Townshi
County Luzerne
Incinerator Perm)t Number(s) N/A
Telephone Number (215) 774-7889
Person Completing Form Jerome S. FieldsP int Name
SignatureY )Title Sr. Envh tJnmental Scientist
1. Total Hours Incinerator Operated
2. Type of Fuel
3. Total Fuel Usage
4. Supplier of Fuel
5. Estimated Amount of Sludge Incinerated
N A
N/A
N/A
N/A
6. Incinerator Ash Disposal N/A
(a) How Much (Tons)(b) Where(c) When (Last ccurrence(d) Hauler(e) Receipts: es no
8. Other Wastes (Gr1ts, Barscreen1ng, etc.)
(a) How Much (Tons)(b) Where(c) When (Last ccurrenci(d) Hauler(e) Receipts: es o
9. Septic Tank Masts Accapten: Yes Ro
7. Sludge Disposal Water Treatment
a) How Much (Tons)b) Vh Jh
(c) Mken (~st ccurrence I~egg(d) Hauler(e) Receipts: Yes No
*Republic Environmental SystemsHatfield, PA
10. If yes:(a) Volume(b) Hauler(s Percent (%) Hauled
11. Analys1s Performed to ensure tank waste conta1ns no 1ndustr1al wastea) Yes
(o) It yves, requency
12. Addit1onal Cotancnts: 2,000 allons of septic tank waste taken offsite and
treated at the Hazl eton Sewer Authority (Permi t PPA0026921)
rERMITTEE NAME/AODItESS i/nt/tdtocf/ltyI/tntt/Locetbn gdm'tran//uzi
~2LQR.'O'iZtLLH WUl "~ccccl
FACILITYLOCATION
ATTII: R ~ L ~ DOZY SUPV OP" R TECHNOL
MONITORING PERIODYEAR MO DAY VEAR MO 'DAY
FROM TO
/ 02II /22.2 I / / / ~ I /
NATIONAI.POLLUTANTDISCHARGE ELIMINAYIOHSYSTEM /NPDI/5/DlscHAItoa MONITOItlNartcrortT /D)f/t/216 IF/9
(I7 5 07 APERMIT NVMSCR otacHARos NUMSXR
«%«
Form Approved.(SU BR 02) OMB No. 2040-0004.F «FINAL Approval explrese-30-91.SERV AND ADNIH BUILDING SUMP
'rF
~ HO DATA I INOTE: Read Instructions before compietilr!Ithis form.
'PH
PARAMKTKlt(524F)
SAMPLCMEASUREMENT
AVERA4K MAXIMUM
n trt(t(»II«"v
(5 Cord On/i) OUANTITY OR LOADIN4(dtM5) (5Af/)
UNITS
(d Conf Only)(5645)
MINIMUM
7. QO
AVKRAOK MAXIMUM
a. 20
DUALITYOR CONCCNTRATION(4W5) ($4@i)
VNITS
( 12)
NO.EX
FttEOUSNCYOF
ANALYSIS
(6d48)
SAMI'LCTYPE
(69-Fe)
;00(IUO 1 0 0"
UE GROSS VALUSOLIDSF TOTALSUSPENDED00530 1 0 0
H GROSS VALUOIL AND GREASEFREOII EXTR"GRAV NETO0556 1 O O
U,IIT G OSS VALUFLOIIF IN CONDUIT ORTHRU TREATNEIIT PLAN50050 1 G 0
U
SAMPLEMCASURKMKNT
SKKCINRNkgeTi ":">q'~ y~~e, X'„~, pic; I(» Vg"'c~;<~cic'",cu
8AMPLKMEASUREMENT
-".':" S«IRMCT.:", '."
'RKCIVIRESCIIKTIq»'c'sc~C++Qgtttt»c ~'c')rtlrtggg+4c
SAMPLEEASUREMKNT Q, Q3.10 O.O > IO
-;:.,'PKRMiT!.'':, j"'".;„REPORT-'; "; "'.-REPORT
SAMPLKMEASUREMKNT
";P,PERMIT,-...:,„","„-,.Ald+I(ttt",,q. /F',.„',.;l)ICP~t)'4:,„„ c tc Avd
Aa c
Ac l($
c gA»c
;::;e'.;IIc4$4!+(~$:
~n-OC:O'tr
gc»30,O Q, crc«wNcc,.c»
«W50)r V
t~g>$ » 0'»t»n ~c tv+«
0"''QO "r«t Q c "v'c
„',,<Qn Irtt/t55rd i«,
I 1"0;9~,0;:,'g:~."((''ll
".«8 HG L
3.Q ( 19)
;-20 S,0,8~ 'c 5 ~r
'.."«O'i 2'8X H G/L
@;.'Qs~gttt/Y+
NKXISHf8+ SU
( 19)
c ccc+
6: »..r
SCE/;".NOHT
5'(i SC» E/j:n» $ ''':i808 H
Q ~1 )t/
;RIB";:j""
ESTXHr<
" rl (nERMET:"': i.'".r,
RCOVtRKSd CRT."
SAMPLEM EAS UR EM KNT
+. '+«t »," ci~iccc"
C«M"
SAMPLEMEASUREMKNT
'"" 'tc
NAMC/TlTLKPRINCIPAL EXECUTIVE OFFICER
8 W2.Aa SV,. 5it P
Nuc.~ha.OPa~zeVX'YIrKD
OR PRINTED
I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PEttSONALLY EXAMINEDAND AM FAMILIAR WITH THC INFORMATION SUSMttTED HCRftN. AND SASKDON MY INCWIRY OF THOSE INDIVIDUALS IMMEDIATELY RKSPDNSISLE FOROSTAINYIG YHK INFDRMATIO'4. I SKLIEVE THC SUSMFIYED INFORMATIONIS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARC SIG.taFK.'ANT PfNALTIKS FOR SUSMITYING FALSE INFORMATION. INCLUDINYHK PDSSiSILITY OF FINK AND IMPRISONMENT SKC te USC l IODI33 USC I 53IS. IPrnaltirr ucutrr thrrr ~tatutrr may tnrtudr /tnrr up lu dttt.and vr marimum tmpnrccnmrnt u/INturrn d mccnthr and I yrarnt
4 AT OF PRIN IPAL EXECUTIVEOFFICER OR AUTHORIZED AOKNT
TKI.KFIHONK'ATEMO
'f -3a&NUMSER
~ YEAR DAcrOMMENT AND EXPLANATION OF ANY VIOLATIONS (Rtltltntt ou ouvahmtntt trt)
FLOii AND PH SHALL BE IIEASURED DAILY IIHEII DISCHARGIHG ~
:.PA Form 3320-1 (Aev. 048) PIE Yious editions may be used, (REPLACES EPA FORM T do WHICH MAYHOT ~ E USED.I00573/930611 1/)25 ~ AOE Ot'
~ cRMITTcc NAMEIADDRcss ffncrttddocdlty /rdntd/cocctbn lfdlfftront/me ~>JU~M~~~~~JLS~M~
JiQ.HZ'>'LH ~RP'LMX~lForm Approved
(SUBR 02) = OMBNo.2040-0004.F FINAL Approvalexplrea6-30-91.COOLING TOilER BLOMDOMN
0(I7 07 APERMIT NUMSER otacHARoc HUMaclt
MONITORING PERIOD
HATIDHALPDLLUT*NTDISCHAIICC CLIMIHATIDHSYSTEM (P(PDE5/DIICHAltOCMONITOIIIN(3ltCPOItT fDhlR/
216 11/9 HAJOR
rACIUTY-OCATION
ATTN- R ~ L ~ DOTY SUPV OPER TE HNOL
YEARFROM
MO DAY VCAR MO 'DAYTO
1 1 l 1 /NO DATA
NOTE: Reed instructions before completlnII this firm.
PARAMETER
(5My) AVERAOC MAXIMUM
(5 Cord Only) OUANTITY OR LOADIN4(4M5) (5Afl )
UNITS MINIMUM AVCRAOC MAXIMUM
(d Cord Only) DUALITYOR CONCENTRATION(5') (dtw5) (5461)
UNITS
NOrEX
FIICDUCNCYDP
ANALYSIS
(6dnre)
SAMPLETYI K
(69-10)
SAMPLEM CASU RKMKNT 8 8.80 ( 12)
/35 Qpihg00(IOO 1 0 0
R SS VA U
«''+PKIlhtt'i;~~;,.~+~8' 8 f48 P%~4~p~'k;;~-,'~".',<,"'4 1895'";- S U
3P:. 'AXL'X':; .Rk:5/iY
ZINCF TOTAL(AS ZIi)01092 1 0 0
N G 0 VALU
~AMPLEMCASU R CMCNT
YhX~g+);,,.~>~h~,t r-8 t,
¹¹ ¹¹¹ ¹¹¹¹¹¹):¹td¹
o. oP,
RSRliY,O5&".A;~V~W/gM ~M$fKM'n~H~"CÃ It' '-'IG L t5Wn
W~';".Z(k:~;;,~su-4"'4'LOMF
IN CONDUIT ORTHRU TREATIIENT PLAII50050 1 0 0
CHLORINE, FRFEAVAILABLE50064 1 G 0r O V
SAMPLECASURKMENT
"O'rKRMst,r:3'5'>'ICK4UlRKCCKNT,',
SAMPLKMEASUREMENT
> ",1 SIKRMH'l~'KOLltRKMKNT
SAMPLEM EAS UR KMENT
I t) . 7'P> >~, tl
¹n.¹¹¹¹:cj'„';,"882,OR+".;;;.';-",,'RBj308T:3
( 03)
¹¹¹¹¹40~ ~„'p.~jyi"j,.
( 19)
3</» R.(J3F ()R
)46~ XXL'Yh",RCOR9
FCm Owg(1)
"..'.j'=,,,'EE.W ':I ~R'AS'."„"
"'""SrKRMIT~-RKOUIREMKNT.,
SAMPLEMEASUREMENT
«ih i "'PERMIT. c'.".;.'~RKOUlRKMK)ctI
SAMPLEMEASUREMKNT
"'SrCRMht.":="r'.'RCOUlRKMKNT
NAME/TITLEPRINCIPAL EXECUTIVE OFFICER
g. Cy ~ 8'tg,Atrt SP., V t',gI/~g, CIPCg+mLC)III'(r
TYPED OR PRINTED
I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMWCDAND AM FAMILIAR WITH THE INFORMATION SUSMtlTED HCRCIN. AND SASCDON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RCSPONSISLE FORDSTAWWC THK WFDRMAYIOV. 1 SELIKVE THE SUSMITTCD WFDRMAYIDNIS TRUE. ACCURATC AND COMPLETE. 1 AM AWARE THAT THCRC ARC SIC-taFICANT PENALTICS FOR SUSMfYTWC FALSE INFDRMATON. WCLUCNNCYHK PDsststLFIY CF FINc AND tMPRtsDNMENT sKc ls Usc I 1001 AND33 USC I 1310. Iprnaltirr anarr thrrr rlatrlrr may tnrltrtr /mrr ap lo Stajttrtancf or marimam nnpnronmrnl ol hrtorrn d month r and 5 pram l
TKI.KPHONK ~
hersSIONA U C 0 PRINCI AL EXCCUTIVC
OFIFICCR OR AUTHORIZED A4ENT7I7 S'D-Sm 79
NUMSER YEAR
DAT C
MO DAY
(RCPLACCS CPA FORM T dO WHICH MAYNOT SC USED.I
=QMMcNT AND cxPLANATIDNoF ANY vloLATIQNs (Rrlrrrnca au anachmrntl rra) CI) U~to: 6 0 W~< A3F O'LSCC t tLtt 'rFREE AVAILABLE CHLORINE SHALL BE TAKEN DAILY BY GRAB DURING CHLORINATION~ 9QQBQ30$ tc,g 9+081+
PDR ADOCK 05000387R „ PDR
-:PA Form 3320.1 (Rev. MS) Pilous edtVons may be used. PACE00570/930611" 1625 10F
acRMITTCK NAMEIADDRCSS /IndudoYodlltyIIotns/Loartbn tfd+crontI
3LSMZDXb'~DRCSSZRQ ~iLKSi12LT~~'DiEET
DL.&101I ACILITYLOCATION
TII: R ~ L ~ DOT Y SU P V OP ER T ECHIIOL I I I I I I I I
NATIONALteOLLUTANTDISCHAROC ELIMINATIONSYSTEM IIIPDESIDISCHAltOL'ONITOlalNOIKL'PORT IDII(W
2 Id Iy IpII
OtaCHAROC NUMacttPERMIT NUMSCR
MONITORING PERIODYCAR MO OAY YEAR MO DAY
FROM TO
Form Approved,(SUBR 02) OMB No.2040-0004,F FI NAL Approval expires 6-30-91.
l2 TURBINE BLDG MASTE SUNP
NQ DATANOTE: Reed Instructions before coml)lettlIIIthla
fore'ARAMETER
(5241)
SAMIaLEMEASUREMENT
AVERAOC MAXIMUM
(5 Cord Onttt) OUANTITY OR LOADIN4(66e55) (SAfl )
UNITS M IN I MUM AVERA4E
¹¹¹¹¹¹MAXIMUM
(6 Cord Onttt) DUALITYOR CONCENTRATION(ISA) (6645) (SAfl)
UNITS
( 12)
NoeEX
62nrl)
FRKOUKNCYOle
ANALYSIS
(6645)
SAMPLETYPIC
(dtt.re)
OOII00'
1 '0 0G OSS V U
htcn) tREMCIA',<pi~~=,Cjstttes?e";/WE >+4¹¹IICPIIe'.na'. rr¹ g6 «Q>~+ iaah A i "nr 4¹~i> 4-S Qg 0» AX'I'1r',g,8AS,',
SOLIDS, rOTALSUSPENDED00530 1 0 0
N V LlOIL AND GREASEFREON EXTR".GRAV NET
j00556 1 C 0
SAMPLEMEASUREMENT
mi > ee imere e e
SAMPLCMCASURKMCNT
«ega "i,"n r: 6) P PSSCM (TP:"~'atItttaMIREM~<:
¹rjt¹r r,¹
¹¹¹¹¹¹¹r J¹
¹~¹~¹¹¹
etV¹¹¹¹
rrrcri'r Ir¹¹ e
ig8pj+Qtts+Ilteret+ 'er gati/'V,'0', ''„%$ 'py,y hQ 0 go'+g'$@jph
( 19)
( 19)
QQQ'gIPddt" I O
Rkae~+'e'e +~+5 «(
RA 8",:ey
; FLOIIF Iti CONDUIT ORZHRU TREATIIENZ PLAN
,50050 1 0 0U"
SAMleLEMCAS U R KMKNT
",""~~.<PERMIT,».'t4UlREMENT
SAMPLCMEASUREMENT
--'-'«"3tEPOR'ZP ',:.::" 'AR'RCPORT '
o3) r r e ¹r ¹¹:c"¹¹¹
.'~~$QQQPQ$ -.;,.- "->';",lt:s)I4rggg +'j~Qg+ggP„:» ¹¹¹M e': e.a'"r~t"er<<
,k,ILYy: STIGMA
„'ne„"'rtthiIfT''CCOUIREM CNTrr
SAMPLtMEASUREMENT
I"I i:tthletTrnr '«'i»
,: lltCIUIREM047„'"
SAMPLEMKASURCMCNT
~e'i<e PERMCT,» -',
RCOUlREMEN'T.
~ NAMC/TITLCPRINCIPAL EXtCUTIVC OFFICER
R. ('SIC.Ae ~P V P
lVV~pg. DPaA.A-WICl(25
TYPED Oh I'RINTtD
I CERTIFY UNDER PCNALTY OF LAW THAT I HAVE PERSONALLY KXhhttNCDAND AM FAMILIAR WITH THE INFORMATION SUbMITTED HKREIN. AND SASCDON MY tNOUIRY OF THOSE INDIVIDUALS ttatafutATELY RCSPONStbit'OROSThtNINtr THE tNFORMATIDN. I SELIEVE THE SUbhtlTTKD tNFDRtaATIONIS TRUE. ACCURATE AND CDtaPLKTC I AM AWARE THAT THERE ARE SICrartCANT PENALTtES fOR SUbtalTTINO FALSE INFORMATION. INCLUDtNGTHc PosstbCITY DF Ftnc AND IMPRtsontaKNT sEK lb Usc I IDDI AND33 USC h 13IQ. tprnattirc tenner them atatatra may enrteatr nenra ap ln gtntttatand eer mazimam empnaemmrnt nr hrtarrn 6 month a and 8 scarlet
Sl AT R OF RINCIP L EXCCUTIVKOFFICER OR AUTHORIZED AOCNT
TELKleNONC'ATE
NUMSCR. YEAR MO DAY-OMMCNT AND EXPLANATION OF ANY VIOLATIONS (Rclcrcncc vll vuvchtncnts herc)
FLOII AIID PH SHALL BE tlEASURED DAILY lIHZNDISCHARGING':PA
Form 3320-t (Rev. (HIS) Previous edt'lions may te used. (RCPLACCS CPA FORM TAO WHICH MAY HOT SC USCD.I005B1/930611 1625 PAOC OF
uERMITTCE NAME(ADDRESS (Jnt(ttdtotdltyHatnt/Local(ctn (fdlfftrtntJrem ~~~~~~~~JLSMJQM
JiQEZfLZ)LZX2i WLRKZ~wZZ0191
Form Approved.(SUBR 02) 0MB No. 2040-0004.F
' FINAL Approval explrea6-30-91.Ii TURBINE BLDG MASTE SUMP
073 A7 2PCRMIT NUMSIR cttaCHAROE NVMSER
MONITORING PERIOD
NATIONALPOLLUTANTDISCHARGE ~ LIMINATIONSYSTEM (Hy()ESIDISCHAIIOKMONITORINO ItCPOItY (D)(JIJ
2 Jd JW9 MAJOR
~ACILITYOCATION
A N: ~ L ~ DOTY SUPV OPER TRCHNOL
YEAR MO DAY YEAR MO 'DAYFROM TO
( J (2 ~ J ~ J J ( J
NO DATANOTE: Reed InstrUCtlons befor compIstlrrlltlils firm.
PH
PARAMCTCR
($142)
~AMPLEMEASURCMCNT
AVCRAOK
4 L'Itl nC <~ ~
MAXIMUM
(J Cord Only) QUANTITY OR LOADINO(4M)) (f
All�
)
UNITS MINIMUM AVCRAOC
I) gt>cA
MAXIMUM
(6 Card Only) DUALITYOR CONCENTRATION(&42) (dtMS) (SAfl )
UNITS
NO>CX
(12)„
FREDUENCYOF
ANALYSIS
(6648)
SAMPLETYPC
(69.10)
004(J0> 1 0 0 '<'",jg" "'j'""(hE":;)~;- au(res>rh(P'(gal 4„'ghtcyjjEys)ly'4/ ~~/ I
UBH GROSS VALU ++Urt'.(~:5%'~~»::.";"„'Ã8 ~"'.k~~,;" ~>-.:,::/l 0:0"~C: XIIX Itj'fNXXI'X'AB';-'-
SOLIDSF TOTALSUSPENDED00530 1 0 0
F. SS V U
OIL AHD GREASEFREON EXTR-GRAV MET00556 1 0 0
G SS VA U
SAMPLEMEASURCMCNT
SAMPLCMCASURKMCNT
IIKQUIIIKMKNT'>c
tr: Fr "A
,»uu»";1+Vg+Q IsCQI>Ch
Fr vent>:tr'Sn
t(cl~gt(ct„" "".v F.g I'c
<„'3„-'5 9.0g~F""."'j'." ',4'(I u':,0'.,.'<5;4
( 19).
MG L( 19),
MG L
SC,,Ef;„i Rk.1'508' .4~~ +»> 'I;h9
ltCEfg RASE'~ago
FLOli 6 IN CONDUIT ORTHRU TREATMENT PLAN50050 1 0 0
SAMPLEJ6EASUREMENT
".:."'IIIRtMPITt::;; .':,'"'. REP,OR X!
SAMPLEMEASUREMENT
( 03)
MGD
IIntrchFPrctIK 'XLES ESTXH
," jnIlAlIT.'iRI(OUIRKMKgt>'AMPLE
MEASUREMENT
SAMPLEMEASUREMENT
. PIRMlT",'I%'OUIRKMKNT
I ic ',
NAME/TITLEPRINCIPAL CXKCUTIVKOFF ICCR
P. &. Gqlt.ASA ~a. VP
Alu'c.L2=rhtt. OP EIt.h T (weTYPED OR PRINTED
I CKRttFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXANtHEDAHD AM FAMILIAR WITH THE tHFORt>IATIDN SUStatttED HEREIN. AHD SASEDON MY INQtttRY OF THOSE atDIVIDUALS ttataEDIATELY RKSPONSISLE O'DROSTAIHIHG THK IHFDRMATIDH. I SELtEVK THK SUSMITTKD ItlfQntaATIDNIS TRUE. ACCURATE AHD COMPLETE. 1 AM AWARE 'tHAT THERE ARE SIGNtfICAHT PEHALTIKS FOR SUStattTING FALSE IHFDRtaATION. INCLUDINGYHK POSS18nttY Of FINE AND tMPRISDHtaKNT SEK 1S USC I IDDI AND33 USC I 1319. tprnattira tvvtrr thrrr ~ tat tra may tart>vtr />lira ap tu sto/stata>vt ur masimum tmpnrunmrnt uf hrtvrrn 6 muntha and 6 >rarni
~ r /o>SIO ATU I OF RINCIP L EXECUTIVE
OFFICER OR AUTNORIZEO AGENT
TCLKPNONC
'Q-
3gbNUMSCR YEAR
DATE
MO DAY=OMMENT ANO CXPLANATION OF ANY VIOLATIONS (Rr(rrrnct au auvchtnrnts trt)
FLOII AHD PH SHALL BE MEASURED DAILY IIHENDISCHARGING'PA
Form 3320-1 (RSV.048) Plsv(ous ed(lions mey Jle used. (REPLACES CPA FORM T 60 WHICIIMAY NOT ~ C USCO.I00576/930611-1625 PAGE OI
PERMITTEE NAMKIADDRKss /IncludeYadlltyFamc Jlocotbn lfdlffcrcntJuse ~~ ~~~~~2SMJikI
U'KKSZJM~LL'8~UL~~~L18101.—
FACILITY'CATIONATTN: R ~ L ~ DOZY SUP V OPER TECHNOL
MONITORING PERIODYEAR MO DAY YEAR MO 'DAY
FROM TO
/ 0.2IJ /2 ~ I J I I I
NATIOHALPOLLUTANTDISCHAROC ELIMINATIONSYSTCM /IIPDESJDISCHAICOR MONITOItlN4)%RPOItT /DJI/RJ
216 /2.//I0 7 079 A
PERMIT NUMSER DtaCHAROC NVMSCR
Form Approved.(SUBR 02) OMB No. 2040-0004.F -.. FINAL Approval expires 8-30-91.
SEIIAGE TREATHEIIT EFFLUENT
l(0 DATA t )NOTE: Read instructions before completin(I this Air(IL
PH
tAIIAMETKIC()242)
SAMPLEMEASUREMENT
AVKRAOK MAXIMUM
+ittYOn On.
(I Card On/y) OUANTITY QR LDADINO(4M)) (5'/)
UNITS MINIMUM
7. 90
AVERAOK
AgAQgAMAXIMUM
7. e5
(d Card Only) DUALITYOR CONCENTRATION(JILL) (4642) (Sdcrl)
UNITS
( 12)
NbrEX
FRKOUCNCYOF
ANALYSIS
(ddnra)
SAMtLKTYPE
(69-10)
00400 A 0 0S N E T PRCS CHPL
SOLIDS TOTALSUSPEllDED00530 h 0 0
~s
RRCtUCRRMRNT~
SAMPLEMEASUREMENT
'CRQUNRMRNTA
'c <, A+psst Ist girt<~
r~t"t(:~n".
:-,"',;:,4CS):$04~';
AO Ales
( 26) ( 19)
,AXXil;$
'I3 I
ICjlfj',''KOHTH
Csr t-8
-FLOQF IN CONDUIT ORTHRU 1REATHT.NT PLAN50050 A G 0F'I PL
CIILORINE, FREEAVAILABLE50064 h 0 0
SAMPLEMEASUREMENT
'ItRCIU(RRMRICT;
SAMPLEMEASUREMENT
'„.; rtKRMIT;,".
'RCtU)RRMRNT
Q Gt'l> o, o>54 ( 03)
HGD
,+r~~,gQPL'I IX'„
6.>5
slt+ncgtit c
~~ ~rIi+a'.~ IsCQ+C$
"4 <'">'v "s2) "en 'Pc ~'
19)
'; ~, '"LREPORT;;l,4-'.>REPORT':, ';,I)","
J3I trLOIIUD
kXL'Y$
3 l /pi Ql'ng
'OLIFORIIF F BCAL,'- GENERAL'74055 A 1 0
QODF CARBONACEOUS05 DAY, 20C80082 A 0 0
~AMPLEMEASUREMKNT
„'" ", taRRhICT" i'; '~„.
CUIR K)SENT,„"
SAMIIILKMEASUREMENT
'Cta UIRRMRAT'AMPLE
MEASURKMKNT
'v." » PERMIT/'jltax)UlRKMRNTq
X",'a',,'y6+gh)t);)st >~
I. 50
;,'r ',", Issfscgggtsttrt
DORIC:C:0 ( 26)
4I AAAApv wT'n
O9084 Cc
'05 o:O„,.F;: 'I~'~".»;,:,"'4":j>9p/Iieet)II4ih„'
13)
( 19)
G L C~".
~fIC$1.',.'yflO
')/aRk;B»::-'CAPI/;j
«0 OIISd/,8
~/p I ~II
, NAME/TITLEPRINCIPAL EXECUTIVE OFFICER
g, Cp 8 q(C.~ Sa.
~IIEET.At LO Q(s
TYPED Olt PRINTED
I CCRYIFY UNDCR PCNAI.TY OF LAW THAT I HAVC PCRSONALLY EXAMINEDAND AM FAMtLIAR WITH THK INFORMATION SUSMITTCD HCRKIN. AND SASCDON MY INOU1RY OF THDSC INDIVIDUALS IMMEDIATCLY RCSPONSISLC FOROSYAININO THK INFORMATIOY. I SCLIKVE THC SUSMITtED INFORMATIONIS TRUE. ACCURATE AND COMPLETE. I AM AWARC THAT THERE ARK SIOtarcANT PKNALTICS Fon SUSMITTINO FALSC INFORMATXW. INcLUDINoTHC POSSISILITY OF FtNC AND lMPRISONMCNT SEC IS USC I lOOI AND3S USC I 1$ 1S. tPrnaltirs sndrr shear ttatstrs may snrlsdr /tars ap la Stttlsstand sc masimsm tmpnsvnmrnt s/hrtsvrn S mnntha and S swrs.t
SI A R 0 IsRINCI AL EXECUTIVEOFI'ICKR OR AUTHORIZED AOENT
TKLKIsNONR ~
I 7 878-BaPaNUMSKR YEAR
DATE
DAYOMMKNTAND EXPLANATION OF ANY VIOLATIDNs (Rc/crcncc vtl vuvchmcnts crc)
=CPA Form 3320.1 (Rev. Ms) Ptevlous ed/Vena may be used. (RKPI ACES KPA FORM TWO WHICH MAY NOT SE USED.)00584/930611 1625
PAOK OF
PERMITTEE NAME/ADDRKss ((nc(udc8'acdlty I(amcllocatbn (fdlffcrantI
LLSQ9~~ADDR~XQCL3KB~JkXliT~ST~ZT
~M3233)3
Form Approved.(SUBR 02) . OMB No.2040-0004.F -- FINAL Approvalexplres6-30-91.RADNASTE TREATMENT EFFLUENT
PCRMIT NUMSCR c>lacHAR44 HU>a ~ cn
MONITORING PERIOD
NATloNALPOLLUTANTDlscHARoc ELIMINAYIDHCYCTcM (NPDErlDISCHARGE MONIYOltINOItKI>OItY(Dh(RI
2.16 MAJOR
I'ACIUTYI OCATION
"CHN
YEAR MO DAY VCAR MO 'DAYFROM V TO
(20.211 (22.2 1 ( I 1 ( ~ 1 ( 1
¹¹¹ NO DATANOTE: Read Instructions before completlnIItlsls form.
PARAMETER(1247) AVCRAOE MAXIMUM
(S Card Only) QUANTITY OR LOADINO(4M)) (sdar)
UNITS MINIMUM AVERAOC MAXIMUM
(d Card Only) QUALITY OR CONCENTRATION(NAS) (ddt), (Sddll)
UNITS
NO.CX
6243)
FRCDUENCYOF
ANALYSIS
(dd48)
SAMPLETYPE
(69-70)
SOLIDSF TOTALSUSPENDED00530 1 0 0
SAMPLEMEASUREMENT
;".;4> PERMIT.n.. 4
¹¹¹¹¹¹3- "¹ISK -44¹"~ . ".'~'" '$(r g~'"+~r)c,';30
4'.0„';:";.,'',@',:.'3;"",''00'h",0,~;"'".I,",„',"
( 19) CyrLIs8
:.4::„" 'tICE/;:.BIB;"'*'~.'LOM
a 1N COIIDUIZ ORTHRU TREATMENT PLAN50050 1 0 0
SAMtLKM CASU R EMCNT
;:;:~marks'V4'.',L""-R8POgkj '=~,gRgPORT;":;,'AMPLE
MEASURKMCNT
( 03) ¹¹¹¹¹¹g6/~,
kX,LV',4> ST>.g~~>;~ 0'>"...;>r a'>i"."rr
SAMPLCM CASU R KMCNT
RKQS)IISOECSSTc'r'",,".~~;i.''.i'."r>""'q>,: '>> 'Wq~~~."'>'j~'> 4'g:."'d',
SAMPLEMEASURCMKNT
SAMPLEMEASUREMCNT
SAMPLEMKASUREMENT
NAME/TITLEPRINCIPAL EXECUTIVE OFFICER
R.6 Bwp.~ Sg. VP
N~C OPGLM'1 W5TYtKD OR tRINTKD
I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINEDAND AH FAMILIAR WITH THE INFORMATION SUS>a>TFED HKREIN; AND CASEDON MY INQIRRY OF THOSE n>DIVIDUALS IMMEDIATELY IIKSPDNSISLE FOllDSTNN>HG YHC n>FORMAT>OY. I SELCVE THE SUS>a>TYED INFORMATIONIS TRUE ACCURATE'HD CDMPLCTC I AM AWARE THAT THERE ARE S>C.taF>CAHY PEHALT>ES FOR SUS>a>TT>NG FALSE IHFDRMAT>OH. IHCLUDIHOTHE PDSS>S>LITY OF FINK AND IMPR>SDHMKHT SEC IS USC S 1001 AHD33 USC S 1310. >t>rnattirr andrr thrrr rtatrtrr may >nrlrdr finrr ap to staler>and or mariman»n>pnn>nmrt>t o(h> >arm a mon>ha ands tram>
COMMCNT AND CXPLANATION OF ANY VIOLATIONS (Rc(crcncc au attachmcntt crc)
FLON SHALL BE MEASURED DAELY MHEN DXS™HARGING~
TCLKtHONC ~
7(7 ~f(g-324o )5NUMSKR YEAR
SIO AT R 0 RINCIP EXECUTIVEOFFICER OR AUTHORIZED AOCNT
DATE
S > IfMO L DA.Y
o
-PA Form 3320-t (Rev. 048) Previous edillona may be used. IRcPI Aces KPA FDRM T.40 wHlcH MAY NoT sc UscD.I00586/930611 1625
~ AOC Olr1
>ERMITTEE HAMc/ADDftcss /lncltldaaa/tlsy Nama/Locct lan (Idl//erontJum MULES.XLS~~~~MJLSJKM~LDDRCSS
FACILITY'CATION
ATTN: R ~ L ~ DOZY SUPV OPER TECHNOL
NATIDNAI PDLLUTANTDtscHARoE ELIMINATION%TOTEM /JVPDESJDISCHAR4K MONITORING RCPORT /Dtt/RJ
2.16 J>t Jlt
0047325 271 APERMIT NUMSCR DtacHnnoc NUMaan
MONITORING PERIODYEAR MO DAY YCAFI MO 'OAY
FI%OM I/ TO
/ 21/ /2r2/ l ~ J / ~ J /
Form Approved.(SO B R 02) OMB No. 2040-0004.F - FINAL Approvalexplres6-30-IIASTE FILTER BYPA'SS
NO DATANOTE: Read Instructions bsforicompIatIIIlItIIls firm.
PARAMETER(1247)
SOLIDSF TOTALSUSPENDED00530 1 0 0
FLUEN GROSS VALU
~AMPLEMEASUREMENT
AVERAOC
n:n.y>:u:I>"-0
MAXIMUM
Frt ">II>: I>: n- 4
3<'.~Mr'iTS~I';:;,'~>>>+>k,'~k
(J Card Only) QUANTITY OR LOADINO(6tws) ($64/)
(6 Cord Only)(Ndf)
MINIMUM
" F 4 I(tQ~
AVERAOK MAXIMUM
QUALITY OR CONCENTRATION(6642) (SAf1)
UNITS
( 19)
MG L
NO>KX
FRCDUENCYOF
ANAIYSIS
(66'/a)
'N,CE'j~',$HOSf H
SAMPLETYPE
(69 10)
OIL AND GREASEFREON EXTR-GRAV MET00556 1 0 0
U"N GRO VALUFLOII a IN CONDUIT ORTHRU TREATMENT PLAN50050 1 0 0
V G 0 V LU
~AMIILCMEASUREMENT
QA Ny wt
SAMIrLKMKASUREMKNT
SAMPLEMKASURKMCNT
I;:grh>>a~+i> +>ragr>uatqg"
SAMPLCCASUREMKNT
~ I>IA >I 4I>)
( 03)
MGD
dg 4( A t>t 4 A
),,~',n,', „.Qg5 'j~+ tX~i;".>;. I'>ht'I',.'„a~gp>lpga ".>,.'t '.%g',
~r> "rt '
19)
MG LNOPE,'j,
FNOHTH
AXJjX;-;.',I„Ng'
">'; '.L,t
aA:BPVR
,r'()IH
SAMPLKMEASUREMENT
',RCQUIRCMCSCT> t:; ~> ., 's~'v".'"~i:.„,q
SAMPLEMCASUREMCNT
HAMKJT ITLE PRINCIPAL EXECUTIVE OFFICER
R.. Cr . $3@,~ S('Pg Vu~A- Oft.Ih«ogg
TYPED OR PRINTED
I CERTIFY UNDCR PENALTY OF LAW THAT I HAVE PERSONALLY CXAMOIEDAND AM FAMILIAR WITH THE INFORMATION SUOMITTED HCREIN. AND SASCDON MY INDIXRY OF THOSE INDIVIDUALS IMMKKXATELYRKSPONSISLE FOROSThotatth THK RIFDRMATIO'4. I BCLTEVC THE SUSMITTED INFORMATIONIS TRUE. ACCURATE AND CDMPLETc I AM AwARE THAT THcRE ARE sus.taFICANT PENALTICS FOR SUSMITTVIG FALSE RIFORMATION. VICLUDINGTHE Possto>LITT oF Fate AND IMPRtsDNMKNT sKE Ie Usc I tool AN33 USC I I3IO. tyrnatticr u>utrr thrrr rlatutrr may inrtudr />nrr up I» Sttt/urtand u> matimum tmpnrnnmrnl u/hrturrn 6 mnnlhr
units�
>rara ISIO A R OF PRINCIP EXECUTIVC
OFFICER OR AUTHORIZED AOENT
TELEPHONE
'/
7 ~tr - 5golZ)NUMSER YEAR
DATC
DAY:OMMENT AND CXPLANATION OF ANY VIOI.ATIONS (Rctcrcncc au attachments herc)
FLOII SHALL BE IIEASORED DAILY IIHENDISCHARGING'.PA
Form 3320.1 (Rsv. 048) Plsvtoua ed/I/one may be used, (REPLACES CPA FORM? 60 WHICH MAY HOT ~ C USCD.)00588/930611-.16 25
PAGE OF
FERMITTEE NAME/ADDRE55 /IndudcYoct/ttyI/ctnc/Local/on /Idlfjcrcntl~M M~~UJIM~?~~TADDR~ZXO 2LK~3DJkZH SZ~LX
«««II«— PCRMIT NUMSCIE Dtvcknnoc HUMscn
MONITORING PERIOD
NATIONALI«OLLVTANTDISCHAROC ELIMINATIONSYSTSM /IIPDESIDISCHARGE MONITORING REPORT /DIdRI
2/6 /7 /tt Form Approved.(SU BR 02) OMB No. 2040-0004.F -, FZ HAL Approval expires 6-30-91.NEUTRALIZATION BASIN DISCHARGE
I'ACILITT'LOCATION
TT i: R ~ L ~ 'OZY SUPV OPER T ECHNOL
YEAR~'ROM
/20 2/I /22.2 I ~ I I /2 ~ I /
MO DAY YEAFI MO 'AYTO ¹¹¹ HO DATA I I
NOTE: Reed lnttructlons before completl(I((this form.
I ARAMSTER
(3247) AVCRAOC MAXIMUM
(3 Card Only) OUANTITY OR LOADINO(dtW3) (5'/)
UNITS MINIMUM AVCRAOC MAXIMUM
(d Cord Only) DUALITYOR CONCCNTRATION(3aA5) (d6»53) (5Afl)
UNITS
NO.CX
FRCOUCNCYOF
ANALYSIS
(6C48)
SAMPLETYPE
(60rre)
SOLIDSF TOTALSUSPENDED00530 1 0 0
OIL AHD GREASEFREON ZXTRGRAV MET00556 1 0 0
(I U
SAMPLEMEASURCMKNT
.",~%3PCRISITL ';«'IEKEIUIRKMKIA';
SAMPLEMCASUREMKNT
< 'rt«<'KRrtIT«~«'drtCElllrRKMK/dTr
'„,«(,,n ggtcltgptvr~«v
»r» «'«;"4Q$ ¹QQ„'q) j r;: I(ttg~
¹¹ "):
J J J~ n n ~
¹«¹¹L ¹n
, '~+K«,'(FOP',((IIWEILY,'x
8(3 or 0 5,"~jO'i~gj
(.5
( 19)
MG LICE/.",~
«808
5/~ I
SC;83/'.3
FLOMF IN CONDUIT ORZHRU TREATMENT PLAh50050 1 0 0
SAMPLCMEASURCMCNT
«4 rrCRMIT.» 'iRKEIUIRKM~„'AMPLE
MEASUREMENT
G. I)(Q
> ""REPORT"r,", -"''~'-'REPORT»«,
( 03)
MGD
«»¹¹ J
7' ErJTI Pr(/)
,AXIIY:~
'(c~«PC/Mt(IT/'R~EQUIRrKMKNT-'.
SAMPLEMEASURCMENT
«
CUIR 3 „3(3
SAMPLKMEASUREMENT
SAMPLEM CASU REM CNT
'»'»~<'"tPKRMiTN';UIRKMKNTCIECEI
vS
NAMC/TITLE tRINCIPAI EXECUTIVE OFFICER
g, G, ~IRa~ SR. YP
! Nu (:~9 Of'a9,/T-E %OS) S
I TYtCD OR thlNTCD
I CERTIFY VNDCR PENALTY OF LAW THAT I HAVC FCRSONALLY CXAMtNCDAND AM FAMILIAR WITH THC INFORMATION SIISMITTCD HCRKIN. AND SASCDOM MY INQIRRY OF THOSE INDIVIDUALS IMMEDIATELY RKSFONSISLC FORDSTAINNG THK RIFDRMATIOM. I SELltVK THC SUbMITTED IMFQltMATIONIS TRUE ACCURATE AND CDMFLETE I AM AWARE THAT THERE ARE SloICFICANT FCNALTIKS FOR SUSMITTINO FALSC INFORMATION. IMCLIIDINOTHC FOSSIbtLITY OF FINE AND IMFRISDNMENT Stt Ib USC I 1001 AND33 USC I 1315. IPrnvltirv vrvtrr thrrr Itvtvtrv mvp tnrtvdr /tnrv vp ln ltotttvtvrvt nr movimvm tmpnvunntrt«t «>/hrtvrrn d mvnttlv cnit 53rvrv I
SIONAT R OF RINCII A EXECUTIVEOIFFICCR OR AUTHORIZED AOCNT
TELEPHONE
'I
7 ZQ-3NUMSCR,
DATE
YEAR MO D/IV=OMMCNT AND CXPLANATION OF ANY VIOLATIONS (Rr/rrrncc all auuchrncntc crc)
FLOM SHALL BE MEASURED DAILY MHEH DISCHARGIHG ~ ¹EM ~ FLOM SHALL BE MEASURED DAIL'Y¹HEN DISCHARGIHG ~ THERE SHALl BE H¹ DISCHARGE OF POLYCHLORIHATED BIPH¹llYL COMPOUHDS ~ SEE PERMIT FOR.O'I'H
0 8) Ptsvtoud ddltlons may be used. (RCFLACCS CPA FORM 7 de WHICH MAY NOT ~ C USED.) PAOC OF00593/930611 1625 1
>cRMITTcc NAME/ADDRcss (lnc(vdtYoc(l(ty/(otnejlocot(an Ifd(ffcrcntJ
~~LkSYJJfJ'd~?~~ - cglSQ933~\ODRCSS~i
PERMIT NUMSCR cnacHAR46 HUMaaR
MONITORING PERIOD
NATIDNALPOLLUTANTDISCHARGE ELIMINATIONSYSTEM (I(PDE5/DISCHARGE MONITORINQ RCPORT /DHRI
2./6 I7.19r
N AJO R Form Approved.(SDBR 02) OMB Nor 2040-0004.F -. FINAL Approvalexptres6-30-91.. ~
IIASTE FILTER EFFL'DENTFACILITY'CATION
UP
YEAR MO DAY YCAR MO DAYFROM TO
(20 2II (22.2 I ( d. I(2 I ( INO DATA
NOTE: Road Inctructloiss before compl ettlsII wIIIS fortran
PARAMETER(5247) AVERAGE MAXIMUM
(5 Card Only) QUANTITY OR LOADING(dtw5) (5dnll )
UNITS MINIMUM AVERAGE MAXIMUM
(6 Card Only) QUALITYOR CONCtNTRATION(5%45) (dtS45) (5Afl)
UNITS 62'))
FREDUKHCYOF
ANALYSIS
(664')
SAMI'LKTY PC
(69-10)
SOLIDSF TOTAL"SUSPENDED*00530 1 0 0
I OIL AND GREASEIFREON EXTR-GRAY MET'00556 1 0 0
SAMPLEMEASUREMENT
SAMPLEMCASUREMENT
A 'hydr
„: "'Qpgttogg~l:$ ,++0 ~g»gv, =20 4'0$ : 4'.s'~"
( 19)
( 19)
na.4')CE//:;
O
H,eE/'. RjB„r.';.„,
«<Vrtr Wi", Lr
IFLOWF IN CONDUIT OR'HRU TREATIIEtlT PLAt):50050 1 0 0
SAMPLEMCASU REM CNT
)SITS .;;,Q4',~ RF,PORT,~4»
«AD�REPORT;":
2> Lrr
( 03) h"C:SIC:(I
;LOX,tID
SAMPLEMEASUREMENT
~ltegUSRKgKNg '.Sr4"<g>~~".+Xe'gr-+'P'AM
PLCMEASURthlENT
ISCQUIRKMKNI;y .'!'. ".O'"".",~„;;~"'„';"~Y~'. r")+'4'" d >rd<'+j~'"gc',q(n",r@ „",„q
SAMPLEMKASURtMCNT
SAMPLEMKASUREMCNT
, r,,rq«,re It>N
RCQUSREMCNTl jI NAMC/TITLEPRINCIPAL EXECUTIVE OFFICER l CERTIFY UNDKII PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED
AHD AM FAMR.IAR WITH THC INFORMATION SUSMITTED HCRKIN. AND CASEDON MY NOU1RY OF THOSE NDIVIDUALS IMMEDIATELY RKSPOHSISLE FDROSTANNG THC NFDRMATIOV. I SCLIKVC THE SUSMITTED IHFDRMAYONIS TRUE. ACCURATE AHD COMPLETE. I AM AWARE THAT THCRC ARE SIGtaFICAHT PKHALYICS FOR SUSMllTNG FALSE INFORMATION. NCLUDIHGTHK Possl&LITY of PINE AHD IMPRICDHMKHT scc Ie Uac S IDDI AND$ 3 USC $ lolo. tyrnattirr andrr three ~ lalalrr may <nrtrdr /inrr ap ln ltv/amand ur marimam tmpnvmmrnt n(hrtarrn 6 menthe and I yearn.t
. A ~ &iG'tRASI 5p gPH'44IR A(L 0 f'~
TYPCD OR PRINTEDOMMENT AND EXPLANATION OF ANY VIOLATIONS (Rt(erenee att vnvehrntnlc here)
FLOII SFALL BE MEASURED DAILY IIHEN DISCHARGING~
SIO A U C I'RINC AL KXCCUTIVCOFFICER OR AUTHORIZED AGENT
Fa~ Qc r
TCLKPHONC '
I7 Wg-3oQNUMSER
DATE
8YEAR MO DAY
-:PA Form 8320-1 (Rev. 948) P(svtous edl(lone may be used. IRCPL*CCS CPA FORM T 60 WHICH MAY NOT ~ C USED,)00595/930611-1625 F'AGC Olr
FcRMITTEE NAMEIADDRcss (lnclttdr"acdlfy Jfdrnr/Cocefbn lfdfffrrrnt/mu ~~Jf~~M~~ZSMXUMODR~
FACILITnF
I OCATION
ATTN: RE L DOTY SUPV OPER TECHNOL
MONITORING PERIODYEAR MO DAY YEAR MO 'DAY
FROM TO
I 02IJ (2 ~ J ~ J I f I
HATIDHALPOLLUTANT DISCHAROE ELIMINATIONSYSTEM iNPDESJDISCHARGE MONITORINO RCPORT ID)fRI
2 Id I1./9
P 5PERMIT NUMSCR DNCHAROS HUM San
Form Approved.(SU BR 02) OMB No. 2040-0004." FI NAL Approval expires 6-30-91.571 CIRC IfIIATER PUNPHOUSE SUHP
NO DATA ). )44'~I
NOTE: Read Inetructlons before complstIIIIIXIIIIform.
PARAMETER(5241) AVKRAOE MAXIMUM
(5 Card Only) OUANTITY OR LOADINO(4M5) (545l)
UNITS MINI MUM AVKRAOE MAXIMUM
(d Card Only) DUALITYOR CONCENTRATION(W45) (4145) (Seal )
UNITS
NOrKX
FRCDUENCYOF'NALYSI~
(dolt)
SAMPLETYPC
(d9.10)
SOLIDSF TOTALSUSPENDED00530 1 0 0
SS VA 0OIL AND GREASEFREON EXTR 'GRAV tlET
I00556 1 0 0V 0
I F LOII a IN COIIDUIT OR1HRU TREATHENZ PLAN50050 1 0 0
~AMPLEMCASVREMENT
SAMPLEMCASUREMtNT
SAMPLEMEASUREMENT
wKKIUIRtrdc)dt;"
SAMPLKMEASUREMENT
0 ""ifEP.QR'f,'„',
A+I% ngoal
Q. 6'9Q ( 03)
~;r"',.884'OR/:;:.'GD
4 lit>iIlr"44
1,7 I.7i60a 0'-",4~
O'Q'2.'O'II
Qj'~gW„~-
C-'r:Ir'~I)'I(t
6 'I~) C ~~53( 19)
BCE/,I RkH L 'R".;,,;595TH V<A,l~Yg'".4
Q >/gI
h'XX"Y',I,
%OX'EQUIREMENT,';:
'»";;,„',,',«,:; „','„'s
'AMPLE
MEASUREMENT
,r:.PKRblrT'KOVIREMILNT,,
SAMPLEMEASUREMENT
'RCC}UlRKMCNT,
SAMPLEMEASUREMKNT
, RKOUIRCMCIIT;;
NAME/TITLEPRINCIPAL EXCCLITIVKOIPFICKR
8 (In S.~1I.W~ SI. Vf'
N IJ~o,g &P~A-r(clueTYPED OR PRINTED
I CERTIFY UNDER PENALTY OF LAW THAT I HAVC PKRSONALLY EXAMINEDAND AM FAMILIAR WITH THC INFORMATION SUSMITTED HKRCIH. AND SASCDOtt MY INDUIRY OF THOSK INDIVIDUALS IMMCCXATELY RKSFONSISLC FOROSTAININC YHC INFDRMATID'N. I SCLIKVE THK SUSMITCED INF'DRMAYIONIS TRIIK. ACCURATE AND COMFLCTC I AM AWARC THAT THERE ARE SICNIFIC*NT PCNALTIES FOR SUSMITTINO FALSE INFORMATION. IHCLIIIXNQYHK PDSSIStLITY OF ABC AND IMPRISONMENT SCC IS USC I IDDI AND33 VSC I ISIS. IPrnaltirr arvfrr thrrr rtatatrr may tnrfrdr finn ap ln dltlfrrand nr rnarimarn tntpnvrtntrnt nf hrtarrn d manthr anif 5 lraral
SIO A VR 0 PRINCIP L EXECUTIVEOIFFICCR OR AUTHORIZED AOENT
TELEPNONC ~
7/ egg- egaNUMSCR
DATE
YEAR MO n DPrtfOMMCNT AND CXI'LANATIONOF ANY VIOLATIONS IRrlrrrnrr au vttvc manta rrr)
FLOII SHALL BE IIEASURED DAILY IIHEN DISCHARGING'~
-:PA Form 8320 1 (Rev. M8) Pfsvtoua &If(onemay I)e uaed. (RtPI ACES CPA FORM T dO WHICH MAY NOT SC UatD,I00599/930611-1625 ~AOC OF
Top Related