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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

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1 11 11 1

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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.(

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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.

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( 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)

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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