GENERAL U.S. ENVIRONMENTAL PROTECTION AGENCY I. EPA I.D. NUMBER A c Di& GENERAL INFORMATION s

FORM 11 GENERAL U.S. ENVIRONMENTAL PROTECTION AGENCY I. EPA I.D. NUMBER A c Di& GENERAL INFORMATION s VACIIIII Lill ri Consolidated Permits Program "General FVI 0040525 (Read the Instructions" before starting.) , 2 13 14 15 LABEL ITEMS GENERAL INSTRUCTIONS I. EPA I.D. NUMBER If a preprinted label has been provided, affix it in the designated space. Review the information carefully; if any of a is incorrect, cross through k and enter the II. FACIUTY NAME correct data in the appropriate Ellin area below. Also, if any of the preprinted data Is absent (the area to the left of the label space lists the III. FACIUTY MAILING ADDRESS PLEASE PLACE LABEL IN THIS SPACE information that should appear), please provide it in the proper fdl-in area(s) below. If the label is complete and correct you need not complete hems I, III, V, and VI(except VIER which must be IV. FACILITY LOCATION completed regardless). CompSeto al irons if no label has been proved. Refer to the instructions for detailed item descriptions and for the legal authorization under which this data Is collected. II. POLLUTANT CHARACTERISTICS INSTRUCTIONS: Complete A through no detentewhether you need to submit any permit application forms to the EPA. I you answer *yes* to any questions, you must submit this form and the supplemental from listed In the parenthesis following the question. Mark 'X' in the box in the third column it the supplemental norm is attached. If you answer *no- to each question. you need not submit any of these forms. You may answer 'no' if your activity is excluded from permit requirements; see Section C of the instructions. See also, Section D of the OMR:Aims for delnitions of boldfaced terms. MARK " MARK "r SPECIFIC QUESTIONS YES NO FORM ATTACHED SPECIFIC QUESTIONS YES NO FORM ATTACHED A. Is this facility a publicly owned treatment works which results in a discharge to waters of the U.S.? (FORM 2A) • irIl . B. Does or will this facility (Sher existing or proposed) Include a concentrated animal feeding operation or aquatic animal production facility which results in a discharge MI 9 0 16 17 18 to waters of the U.S.? (FORM 2B) 19 20 21 C. ts this facility which currently results I'.❑ discharges to waters of the U.S. other than 0 D. Is this proposal faddy (other than those described in A or a above) which will result in a . cli ❑ those described in A or B above? (FORM 2C) n 23 24 discharge to waters of the U.S.? (FORM 20) 25 28 27 E. Does or will this facility treat, store, or dispose of hazardous wastes? (FORM 3) ❑ 0 . F. Do you cr win you inject at cis facility industrial a municipal effluent below the lov.orrost stratum COntaning, within one quarter mte of the well bore. . 0 ❑ 28 29 30 underground sources of drinking water? (FORM 4) St 32 33 0. DOWN a will you inject at this facility any produced walla caber fluids which are brought to the surface in connection with conventional oil or natural gas production, intect fluids used for enhanced recovery of oil or natural gas, or seed fluids for 36:4890 01 0 9 ❑ H. Do you or will you infect at this facility fluids for special processes such as mining of suffer by the Frasch process, solution mining of minerals, in situ combustion of fossil fuel, or recovery of geothermal energy? (FORM 4) . 0 0 liquid hydrocarbon? (FORM 4) 34 35 36 37 38 39 I. Is this facility a proposed stationary source which Is one of the 28 industrial categories listed in the instructions and which will potenhally emit 100 tons per year of any air pollutant regulated under the Clean Air Act and may affect or be 00• J. N this facility a proposed stationary source which is NOT one a the 28 industrial categories listed in the instructions and which will potentially emit 250 tons per year of any air pollutant regulated under the Clean Air Act and may affect ip 0 0 located III. NAME Cin an SKIP attainment area? FORM 5 OF FACILITY 40 41 42 or be located in an attainment are? FORM 5 43 44 45 1 15 113-29 30 130 IV. FACILITY CONTACT A. NAME A TITLE (last, first, 8 title) B. PHONE (area code & no) CGordon Brice Manager 340 513 9855 2 15 113 46 46 48 49 61 62 65 V. FACILITY MAILING ADDRESS A. STREET OR P.O. BOX C Red Hook Quarters B-3 3 16100 16 16 ws S. CITY OR TOWN C. STATE D. ZIP CODE cSaint Thomas VI 00802 4 16 VI. 16 40 FACILITY LOCATION A. STREET, ROUTE NO. OR OTHER SPECIFIC IDENTIFIER 41 42 47 61 cLittle St. James Island 5 16 16 45 B. COUNTY NAME USA 46 70 C. CITY OR TOWN D. STATE E. ZIP CODE F. COUNTY CODE N/A VI 00802 N/A 15 16 40 41 42 47 51 62 64 EPA FORM 3510.1 (8.60) CONTINUED ON REVERSE EFTA01221870 CONTINUED FROM THE FRONT VII. SIC CODES 4-di it, in order of nont A. FIRST B. SECOND c N/A I (sax*/ 7N/A (specify)7 7 I 15 18 17 15 16 19 C. THIRD D. FOURTH c N/A 4PecifY) 7 N/A (specify)) 715 16 17 15 16 19 VIII. OPERATOR INFORMATION A. NAME B. Is the name listed in Item C Arran Mc Ginnis VIVA also the owner? 8❑YES I ❑ NO 18 19 55 C. STATUS OF OPERATOR (Enter the appropriate letter into the answer box; if "Other;" specify.) D. PHONE (area code 6 no.) F • FEDERAL M = PUBLIC (other than federal or state) I p I (specify) S is STATE On OTHER (Specify) c 340 690 1487 I A P a PRIVATE 16 16 16 19 21 22 25 E. STREET OR PO BOX 6100 Red Hook Quarters B-3 ze 55 F. CITY OR TOWN G. STATE H. ZIP CODE IX. INDIAN LAND St. Thomas VI 00802 Is the facility located on Indian lands? B ❑ YES 0 NO 15 16 40 42 42 47 51 X. EXISTING ENVIRONMENTAL PERMITS A. NPDES (Discharges to Surface Wafer) D. PSD (Air Emissions from Proposed Sources) C9I N/A 6 7 4 I NT I i 9 P 15 18 I 17 I le 3D 15 16 17 18 30 B. UIC (Underground Injection of Fluids E. OTHER (specify) (Specify) C T IN/A c T s 9IU15 16 17 18 30 15 16 17 18 30 C. RCRA (Hazardous Wastes) E. OTHER (specify) (Specify) CT I N/A C•• 9 R 9 16 XI. Attach show hazardous rivers 16 MAP 17 to this the and 18 30 application a topographic map of the area outline of the facility, the location of each waste treatment, storage, or disposal facilities, other surface water bodies in the map area. 16 16 extending of its and See instructions 17 existing each IS 30 to at least one mile beyond property and proposed intake and discharge well where it injects fluids underground. for recise re uirements. boundaries. The map must structures, each of its Include all springs, XII. NATURE OF BUSINESS (provide a brief description) Private Residence, Domestic Use, Irrigation use. XIII. CERTIFICATION see instructions I certify under penalty of law that I have personally examined and am familiar with the information submitted in this application and all attachments and that, based on my inquiry of those persons immediately responsible for obtaining the information contained in the application, I believe that the information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibilit of fine and imprisonment. A. NAME & OFFICIAL TITLE (type or print) B. SIGNATURE Brice Gordon - Island Manager C. DATE SIGNED COMMENTS FOR OFFICIAL USE ONLY c C 15 16 56 EPA FORM 3510-I (8-90) EFTA01221871 Please type or print in the unshaded areas only EPA ID Number (Copy from item 1 of Form 1) VI 0040525 Form Approved OMB No. 040-0086 Approval expires 8-31-98 Form 2C NPDES a EPA %u.& ENVIRONMENTAL PROTECTION AGENCY APPLICATION FOR PERMIT TO DISCHARGE WASTEWATER EXISTING MANUFACTURING, COMMERCIAL, MINING AND SILVICULTURAL OPERATIONS Consolidated Permits Program I. Outfall Location For this Duffel', list the latitude and longitude, (degrees, min.xxxx) and name of the receiving water(s) Outfall Latitude Longitude Receiving Water (name) Number (8) Deg Min Deg Min 001 18 18 64 49 Drainage System of RO Local II. Flows, Sources of Pollution, and Treatment Technologies A. Attach a line drawing showing the water flow through the facility. Indicate the effluent, and treatment units labeled to correspond to the more detailed drawing by showing average flows between intakes, operations, treatment (e.g., for certain mining activities), provide a pectoral description of the treatment measures. sources of intake water, operations contributing wastewater to description in Item B. Construct a water balance on the line units, and outfalls. If a water balance cannot be determined nature and amount of any sources of water and any collection or B. For each mitten, provide a description of (1) AN operations contributing wastewater to the effluent, including process wastewater. sanitary wastewater. cooling water, and storm water runoff; (2) The average flow contributed by each operation; and (3) The treatment received by the wastewater. Continue on additional sheets if necessary. 1. Outfall No. (list) 2. Operations Contributing Flow 3. Treatment a. OPERATION (list) b. AVERAGE FLOW (include units) a. DESCRIPTION b. LIST CODES FROM TABLE 2C-1 001 R.O. gpd Discharge 300,000 Reverse Osmosis 1S Surface Water Discharge Water is pumped to a Brine Well on land then filtered out to sea 4-A EPA Form 3510-2C (8-90) Page 1 of 4 CONTINUE ON REVERSE EFTA01221872 PLEASE PRINT OR TYPE IN THE UNSHADED AREAS ONLY. You may report some or all of this information on separate sheets (use the same format) instead of completing these oaoes. SEE INSTRUCTIONS. EPA M. NUMBER (copy from Item 1 of Form 1) VI 0040525 V. INTAKE AND EFFLUENT CHARACTERISTICS (continued from page 3 of Form 2-C) PART A - You must provide the results of at least one analysis for every pollutant in this table. Complete one table for each outfall. See instructions for additional de ails. 2. EFFLUENT 3. UNITS (specify if blank) 4. INTAKE (optional) 1. POLLUTANT a MAXIMUM DAILY VALUE b NAXialule 30 DAY VALUE (I I avaaab.$O C. LONG TERM AVRG. VALVE 0 I avallatM) d. NO. OF a. LONG TERM AVERAGE VALUE b. NO. OF ie COMCENTRAR ON 121 MASS in CONCENTRATI ON MKS NI ectievereari ON d) moss ANALYSIS a. coNcEN. I o LIASS TRATeON to COWIN-MAR ON (2) MASS ANALYSES a. Biochemical Oxygen Demand (BOD) N/A b. Chemical Oxygen Demand (COD) N/A e. Total Organic Carbon (70C)N/A d. Total Suspended Solids (75S) N/A I e. Ammonia (as N) N/A f. Flow Value 300 000 Value 9,000,000 Value 30 Day Value g. Temperature (winter) Value Value Value Daily °C Value h. Temperature (summer) Value Value Value Daily Value °C i. pH Minimum 7.6 Maximum 7.8 Minimum 7.6 Maximum 7.8 30 Day STANDARD UNITS PART B - Mark "X" in column 2-a fo each pollutant you know or have reason to believe is present. Mark 'X" in column 2-b for each pollutant you believe to be absent. If you mark column 2a for any po lutant which is limited either directly, or indirectly but expressly in an effluent limitation guideline, you must provide the results of at least one analysis for that pollutant. For other pollutants for which you mark column 2a, you must provide quantitative data or an explanation of their presence in your discharge Complete one table for each outfall. See the instructions for additional details and requirements. 1. POLLUT- ANT AND CAS NO. (if available) 2. MARK 'X' 3. EFFLUENT 4. UNITS (specify if blank) 5. INTAKE (optional) a. LONG TERM AVERAGE VALUE b. NO. OF tj". :Es- ENT ti- BE. O A. a. MAXIMUM DAILY VALUEb. MAXIMUM 30 DAY VALUE (iavaaabla)C. LONG TERM AVRG. VALUE (if avaaabia) d. NO. OF a. CONCEN. TRATION b MASS 0 00.441i7AATIOW CI W.11 ANALYSES SENT In comENTRe TAN 0)444$ (I) coreetrteAno N CO MASS oi ccroceirekno N (2) MASS ANALYSIS a. Bromide (24959-87-9) ❑ ii b. ClIceine. Tat/ Residue/ _4 c. Color • Cli d. Fecal Coliforrn l) e. Fluoride (16964-48-6) ci f. Nitrate- Nitrite (as NI • e EPA FORM 3510-2C (Rev. 8-90) Page V-1 CONTINUE ON REVERSE EFTA01221873 FORM 1 GENERAL U.S. ENVIRONMENTAL PROTECTION AGENCY I. EPA I.D. NUMBER a EDA GENERAL INFORMATION s T/A C 4110 IGI—ni Consolidated Permits Program "General FVI 00t/t0 Sa 5 D (Read the Instructions" before starting.) , 2 13 14 15 LABEL ITEMS GENERAL INSTRUCTIONS I. EPA I.D. NUMBER Hamannled label has been trended, elk it in the designated space. Review the infcanagon careful; if any incorrect, moss through it and calor the II. FACILITY NAME correct data in the appropriate SI-In wee below. Also, if any of the preprinted data Is absent (the area to the left of the label space lists the III. FACILITY MAILING ADDRESS PLEASE PLACE LABEL IN THIS SPACE iinbrthat shrea(s)beiould appear). p103513 pecAide II M the proper Bin a cw.li Ihe label is complete and correct, you need not complete Items I, III, V, aid Vtexcept Vl-B which must be IV. FACILITY LOCATION completed regardless). Complete ill dens if no label has been proved. Refer to Ilse instructions *or detailed item descriptions and for tie legal authorization under Midi this data is collected II. POLLUTANT CHARACTERISTICS INSTRUCTIONS: Complete A through J 10 determine whether you need to submit any permit our-Moen forms to the EPA. I you answer 'yes to any questions, you must submit this lam and the supplemental from filed in the parenthes s (Mown the question. Mark ')C in the box in the tend column if the supplemental ken is attached. If you answer -ne to each question. you need not submit any el these terms. You may answer 'no' it your act* is exduded tom permit requirements; see Section C of the instructions. See also. Section 0 of the instructions for detains of bold-faced terms. MARK 'X " MARK "X" SPECIFIC QUESTIONS YES NO FORM ATTACHED SPECIFIC QUESTIONS YES NO ram ATTACHED A. Is this facility a publicly owned treatment works which rears by a discharge lo waters of the U.S.? WORM 2A) ❑ LSI O B. Does or will this feebly (either existing or proposed) include a concentrated animal teeing operation or aquatic animal production facility which results n a discharge II rgi ❑ Hi 17 18 10 wawa of the U.S.? (FORM 2B) if. 20 21 C. Is this facility which currently results in discharges to waters of the U.S. other than rj '' . Exi D. Is this proposal facility (other then those desafbed I n A or B above) al will result in a ii 0 ❑ those deathbed in A or B above? (FORM 2C) 22 23 24 discharge lo waters of the U.S.? (FORM 20) 25 28 27 E. Does or will this facility best store, or dispose of hazardous wastes? (FORM 3) ❑ g • F. Do you or will you inject at this lac* industrial a municipal elite* below the limearmst stratum containing. Within am quarter ride of the wel taw ❑ a O 26 29 30 undargroind sources Or thigh° wider? WORM 4) 31 32 33 G. Do you awl you teed *Its ridgy any produced water other luids which we brought to the surface n connection with ccrwenlional cd or nand gas production. Intact kids used fa enhanced recovery of oil a natal gas, or need Odds for storage of El 0 Ill H. Do you a wd you inject at this facility fluids for medal processes sudi as mining of aver by the Fran% process, solution mining of miner.* in situ combustion of fossil fuel, or recovery of geothermal energy? (FORM 4) . isi O iquid hydrocartcns? (FORM 4) 34 35 38 37 38 39 I. Is this MOW a proposed stationary source which is one of the 28 industrial categories listed in the instructions and Mach will potentially anvil 100 tons per year of any air pollutant regulated under the Cl Act and may affect a be ri L-I ❑ igi • J M this facility a proposed stationary source which is NOT one of No 28 industrial cremate listed in the insbvctions and which will potentially emit 250 tons per r of any air pollutant regulated under the Chen Mr Ad and mat ailed O 5( O located III. NAME cin an SKIP M ent area? FORM OF FACILITY 40 41 42 or be located In an attainment are? FORM 43 44 45 1 15 16-29 30 69 IV. FACILITY CONTACT A. NAME & TITLE (last, first, & title) B. PHONE (area code & no.) , . c---- .). r-, 2 LO" C) C acri-C\ V-) e x ( e . 6\ A, i•-)< • 3L/c S i 9 V c S- 15 V. FACILITY 16 MAILING ADDRESS 45 46 46 49 51 52 55 A. STREET OR BOX 3 lobo 1-24.8 wor,Ic Q....torez:1/2- ea s 121- 316 to 4 B. CITY OR TOWN C. STATE D. ZIP CODE Ci 4 — T. 7--- \re:, vvvikc, 3z2E ✓2 0 o Ere 7— Is VI. 14 40 FACILITY LOCATION 41 42 47 51 A. STREET, ROUTE NO. OR OTHER SPECIFIC IDENTIFIER -3-4 5 1"--I 4-4-I e.. St. \ tm-e s ..r. sky\ •--) ci 15 M es B. COUNTY NAME (A 5 A a 70 C. CITY OR TOWN D. STATE E. ZIP CODE F. COUNTY CODE C A- A/ v i ocwoz_ AV5A 16 40 41 42 47 51 l 52 54 EPA FORM 3510-I (8-90) CONTINUED ON REVERSE EFTA01221874 CONTINUED FROM THE FRONT VII. SIC CODES (4-digit, in order of priority) A FIRST B. SECOND AyA I 6 17 OnecifY) OW:thy) 17 A) I 16 18 19 6 C. THIRD D. FOURTH (5/29000 7 (spice) 7 / 7 14 15 VIII. 17 OPERATOR INFORMATION 16 16 19 A. NAME B. Is the name listed in Item VIII-A also the ownef? tI 741-Z. R_ A ts.) tkAe- CO 1" r\ ‘ S • YES 0 NO 18 19 55 C. STATUS OF OPERATOR (Enter the appropriate letter into the answer box; if "Other snooty) D. PHONE ame code .4 no.) F = FEDERAL M= PUBLIC (other than federal or Stale) ? S =STATE O = OTHER Oman P = PRIVATE (specify) 3q0 640 / eleY 7 A —Fr 16 18 19 21 22 26 E. STREET OR PO BOX j, 1 00 lecel_ Root,- G., AR_ A- (r. 13 - 3 26 ea F. CITY OR TOWN G. STATE H. ZIP CODE IX. INDIAN LAND c -r Is the facility located on Indian lands? B —) I . kexcvn ik S ti_T corm?0 YES igi NO 16 X. 18 40 EXISTING ENVIRONMENTAL PERMITS 42 42 47 SI A. NPDES (Discharges to Surface Water) D. PSD (Air Emissions front Proposed Sources) C T I C T I 9 N A) A / 9 P 117 15 16 17 18 30 15 16 116 30 B. UIC (Undo round Injection of Fluids E. OTHER (specify) (Specify) C T I C T 9 U 4 9 T 118 16 15 17 18 30 16 16 IT 30 C. RCFtA (H zardous Wastes) E. OTHER (specify) (Specify) T I C T I 9 R N A 9 16 XI. IC MAP IT 18 30 16 IC 17 ILI 30 Attach to this application a topographic map of the area extending to at least one mile beyond property boundaries. The map must show the outline of the facility. the location of each of its existing and proposed intake and discharge structures, each of its hazardous waste treatment, storage, or disposal facilities, and each well where it injects fluids underground. Include all springs. rivers and other surface water bodies in the map area. See instructions for • ecise r • uirements. XII. NATURE OF BUSINESS (provide a brief description) 7-) XIII. • .4..1/4-C__ Ta<.--,.1 8-e—AA CC— I r u NniN..`-77--, , ler', cerktiCre m LA- Ca-12- 1 ) CERTIFICATION (see instructions) I certify under penalty of law that 1 have personally examined and am familiar with the information submitted in this application and all attachments and that, based on my inquiry of those persons immediately responsible for obtaining the information contained in the application, I believe that the information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment. A. NAME & OFFICIAL TITLE (type or print) — B. SIGNATURE S i I vr ,\ ce Go va r-1 1 A IN2, r COMMENTS FOR OFFICIAL USE ONLY C. DATE SIGNED C C 15 IC 65 EPA FORM 3510-1 (8-90) EFTA01221875 PA I.D. NUMBER(eOPY from Item 1 of Form I) T OO L C StaS Fo Approved. Okrma No2O4O4Oa. Approval wakes 6.31.68. Flaw print or type In the unshaded areas only. FORM 2C NEDES I. OUTPALL &EPA LOCATION U.S. ENVIRONMENTAL PROTECTION AGENCY APPLICATION FOR PERMIT TO DISCHARGE WASTEWATER EXISTING MANUFACTURING, COMMERCIAL, MINING AND SILVICULTURAL OPERATIONS Consolidated Permits Program ude and longitude of its location to the newest 15 seconds end the name of the receiving water. For each outfall, list the let; A. oP u trALL in) R. LATITUDE C. LONGITUDE HUMMER D. RECEIVING WATER (name) I. IMO . 3.. tae. I DEO a MIN I, *NC CC 1 ig° IV (o14(9'1°y9 2.Z" b ,=„v-....._ e c-, ...) s .4 , vy, gill 24 LC, C_A..\ II. FLOWS, SOURCES OF POLLUTION, AND TREATMENT TECHNOLOGIES of intake water, operations contributing wastewater to the effluent, Item 8. Construct a wear balance on the line drawing by showing avenge cannot be determined Mµ, fOr certain mining alivilisst MOMS • or treatment matures. A. Attach a line drawing showing the water flow through the facility. ncliatte sources end treatment units labeled to coneepond to the more detailed descriptions in flows between intakes, operationo, treetment units, and outfalls. If a water Winos pictorial description of the nature end amount of any sources of water and any collection B. For each outfall, provide a description of: til All operations contributing wastewater cooling water, and storm water runoff; (2) The average flow contributed by each on additional sheets if necessary. to the effluent, Including process wastewater, (3) The trestment by the sanitary Wettrefillef, vaetawater. Continue operation; and received I. OUT- S. OPENATIONISI CONTRINUTING PLOW S. ,A4,84, Prltl 16 OPERATION ANSIb. (Include unir WIL DESCRIPTION O. LIST CODES PAWN SC-2 COI H I C . SPCA b`SeilAiii- Re-Lie/Z.5C (1) SyYt O cv I S I S SOOin oo ...e.) 04,4- 1- A ( e. Up A k c et \--),s a in A, reit (JD A. k--(4-e . L/-/f ; 5 -p,^-„\ .. e_ck "k--o n A -id A-1.4-in .C- I i-eizei 4. --C-Iti I r.:. ,tie.we \ 1 • ?OrneMt. trot orms-Mmumt gulikihwe esheekstafee) irtf•••,* • a Form 35104C 01-110) • PAGE I OF 4 EFTA01221876 PLEASE PRINT OR TYPE IN THE UNSHADED AREAS ONLY. You may report some or all of his information on separate sheets (use the same format) instead of completing these pages. SEE INSTRUCTIONS. V. INTAKE AND EFFLUENT CHARACTERISTICS (continued from page 3 of Form 2-C) EPA I.D. NUMBER (copy Iron, item 2 of fornn) V T. CC) 0 cM7>) C ouTFALL No. PART A - You must provide the results of at least one analysis for every pollutant in this table. Complete one table for each outfall. See instructions for additional details. 1. POLLUTANT 2. EFFLUENT 3. UN TS (sassily ll blase) 4. INTAKE (optional a. MAXIMUM DAILY VALUE 'Error AX itimava322MY VALUE c.LONC,TfirpolVaitakM.. V ALLICI d NO OF a. LONG TERM AVERAGE VA( tir Ii NO. OF a. CONCEN• TRATION b MASS . (4 (21 MASS C Os C ('IIs) MASS I.) C sC Costa *TICS (21 MASS ( ANALYSES I ') cor.ccimiav,o. (4 Rm. :ANALYSES a. Biochemical Oxygen Demand (BOW id//-I b. Chemical Oxygen Demand (COD) ASV la c. Total Organic Carbon (T0C) IV /A - cl. Total suspended Solidi (TSS) /V74 a- e. Ammonia (a: N) I., Fl f. Flow VAL C cO VALUE x( c. C _: VALUE r 30 b A VALUE p. TemperatureVALUE (winter) VA UE VALUE I ‘...i_ °C VALUE h. Temperature (summer) VALUE VALUE „INC. VALUE 04 , \ . " -1_,- t VALUE I. PH MINIMUM 7, cr- MAXIMUM -7 . W MINIMUM -7 , (c _ MAXIMUM 7, ..S".7C A./STANDARD UNITS PARTS- Mark r in column 2-a for each pollutant you know Or have reason to believe is preSent. Mark r in column 2-b for each pollutant you believe to be absent. If you mark column 2a for any pollutant which is limited either directly, or indirectly but expressly, man effluent limitations guideline, you must provide the results of at least one analysis for that po lutant. For other pollutants for which you mark column 2a, you must provide quantitative data or an explanation of their presence in your discharge. Complete one table for each outfall. See the instructions for additional details and requirements. 1. POLLUT- ANT AND CAS NO. (If availobte) 2. MARK 'X' 3, EFFLUENT 4. UNITS S. INTAKE (optional( a. cc. ^-,:v,.!4"2:5 SC" b. ca Semi 8. MAXIMUM DAILY VALUE b. MAXIIIip= VALUE c.LONG TrpfEtervaNtaf. VALUE d.NO. OF a. EONGEN. TRATION G MASS C. LONG TERM AVERAGE VALUE fr NO. OF ANAL.- toms[ )4VcAT ton 1,1 MASSCONCCWILTIOn (2) MA" _LC OISCC NVPATIOn I') "A" ANAL- ySES iii <CNC C WTRATIOM 12) MASS YSES a. Bromide (24959.67.9) X I — b. Chlorine. Total Residual Y _ c. Color y O. Focal Collier'" ..)C- it Fluoride 116984-eal-.I I. Nitrate— N take (as N) -C _I — EPA Form 3$10-2C (I 90) CONTINUE ON REVERSE EFTA01221877