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IWEVtLV5 G69T- P- CUK <br /> PERMITTEE NAMEIADDRESS(include NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM(NPDES) <br /> Facility Namekocationifdifferent) DISCHARGE MONITORING REPORT (DMR) <br /> NAME RICH aCrTTLP1Q0 (2-16) (17-19) Foml Approved. <br /> ADDRESSCOG- Minor OMB No.2040.00" <br /> co wf)S6�2PERMIT NUMBERDISCHARGE NUMBER I Approval expires 10-01-94 <br /> F-Final <br /> A MONITORING PERIOD <br /> LOCATION S 1 YEAR MO I DAY YEAR I MO I DAY NO DISCHARGE **x <br /> ATTENTION FROM ahml 04 1 ni I TO <br /> (20 1) (22-23) (24-2) (26-27) (28-29) (30-31) NOTE: Read Instructions before completing this form. <br /> FREQUENCY <br /> PARAMETER (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION NO. OF SAMPLE <br /> (32-37) (46.53) (54-61) (38-45) (46-53) (54-61) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS M"V (64-68) (69-70) <br /> SAMPLE *#**** st*#*t tt#*** #*##** ****** <br /> MEASUREMENT <br /> PERMIT 3o-M AYG #*## <br /> REQUIREMENT <br /> SAMPLE *****# #*#*#* ###### ****** #*# #* <br /> MEASUREMENT **#*** #***** * #** <br /> PERMIT 30DAYA G ####*# <br /> REQUIREMENT *##*#* **#* # ###### At <br /> SAMPLE *##*## #***#* *#s##* *#**** #***#* <br /> MEASUREMENT #*#*** ***##* #*#### <br /> PERMIT ###### #####>t #*###a :', **##*# JIWAYAVG <br /> REQUIREMENT <br /> SAMPLE #*### #***#* *##### #*#*## ##*#** <br /> MEASUREMENT *#*#** #*#### *#*### <br /> PERMIT # #*##. #*### t#:#t# ##### 3"AY AVG **##*# <br /> REQUIREMENT <br /> SAMPLE *#*#** *#**## >t*#**# *****# *****# <br /> MEASUREMENT **##*# *###*# t# #* <br /> PERMIT VIVO ####s* <br /> REQUIREMENT <br /> SAMPLE *##### **#e** *####t ###### ###t** <br /> MEASUREMENT *####* *###** tt*##* <br /> PERMIT '-WbAV AVG.t#: * <br /> REQUIREMENT ####*# I# *#* **##t* <br /> SAMPLE ***#** *****# *###*# #*#*** *###** <br /> MEASUREMENT *####* **#*#* * ##** <br /> PERMIT ##s### # $##k #•#### `'. ###### 30-0A #Ili>I# <br /> REQUIREMENT **###* ** #* <br /> NAMEI7ITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY EXAMINED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN;AND BASED ON MY <br /> RVf FRS MWJ> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING .��}/�� b$� <br /> © THE INFORMATION,I BELIEVE THE SUBMITTED INFORMATION IS TRUE,PENALTIES <br /> r ' •� 0(v <br /> RATE AND COMPLETE. 1 AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES ` <br /> FOR SUBMITTING FALSE INFORMATION,INCLUDING THE POSSIBILITY OF FINE (� 3r7 <br /> AND IMPRISONMENT. SEE 18 U.S.C.4 1001 AND 33 U.S.C.S 1319. o <br /> TYPED OR PRINTED (Penafts under Mese adertea mey Inande Ones up to $10,000 and or mexlmum SIGNATURE OF PRINCIPAL EXECUTIVE AREA <br /> ImpvlsonmeM orbsMeen a monMs and s years.) OFFICER OR AUTHORIZED AGENT CODEJ NUMBER YEAR MO DAY <br /> effachmefille here) <br /> EPA FORM 3329-1(REV.948)➢twbus edid*ns may be used IREPLACES EPA FORM T-"WHICH MAY NOT BE USED) 00005/950315-1633 PAGE 2 OF 2 <br />