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PERMITTEE NAME/ADDRES$ (Include Faciliry Nmne/Locadon ij0i$e.mQ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPDES)
<br />NAME j .: & F' ~ k ~ D A ~, . L) : Y A:: Y DISCTHAR GE MONITORING REPORT (DrMR~9f r Z 9 J (,
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<br />H A Y D h' .r• C D d j f. 3 7 ~ PERMIT NUMBER ~ klli~="F-' olscHARGE NUMBER t' - E L K AL
<br />Form Approved. / ' ^ "4`
<br />OMB No. 2040-0004 ~~
<br />Approval expires 05-31-88
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<br />PENALTIES FOR SUBMITTIN I AM AWARE THAT THEflE ARE SIGNIFICANT
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<br /> POSSIBILITY OF FlNE AND IMPR ISONMENT. SEE 10 U.S.C. ~ 1001 ANO 33 U.S.C. SIGNATURE OF PRI IPAL EXECUTNE
<br />TYPED OR PRINTED meximumlm~onmarrt oI SeM>3en~6 nron6u entl5 ~ fine9 up ro 570,000 entl n
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<br />COMMENTS ANU EXPLANATION OFANY VIOLATIONS (Re/stance all attachments here)
<br />i~:£ PAFr i. A.4 FU.? J~TAILS DF Ti.iT rft);.=:D'Jxk:. REPORT Lul»LST DLLUTIi)iw (.: cFcLJi;NT) YNIi;N IS LETHAL TO SU»
<br />Ji tdSl .)H~A8I3?t5 (LCSU) ANL Ar'PACH A=Urr: "'OCICITY 'r4;sr 3GPUftY FON71 T(1 DHH, CJPIES OF ALL I+iF0Nt7ATIUN
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<br />EPA Form 33267 (0&95) Previous editions may not be used. (REPLACES EPA FORM T,oO WHICH MAY NOT BE USED.) ti X01 Y Y 0 513 ~ 11~ 0 PAGE ~/ OF
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