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PERMITTEE NAME/ADDRESS /Include Fanliry Nume/Lamrion JDiBerenq <br />NAME CYrr•J: Yl"'. 'ti. ;: - .-! .5. <br />ADDRESS'LI NfS 1,11,1 ;(: L'::., ~ '^. :~:i !! PK <br />91G1~ ~AS'f ~ 1.~: k,+L Ci .CL' <br />ENGI.edJOL` CO dV1S': <br />FACILITY <br />LOCATION <br />~T'iN: '!CNnIS Y. K:;SL"c'.'- -;F:Nt:3At. ATT:Y <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR~ <br />f2-161 (1]- 9) <br />COC0272±4 001 l <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ar v v r ~, I. TO ~! v C'd ~ ~; <br />/20.21) (21.231 (24251 l26-2]1 (2e29) (30J1) <br />MA.70~ <br />F - PINAL <br />C(iRJLLC 4:t''L <br />Form Approved. <br />OMB No. 2040-0004 <br />Approval expires 05-31-96 <br />mc_,~~Iyi; FCd OC1A <br />>}L'UTT <br />iIG CISCHAP.GE. I_ I ~:; ::: <br />NOTE: Read Instructions before completing this form. <br /> (3 Card Onry) QUANTITY OR LOADING (<Card Onry) QUANTITY OR CONCENTRATION NO. FREDUENC SAMPLE <br />PARAMETER (46-53) (54-61) (38-45) (46-53) (54-61) EJ( OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(62-0) ANALYS/s <br />(64-s8) <br />69-70) <br />^:t T"CCC '_~'i'n'L'YG /L:AY SAMPLE 'Fvr•:: ;I:t :.•~OT%^~ o <br />~/ <br />~ RII%r'.::z rr :z ::nrx >;=:: ( ZS) <br />1 <br />i <br />R <br />~~ih CF.f i17DA Pi NIA MEASUREMENT ~ <br />0 Q 92 G <br />Af <br />f:.PJP 5 U U <br />"PERMIT <br />" ~ IRQA I. 3~ ~fi~ .~ X• r - ? ~ ER .,~ LY .X G <br />SI:C COL1i~ TS 9b'L0~ " <br />. <br />-REQUIREMENT ~IT'nr-'~-' a "` +`~d`~ ~' - ~(~e~$-. ",_ :. CF.hT ~~ - <br />;.;tYe:C 51 A': ;YE U SAMPLE IIGfiS IIfiAfi 744 ~fififi O 4i 4fii ( j3 ' <br />/ ~ <br /> <br />.:nr <br />PIS:.?l`1LE5 <br />MEASUREMENT /0 O <br />9Z q <br />~g <br />4 <br />. <br />icPbC s U U " <br />RMITr--- ~ e <br /> <br />? rt>ofi -.sl :,I. <br />F' <br />~ k a,l( <br />hr T <br /> <br />1n~ <br />t EA <br /> <br />~ ~, - <br />Ir.. COMP.. -T.i BELOW EMENT I s`;~' ~~+'%'•"• lyM~4;~ -t <br />,t F <br />~,.:~X "`'. CENT '•~ <br /> SAMPLE <br /> MEASUREMENT <br /> "PERMIT - ~ '.a + <br />- - - - ;z •~,- <br />~; ~'REOUIREMENT ~ -z = ~ <br />~ ° ~, - - - _ <br />- - - <br />- - <br /> SAMPLE <br /> MEASUREMENT a'~ <br />u• " <br />1 v <br />~ r <br /> RF~~ IR E {,~ - - ~ ~+~ ~I'~ <br /> SAMPLE <br /> MEASUREMENT <br /> '~f'PEFiMIT - <br />~ 6 „~ ~ ~ `~~ <br />' <br />'~ <br />` <br />~' :,- T,~ ~~^~,; ,t i, <br />' ~'-`: -I'>c' . " .i <br /> R~OUIREMENT ~~q <br />: <br />r ..~ <br />9~ <br />-- <br />- ~~, <br />;; <br />° : P- dp~- .~a v <br />i t:' -x <br /> , „ <br />„ , ; <br />x - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ <br /> <br />~ ~. <br />;. <br />"^ hrg - e~t <br /> REOUIREMENT ~'`~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. ~ ~ " ~ ~ ~ <br />~ .~ <br /> REQUIREMENT <br />" ~ _ <br />- <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED ANO <br />I CERTIFY UNDER <br />LIAR WITH THE INFORMATION SUBMITTED HEREIN <br />AND BASED ON MV <br />M TELEPHONE DATE <br />Richard MI I Is ; <br />AM FA <br />I <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, ~ ~ <br />Environmental IJiana er ACCURATE AND COMPLETE 1 AM AWARE THAT THERE ARE SIGNIFICANT <br />D ! <br />' <br /> ING THE <br />PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLU 970 _870-2 <br />12 /~T/7 <br />~U '7 <br />~ <br /> POSSIBILITY OF FINE AND IMPRISONMEM. SEE 16 U.S.C. 4 1001 ANO 39 U.S.C SIGNATURE OF PRINCIPAL EXECUTIVE r/Li / <br /> <br />TYPED OR PRINTED 5 1319. (Penetties untler Nose srerures mey include lines up ro 310.000 end or <br />menmum impnsonmenr of deMeen6months entl5yeers.) OFFICER OR AUTHORIZED AGENT <br />pA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />_-;e I, P,4 PCH TEST PAGCFDUftc, RFT RE~IJLTS OF L'eTNALI".Y I)t:RIYATI0N5 AS "bE,FF'CCT", •3RO~TH E E£FF.CI7CCTi0~ <br />C,;r+IYATIONS AS °TUXICI.Y°. RPT LUR'r5T '+ f,FF'L AT G"HICi! '"A'iISTICALLY SIG6if' DL^F P.ETWcER TEST f, CC`rT501 <br />(1NC, G•47 RD IICT YC TFCT f-'TOK ucu 9UT Tf 74 IICT Ve' TCCT /`/1:1~ VO11 TU/--x/1114 fTT 6fP r`KDI~L Ttcm ~n ry~ <br />EPA Form 3.720-1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 0 0 O I a / 0 v 0 U 0 S ~ 1$ 0 1 PAGE 1 OF <br />