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PERMITTEE NAME/ADDRESS (/ndude Facllip~Name/Location fDi$erenrl <br />NAME CYii!i9 YAMFA YALL1'.Y COP.L COkP. <br />ADDRESS" i ^F ~~i 1, 1E3 SOLT}ir ~ PCiC >7A{J FR. <br />tilt;U ;.4:;T MI'sEnAL CLdCLb' <br />.+:.-LrwOOD Cu tlU1S5 <br />FACiuTv <br />LOCATION <br />e.TTN: "OdkI3 '~. KL'GLES~ GEt:h_'P.AL A'1'~Y <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FDrm ApprOVed. <br />DISCHARGE MONITORING REPORT (OMR~ ~ OMB No. 2040-0004 <br />f2-16/ IP. 9) ,M,~ax Olt <br />CnlJ7154 OU3 .T (SUER C4) Approval expires 05-37-98 <br />PERMIT NUMBER DISCHARGE NUMBER }' - F I ;r .4 L 3Ji' <br />MONITORING PERIOD "I~iL 1, FCE~ c: TC FOIL}L CREE'r. <br />YEAR MO DAY YEAR MO DAY <br />FROM vv v~ vi TO vv u'.r ~~/ .~ YO CISCHRRGE (~~ '?ri ~` <br />aazn rzz~z3) rz4~z9) rzss]) rze~z9/ Boat) NOTE: Read Instructions before completing This form. <br /> (3 Card Onty) QUANTITY OR LOADING (4 Card Only) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-67) (,38-45) (4fi~53) (54-61) EX OF TYPE <br />(3237) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> rszra) (s4~se) ss-7D) <br />l n:1 tQ~ ~U': F.L SAMPLE .=.-u: .::t^-u:; :z :.a:: -~-;a ( 19 <br />(A U F F,) MEASUREMENT tt11 <br />N l~ (V A NI) A)R <br />;J1U45 :; U U <br />,;- <br />,;P,ERMIT ~t >ar vyv I .P R C IIC i s G <br />ik'E CO'tiiE:+TS RF:LU, , <br />RE~QU~~EMENT Y ,:- '' ` r>x:? ;j ,~ ~;~0}1A AEG - RALLY ~~i;;, )"U/L ~1(JNTH ' <br />L M. ^I t 'L''~"1'ri L SAMPLE ':aauc. - rt a, r,: r. ;, i..vV <br />~ 22y~] ~ J <br />( <br />n I 1, <br />13 / r' <br />~ 2 <br />(n ~ F 3) MEASUREMENT 1 3 .:J l W y UF- <br />~ v <br />:'lUIS 1 U U rs ~ ,,:::~; 1 ' <br />EYr'LllC'.1' GkUS_° VALUE AEOUIREMIENT ~"~~+~ ~-,,1. ~- a><~n ~. 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Ls <br />~ '~~~~ ~ <br />m / <br />~ <br />1 <br />~ fSJ~~ <br />A MEASUREMENT V f ~ I ~ <br />l <br />. <br />d~4Uhb 1 U U >~ ~ <br />P,ERMIr. ~~ ax <br />- ~T .. - <br />~, £°=1 .y;. ~ ,. 0~m <br />- .: $U -L <br />F:FFLUGNT GkOSS YALUE REQUIREMENT- ~i~r'A:![Ax FO=O I '~ <br />%a ~'~~'> '( <br />) ' <br /> w ._ ~ , <br /> SAMPLE ~ }`n ~i <br /> MEASUREMENT <br /> +ERMIT r- <br />~ <br />~R I ME(JT= 5"y~ S.'u .z <br />~-~~rL~~,.rx <br />" A4 <br />~ > <br />r ~,y ia~', <br />A <br /> <br />-, .F a ,, .: <br />40.~s <br />y;.S~ <br />i.. 2t 'z <br />.~ ' i - :: <br /> <br />>; )' <br />" <br />it .. <br /> <br />~~ y~a It' i <br />~ e <br />4*'r '~ ' .- <br /> <br />1. <br />~- <br /> , <br />. ,Y . <br />, . <br />;F <br />..« <br />h ~ <br /> SAMPLE <br /> MEASUREMENT <br /> ~•'PERMIT - i ,t <br />~~ :~~r; ta-2~ T a p+`) "~~.~J~ ~ X.- "S cr~. ~~. §` ~ ~' ,',.,i ~. . <br /> REOUIREMENTr ~; <br />~ ' ; _'< T' ! `~ 1 t~ : ~ <br />~ '4` <br />~ ?I <br /> - ~ ,, <br />,{ ;, <br />} <br /> SAMPLE <br /> MEASUREMENT <br /> ~ ~ <br />rM <br />- I ~ -~ <br /> REQfIIREMEN7 1 <br />f : ,. or .., - <br /> Y <br />I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY ENAMINED AND <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />AM FAMILIAR WRH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MY ~ TELEPHONE DATE <br />t <br />K G erd MI $ INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. <br />Environmental Manager ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES F <br />R SUBMITT <br />NCLUDING THE <br />FALSE <br />F <br />RMATIO /Q//~y/)/ <br />~~i~/~ /~/'W :' <br /> <br />9]O-E7O-2712 <br />ING <br />IN <br />N, I <br />O <br />O <br />POSSIBILITY OF FINE AND IMPRISONMENT <br />SEE to U <br />S <br />C § 1001 AND 33 U <br />S <br />C /y <br />~V <br />~7 <br />. <br />. <br />. <br />. <br />. <br />. <br />(Penerti <br />4 131 e <br />ntlar thes <br />ma <br />lines <br />nd <br />r <br />t <br />bl <br />n <br />Nd <br />ro S/a <br />LVO SIGNATURE OF PRINCIPAL EXECUTIVE L.T J <br />as u <br />y ~ <br />r <br />. <br />e s <br />a <br />es <br />c <br />a <br />up <br />. <br />e <br />o <br />TYPED OR PRINTED m~ximumimpnsonmemofDeMeen6monNSentlsyaers <br />l <br />~• OFFICER OR AUTHORIZED AGENT <br />~ AEA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />. <br />1: ,T,. ODE <br />"; <br />f <br />I <br />1~ <br />COMMENTS AND EXPLANATION OF ANY VIOLAI IONS (Reference ell attachments here) ' " <br />ALXER6".?'_ LIihI?S FCF TSS, IROti E SETTL1:AflLE: SGLIDS (LO:. 'Ur) APRLY CNLY LF G= 10-Yr, 14-ti5r:-CIP iYENT <br />CLAtl1i~. S°H 1. A. 2. Pu 2Y, FGi•: uUSfEY OF PROOF kF;UZ!{ayF'NTS. CIL E l-T'Tli~;-_iE£ f''a"1. , <br />- i/• ;. <br />('FTRLY ti1>~DI TNG E Ai P/1GT TNC TNSTpIIf'TTlIy C--MTT Y:"TTC n/. _ , <br />EPA Form 3320-1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) 0 0 0 3 9 / 0 0 L' 4 0 ~- 1 `~ L 1 PAGE 2 OF <br />