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PERMITTEE NAME/ADDRESS (lnchrde Faciliry Nmne/Lacminn ijDigerenQ <br />NAME RGYI~i•. K~-:I:.I!:{tI•~c, L:' ;^~;' <br />ADDFiESSbOYIE 5?. :` •tTF't <br />, P.O. HOK ":,T <br />PAOMIA CO 81479 <br />FACILITY <br />LOCATIONxOMIE LO B1UL9 <br />A7"S `t: riLL[D,". A, HE9F. !-;,_ 'iT;it: ^cR <br />NATIONALPOLRfTANTDI$CHARGE ELIMINATION SYSTEM MPDES) FOmI ApprOVOd. <br />DISCHAR GE MONITORING REPORT (DMq 9 <br />~ OMB NO. 2040-000.41 ' <br /> ) ) ~ T N {' ? Approval expires 05':37-98 ~, ' <br /> 'n r rn (^tJP.P WC1 ' <br /> PERMIT NUMBER DISCHARGE NUMBER .. <br />- 'T <br />PA!, "2 <br />DF.L° <br /> MONITORING PERIOD ~=' "P ~'~/`T4E D" °i r. Tn ?FER ~'L <br /> YEAR MO DAY YEAR MO DAK °~ <br />FROM ?9 OI TO ~? '14 0 V. <br />`+'~ ~ ,! <br />L..C {ARGF. _ <br />~~( '.`-~'I ~R <br />Izo-zr) !zz-zs) tZazs) (la2r) tze-29) (soar) NOTE: Read Instructions bef ore pleting this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION N0. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-61) (38<5) 465) (54-61) EX OF TYPE <br />(32-37) <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />-UNITS ANALYSIS <br /> <br />69 <br />70 <br /> (6zd3) (64-68 - <br />}jL AND ~: r1 F'ASF <br />IS <br />L SAMPLE <br />MEA <br />U <br />ME ~~#4a;k ( 9q) 3#1C t:fi# it ~lr#-~r ,>r~~t^. / <br />/~ /' 7~ <br />L 1 <br />V <br />UA RE <br />S <br />NT r ~ - <br />dU066 1 0 0 I ~,~- y, ES=1 ~ ro-~ ~, ~,_ <br />~ <br />~ itr <br />~ <br />EFF'L'JF.N7 GRnSS YALU '1' °t+~° `' °' 110=0 ;~ <br />:; 'i` ~~ ~ , <br />~~~d~r T <br />ti C <br />4A = <br />'"+ <br />~ <br />: <br /> L r <br />~ 3 `- s <br />. <br />. <br /> "` <br /> SAMPLE <br /> MEASUREMENT <br /> ~): EA~1~ s ~ m.. ~ YC.i_ rl` ~y a <br />M <br />~ -.~~ a h+„3x <br />~' .v ,~ <br /> ~ <br />~ '+' <br />+~~ ~°c <br /> SAMPLE ~~ ~°"~ - <br /> MEASUREMENT ~~ " <br /> ' PERMIT "' <br /> REQUIREMENT ~`~ <br />„£ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,~ - `~ `~ g . , <br /> REQUIREMENT :~ ,- '.,t <br />- <br />''F1 - } <br />,'.. i~; e <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT •~ ~". x~ <br />~ <br />.rG {~ ~~ ~ ~ <br />~- "^' <br />~ <br />~ +~~ <br /> RE(UIREMENT °- - ~ ~ <br />' ^ ~ <br /> SAMPLE .' <br />• MEASUREMENT <br /> PERMIT,. <br />~ r "; ~ .., ., - - - ,,: -,, . <br /> REQUIREMENT ~ ' ,t ._'. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT v. '- ~ <br />~ '~~ -_ - - <br />2- ~x .. ..~~ , -.i <br />. <br /> REQUIREMENT <br />` * <br />NAME/TITLE PRINCIPAL IXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM UW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY E%AMINED AND <br />IN; AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INONIDUAL <br />THE INFORMATION, I BELIEV <br />AC <br />RAT <br />D <br />P S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION IS TRUE, <br />A <br />T ~ -r <br />~~ i ( - <br />' <br />' <br />L / CU <br />E AN <br />COM <br />LETE. <br />PENALTIES FOR <br />UB <br />7RN WARE THAT <br />I AM <br />HERE ARE SIGNIFICANT <br />G FAL <br />INF <br />RMAT <br />N <br />U r ~ ) <br />j~)/ <br />I <br />I <br />~ ~ <br />~ <br />~ ~ <br />~ S <br />MI <br />IBILD~' <br />PO <br />F F <br />E AN <br />PRI , INCL <br />DING THE <br />SE <br />O <br />O <br />NME <br />E <br />U <br />AN <br />~ (~~ <br />yH f <br />( <br />f, <br />' , ~ { ('/ <br />,J F 3S <br />IN <br />O <br />D IM <br />§ 1319 <br />P <br />tt/ <br />d <br />h E 18 <br />.S.C. 41001 <br />SO <br />NT. S <br />D 33 U.S.C. <br />I <br />l <br />N <br />d <br />d <br />Ef0 <br />00 SIGNATURE OF PRINCIPAL EXECIRIVE f 7 i %- >~ 7 7 ~ ~ j <br /> <br />TYPED OR PRINTED ane <br />es un <br />er t <br />ese smMes mey <br />nc <br />en <br />. ( <br />u <br />e <br />nes up m <br />.0 <br />w <br />meximem impdsonmem olSeMOen Bmptths end5years.) OFFICER OR AIfTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />OOMMENTS AND EXPLANATION OF ANY VIULATIUNS (HB1BTBnCO ell et1aCllmBnLS TIe/BJ <br />,ETTLEABLE SOLIDS LTMIT APPLIF.:i U[tLT IF C=l0YR,2UHR PRFCIP°,YFti'r TS CLA',C,?D. .TF CT.dTM APPr'04P9 c~l ~.;t^D, <br />"55 o IRON LIMITS 1+ILL NOT AE APPLIED T7 BFPORT~'D 1F:ASUREII''YTS-SFP T.!1,7, ar, 4 FOF 9URDFN CF pR0(`F <br />EPd~~orm 3'd2 ~ -9 Previous a Itions may no be fe .' ' " (REP CES~ A F ~ T' I M Y O E E .) ~ - ' '-' ~ ' " PAGE OF <br />OCDn,S/9iT`?22-172 _' <br />11 ~ <br />~.. <br />