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PERMITTEE NAME/ADDRESS (Include Faci(iry,Vame/Cocarion rjDiffexenq <br />NAME t1INREC, INC. <br />ADDRESSN08Ttl TtlCI'PSCA CFEEK 1lINES <br />2768 C08PASS Cfi]YF, SOI1E 101 <br />FACIUTYGRANC JUMCTICN CG 81506 <br />LOCATIO`ARBCNDALE CC 81b23 <br />AT?NO J. F;. STOYEB. CCNSU i.TT NG BYG_ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDE$J Form Approved. - ! <br />DISCHARGE MONITORING REPORT (DMA OMe No. 2040-0004 <br />- rzasl lyr~B1 C I N C F Approval expires OS-3L98 <br />~SGq ~su>;e ric) ~ <br />`"ia C IT NUMBER DI G NUMBER F- F I D A I t F I Y~ A <br />MONITORING PERIO `~ CC1 ~ CCI CC!'EIAEC LSCfiFG <br />Y MO DAY .' YEAR MO DAY <br />FROM u U ~ G' t,~ d ~~~ NC L75C8AFGE ~_-~ fAA <br />rzo~zu rzz-zal n<.zs ..P.~ rzs~zn rza~z9r moan NOTE: Read Instructions before completing this form. <br /> (3 Cerd 0 <br />QUANTITY OR LOADING <br />5J Only) OUANTITV OR CONCENTRATION 'NO. FREOUENC SAMPLE <br />PARAMETER _ <br />6 <br />3 <br />( / (54-67) <br />~ (3845) (46S3J (54-61) EX~ OF TYPE <br />(32-37J AVERAGE MAXIMUM UN MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> r0z-6al (64-68J 69-70J <br />IL AND GREASE SAMPLE =OCC191~ 1 94 •LiiliM Ob~C9t OOC>Cx>C <br />2 <br />YISUAL MEASUREMENT r <br />84066 1 0 0 ~ _. "~~r00ak+11" . 6 -; ':' ~ ES=1 ~ ~~~~~>a O t01C G`t~ 1 <br /> <br />EFFLUENT GROSS YALUE <br />; ~ <br />~C' <br />8~ <br />~~: <br />~ <br />IE8# K` <br />AC=U <br />~~ <br />~ ~ <br />~ks~ <br />~`~~ , <br />RCLiA , .-. <br /> _ <br />.. .. <br />~ - . <br /> SAMPLE ~ ~a_ <br /> MEASUREMENT _ <br /> ~ <br /> HE~pI N$: 4 <br />r ! <br /> ,. , <br /> SAMPLE ~. '~,y ?.''} . <br /> MEASUREMENT ~ '-;. ~ ~':;-~-. ~ ' <br /> 4 <br />~ <br />' <br /> 9~ IbEM~RT ~ ~ '~ 'I ~~'~~ ~. <br />`$.,~ <br /> SAMPLE <br />. <br /> MEASUREMENT <br />^: <br /> R r <br />~~ <br />~ <br />~ ~~ <br /> Q~ - ~ <br /> ~ _ <br />V h <br /> SAMPLE <br /> MEASUREMENT <br /> r <br />~ <br />~ <br />. <br />.. <br />;~... <br /> ~ <br />4}II <br />~NT . <br /> SAMPLE <br /> MEASUREMENT <br /> ~s;. I ~ s <br />~°` <br /> R _ ENS', .,,.rf .. - . ~» <br />a- <br /> SAMPLE <br /> MEASUREMENT ' <br /> .~r ~ ~ ~ - - .. ; <br /> ~ <br />EN x <br /> <br />_,,~. <br />j <br />_ .. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH SHE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED F{ERE NALLY EXAMINED AND <br />IN <br />AND BASED ON MY TELEPHON <br />- DATE <br />' <br />S~YirY2 <br />E <br />. <br />J ; <br />INOUIRY~OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION <br />I BELIEVE THE SUBMITTED INFORMATION IS TRUE <br />_ <br />. <br />. <br />I , <br />, <br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICAN7 <br />PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING THE <br /> <br />' <br />' , <br />I ~ <br />r POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1B U.SC 41001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE ~0) <br /> <br />TYPED OR PRINTED g 1318. (PeneXres undo/ Ihese sratules may include lines up to 510,000 end or <br />maximum lmpnsonroem of beM1veen6monrhs end5 <br />ears <br />) OFFICER OR AUTHORIZED AGENT <br />A <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> y <br />. 0E <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all a(tachmenrs here) <br />PERtlI1'TFE MUST NCIIFI NQCD 30 DAIS.PAIOH TO COtl6IEING DISCHARGES-EARS I.A.4, FG 19. CCFTEI9 SAlFIIAG FCR <br />PH, FLOiI E OEG ALLCYFt DURING PFBIODS.OF LTt ACCE_Sp ATTACN ST ATEeFhI TO [EF. CE7ECIICY I]tITS-SFF I•F.s. <br />T~ ~ni r r 7 A f .r n ~~. w w r 1t Tr ! r w • • r l <br />SPA Form 9320--7 (0&95) Previous editions.may ~boLbe used: "~(fj€PLAC~S EPA FORM T-40 WH CH MAY NOT BE USED.) -- . ~ P GE OF <br />- ~ 00166f00,G]11-1622 - ] <br />... ~ .. .: , ~.,~., ' tea; `.E ~. v , _ .. .' ~ r <br />