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PERMITTEE NAME/ADDRESS (rndude Facililv,vnmr)Lwanon i/D~erenp <br />NAME SEM~CA CCAL COAFADY <br />ADDRESSDRARL'A D <br />tfAYDliN .: C(: Blb~9 <br />,>ti`, a <br />f AGILITY <br />LOCATIOt~AYliEM1 ~ 81830 <br />ATTO+: S. BUD r.Y.O'eLr Gt!I¢H 6E>i <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. ~ <br />DISCHARGE MONITORING REPORT (DMR; <br />nr~ s <br />!I I N G d OMB No. 2040-0004 <br />fz-rsl <br />~(i21 l <br />Clt a <br />(SUEfA ii) Approval expires OS-31.98 1 <br />~ <br />' IT NUMBER DISCHARGE NUMBER E- pI E 1 L F O ~,'I Y <br /> OISCIi{~fiE 1C BCE CN GG.LC11 <br />EEi9 <br />MONIT GPERIOD F , <br />YEAR MO D - <br />FROM ~ YEAR MO DAY <br />`TO y U1 ~" <br />itC L7HCb/6C! <br />~ <br />~ LLS <br />rzo zp (z2j`aJ. ~" f2ssD fzs zs) f3o-3n O7E: Read Instructions befdr ;@D{Dpleling this form. <br />~ <br /> ly) QUANTITY OR LOADING (4 Card Only) QUANTITY OR CONCENTRATION P70: FREOUENC SAMPLE <br />PARAMETER -53) (54-87) (3B-95) (4653) (5761) EX OF TYPE <br />(32-37J <br />- AGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS ~, <br />fsz-sai ANALYS/5 <br />(s4-sB) <br />69-70 <br />' SAMPLE ~' 1 94 '~ a O <br />Y ISU A L MEASUREMENT a <br />a4Gbb I U 0 ., ~=1 8>41r ,~.. 3'~ 31: <br />tFYLUEh'I G8055 VALUE D~ ,''~~ L ~" ~~' . s ~1pCq ~"~~, <br /> SAMPLC7~' ' <br />~ <br /> MEASUREME ~~~.~';. <br /> ~ MIT ' <br />aP ~.. 1 I ::+ <br /> . <br />~1~7~Fj1FlEMENT ~ , ~.: }~~ ~ ~:~ '~ <br />' t<, ' - .. <br /> i ~ <br /> SAMPLE <br /> MEASUREMENT <br /> "~ ~ <br />- ~ ~1. <br />~ ~' >K •Ti~ :~ <br />t . <br /> - it - x ~ - <br />= i. t: - <br /> 1. <br /> SAMPLE <br /> MEASUREMENT <br />~~ <br /> `:. <br />PERMIT` 'g. r,A ~ ~ss ~ ... - . <br /> . <br /> °.. <br /> SAMPLE <br /> MEASUREMENT <br /> Mkt. , '~ ' ~' <br />Y <br />~•, <br /> <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ' z ` <br /> i~~{~UTREryEt~3 ~ i . r <br />bL`°~ <br />3C ..- <br />~ ;. <br />~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> `~"~~RM1'~"°: <br /> <br /> <br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY EXAMINED AND <br />D BASE <br />' TELEPHONE DATE <br /> AN <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN <br />D ON MV <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONBIBLE FOR OBTAINING <br /> THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE. <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />P <br />F <br />N <br />LUDIN n .` <br /> ENALTIES FOR SUBMITTING <br />ALSE INFORMATION, I <br />G THE <br />C U <br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1a U.S C. 41001 AND 03 U S.C. SIGNATURE OF PRIN PAL EXECUTIVE <br /> <br />TYPED OR PRINTED 4 1319. JPenetties under Mrue srermes mey include lines up ro E7D,000 end or <br />mexlmum lmpnsonment of beMeen6montlu end5years.) OFFICER OR AU7 ORIZED AGENT A <br />O <br />NI~MB.~ <br />YEAR <br />MO i <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachments here) - <br />155 E IACN LIC1T5 LI11 He 4AIYF:G ~ 38TTLEAd1E 501705 LIlIIS APPLIED E06 <=l0YN~246E FFEGIF:EYEN7F 755 G <br />LHUti LIClITS YAIYEG EC6 )l0YA,14Nh PkL+CIP EVENT SUEJECT TO 6Gk0Ph OF FFCCF IN I.A.Q. Ct1 Q GEEASE SEE <br />r_u-~-n, me Yrlurv cTUr. _ T.o i c ._ <br />EPA Ferm 3320-1 (OB-95)~ Previous editions may Dot bg used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) Q C 1~~~~~~~,~ ~S PAGE ~ OF <br />