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PERMITTEE NAME/ADDRESS pndudr Fan(+ry Namrl[oeannn iJDifferenq NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME <br />SEYSL;A <br />CCAL CCCiAAY DISCHARGE MONITORING REPORT (DMR <br />r2 +e) na )isJ <br />noDRESSDBAYEk D ~ p000 <br />NAY 0 E: M <br />FACILITY CO 81 E 39 <br />~~_C.J 7,U(-~1-• `` <br />~1 ~~ PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />LOCATION ' Y MO DAY ~ YEAR MO DAY <br />A Y D° M O d 1 E 3U <br />l -]F ROM TO y t' j <br />A T T N i G. Ff U D 8 A 0 li N, G F N E A A L !1 A N A v E N r2o (2q-25) r2B vJ na zsJ Gasp <br />Form Approved. <br />bI MO A OMB No. 2040-000 <br />Approval expires 05-31.98 <br />~SU~e lii) <br />-~ -' PI f111 EGDTT <br />CI:;CHAAG~ 7C TFIF/CEY CGEEA <br />~~~ :IC LI=CNAFGF ~__~ %~~ <br />NOTE: Read Instructions belore completing this form. <br /> /3 Cerd Only) QUANTITY OR LOADI j4 Cab Ony) OUANTIT'Y OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4853) (54-61J (3845) (46-53) (5467) E% OF TYPE <br />(3737) AVERAGE MAXIMUM MINIMUM ~ AVERAGE MAXIMUM UNITS <br />rsz-mJ aNALrSIs <br />64-eB) <br />69-70 <br />It , SAMPLE -^OJ ari ( yti) :aos>.s 07+t+v~ a74 ~>rnZ <br /> <br />Y 15 U 6 L <br />MEASUREMENT <br />~, <br />V <br />V <br /> ~y„ <br />UYU6b I U 1 PERMIT.- Rt <br />. AEiClH }e=1 1E <br />3 ~ 4io C /~iY 15UA.L <br />F.FFLUEAT CROSS VALUE pUIREMENT, i11SY d4'"~ lC=G ,;' ~z _ ~~s," s".' , ~xS~ RG13E <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ~~" -Pp~AN~l~ . - <br />~ , <br />~` <br /> ~'EQ~IRe~ErJT T 4x# <br />~ r;..~ <br />~ - <br /> SAMPLE <br />MEASUREM <br />~ <br />~ a <br />~ ~ ~ <br />' <br /> ENT pu <br />0 ~, <br />yQ w;~ §~ <br /> P~fiMR y t: <br />- <br /> ~E~U1fjEIrrENi , ~ ' <br /> SAMPLE V <br /> MEASUREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> x~'. °~E9M} - >~ <br /> `~}E6t~IliEMl:NT'. a - <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ F~Mv1F~' <br />~ : . - - <br />. ` ~' . <br /> . <br />€3E4UIR~E~1C,[J7 '.., . - r e- <br /> SAMPLE <br /> MEASUREMENT <br /> <br />M <br />~ <br />~ '-~ .mts`.,. -x <br /> E6tl <br />MGKT 3;' <br />a .„ ~' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY El(AMINED ANO <br />IN <br />AND BASED ON MV TELEPHONE DATE <br />- ; <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ~ <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />TT <br />P <br />ES F <br />BM <br />SE <br />T <br />O <br />D <br />N <br /> ENALTI <br />I <br />ING FAL <br />INFORMA <br />I <br />N. INCLU <br />I <br />G THE <br />OR SU <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U S.C. § 1001 AND 33 U.S.C <br />' <br />SIGNATURE OF PR CIPAL E%ECUTIVE <br />TYPED OR PRINTED as up ro S+O,ooo end o. <br />maxi mmmpnSlanmenr orl li»Mee re6 me°n(I~is end 9u~ 9 OFFICER OR A HORI2ED AGENT DE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) <br />1':,5 b I6(JM LItlITS VIII BE YAIYEC AMD SETTLF.ARLF. SCUDS LIRIT AFFIIEL FCh C=IOYA,i4Nh FAECIF EYEIT; T55 E <br />InuN LIFlITS irAIYED fCi ]IUYA,2~Nk PAECIP EVENT SUEJECT TC EiUADEN CF FNCCF IY I,A.2. CII E CFEASE-~EF <br />r 6 j ,. .~na r kii'' i "'G °E'E i k$ <br />EPA Form 3320-T (08-95) Previous editions may not be used. ' (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) O O A ~ ~~, A QO A A »' ~ A; ~ PAGE T OF <br />