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PERMITTEE NAME/ADDRESS (Include Faci(in• Name/Lacanon +JO$erenq <br />NAME SEYF.CA CCAL CGdFlki <br />ADDRESSp kAY bH D <br />HATDEN CO 81639 <br />FACILITY <br />Locnnol~AYUBY CO 81630 <br />ATTh: (V. bUU E4CiiN, CEhEdAL lIANiGlB <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCNARGE MONITORING REPORT (OMR; OMB ND. 2040-00049 <br />rz~wl (+A 91 hINOF <br />0 0 0 0 1 O 1~ (S U B H k i) Approval expires 0531-98 <br />PERMIT NUMBER DISCHARGE NUMBER E- F I F A L Air U t 9 <br />fL~ r <br />MO ~NGPERIOD CI~C.`.'AFCE 4C SACf CFEEK <br />YEA ,MO DA YEAR MO DAY <br />FROM a =T0 y ~u •~'^ tiG LSSCNAFGE ~ ~ ~~~ <br />(zpzl) (22.23) (za zs! (zsw} f2Ba9! (aas+! NOTE: Read InsVUCtions before completing this form. <br /> (3 Card Ony) QUANTITY OR LOADING (a Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (a6-ss) (54-sI) (38-a5) (ab-53) 5a-sf) EX oP TYPE ~~ <br />(s2-s~) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />!6z-by ANALrsiS <br />(64-6a) <br />69-70 <br /> SAMPLE ( y4) ~ ~ t9 '~ <br />Y ISU AL MEASUREMENT <br />duU66 1 0 C i <br />~'PE~ I <br />T `° ;~ tS=1 aooo isa•s 0 ::~. C bCE/ ISUA1 <br />EFYLUENT (:kOSS YALUf _ <br />~ <br />,~CSiU1FEME[~~~ `79~,X lC=O Y+,.. +~=~ ~CATk <br /> SAMPLE <br /> MEASUREMENT ;i,`;, <br /> ~M <br />~ <br />` <br />' zt <br /> 1iE <br />~f <br />Ekt. <br />,~ <br /> SAMPLE <br /> MEASUREMENT `s.. <br /> <br /> 0~~~7R6'ME"~ ~ ~ ~ <br />~- ~+. <br /> . ~ <br />.f. <br /> SAMPLE <br />" MEASUREMENT <br /> ,,,.~ ~r)r.:. ~ :~ r~>w. ~ ~ :~ - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ~. '~CRMtF'~. ~ ~*a <br /> ~~ (~Ul~M6tk7r <br />6. <br />" ~ ~~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> Mi {, <br />n <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ` ~ ~ <br /> ~EGi <br />01~EM~N~ ~ ~ <br />-,. '3-~ r <br />NAME(TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSO NALLY E%AMINED AND TELEPHONE DATE <br />AM FAMILIAR WITH THE INFORM ATION SUBMITTED HER EIN; AND BASED ON MY <br />INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING <br />THE INFORMATION, I BELIEV E THE SUBMITTED IN FORMATION IS TRUE, <br />ACCURATE ANO COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFICANT ~/~ ' <br /> <br />PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE <br />/ ~~ ~ <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1$ U S.C. § 1001 AND 33 U.S C SIGNATURE OF INCIPAL EXECUTIVE "- ' / <br />§ 1318. (Penelrles under chase srerures may mcrutle nrlas up ro aro,ooo end or <br />h <br />tl <br />f GFFICER O AUTHORIZED AGENT ~ UMBEfl YEAR MO DAY <br />between 6 mont <br />s en <br />5 yeah.) <br />TYPED OR PRINTED maximum Impnsanmenr o <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference 9!f attachments here) - <br />TSS 6 IRON LIdITS Y31L HE LAIYE.C 6 S2TTLEABLE SCLIGS LTt;I7 AFPLIEG ECF C=l0Yp~24fF FbECIF FYf1Tf 755 6 <br />5E1'TLEAiiLE SOLIDS lIl1T kAIYED_POF >lOTH.2RHp PkECIP EYtNT SU5dEC 1G BUHGEM ~l F6CCF I1f I.l.i. GII G <br />332o-7 (08-95) Previous editioRS may not <br />OF <br />WHICH MAY NOT BE USED.) Q017.1~!"$ ~ -1 E 5 I <br />