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PERMITTEE NAME/ADDRESS (/nclude Facilip~,vame/Location i/D~gere~q NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. _
<br />NAME S£ 6 EC A CG A L C C C
<br />E A !• Y DiscHn6/GE MONITORING REPORT (DMF;9! F
<br />I W G H OMB No. 2040-0004
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<br />ADDRESSD £ d H E R D , , D I;
<br />C O O C D( 11 .
<br />SUe Approval expires OS-31-98
<br />NAYDSM CO 41639 •#
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<br /> (3 Cab OnH) QUANTITY OR LOADING ~'; : K~ (4 Certl OnH) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46-53) (sa-st) ">)~~ (38-45J (46-53) (5061) EX OF NPE
<br />(37-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />69-70
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERS ONALLY EMAMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY
<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
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<br /> POSSIBILm/ OF FINE AND IMPRISONMENT. SEE 1B U.S C § 1001 AND 33 U.B.C. SIGNATURE OF P INCIPAL EXECUTIVE .l CJ
<br />TYPED OR PRINTED manmum~pnsonme~ol fblwse Bmonms an05u~rsnries up ro Ef0.000 entl or ~}.E OFFICER OR f1UTHORIZED AGENT ODE NUMBER YEAR MO DAV
<br />GOMMEN i5 AND EXPLANATION OF ANY VIOLA I IUNS (Hererence all attachments Here)
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<br />EPA Form 332o-1 (OB-95) Previous editions may not be used~ (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) ~ .PAGE OF
<br />0012,1f 49 0 Es ~-165 3 1
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