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FERMITTEE NAME/ADDRESS lI+eUb FrYiryNaW(srylon IJDyirlJ NATOMAL POLLUTMT DISCNMGE El1MINATON SYSTEM //NPDESI Form Approved. NAME G ri A Y li Y ; I L.. .Y^uAL C,)tiE.it;Y DISCHARGE MONITORING REPORT /OMB/ re ~" " ;''UTr frT4 ~ 04 TT9C~ i'IP• ~'a1~ T''P ADDRESS h C Y G P N C A N Y ;) N !r T fJ ,, la- .t r7-rs . . ~,~~~ ~C~ ~ Approve G,OS-31-99 ~~~ I P.O. RnX 7U PERMIT NUMBER OISCHMGFNUMBER f' - FINAL rnxa ~~ ~i.,w-vvfv FACILITY ,;gAdO ~YAL.I."Y CnA!. CONPAhT MON nLNVn IT I GPERIOD ' LOCATION YEAR 0 DA ~"t YEAR MO DAY _ FROM ~ ^ TO .. O DISCM/ itt' `' ~•'r ~' A T T Y C J O i d M . ',. D, L'r F; 9 S , '! A ; A , F: H 1x01 Fl /22-131 / la6a71 lab-asl 13631) ~ ~' ~ Bud Inetruetlarr bef w NeMy this form. PARAMETER l3 Grd Only) QUANTITY OR LOADING Gro Only) QUANTITY OR' TION ND. FREOVENCY SAMPLE I3a-371 l~6531 15481 (38.(51 It65 !5467 of TYPE EX AVERAGE MAXIMUM MALrss MINIMUM AVERAGE MAXIMUM UNITS ((2.6]1 (5/-681 159-701 LC`.>1) 2iTA'1'i![ V~'i 'I SAMPLE .: C':G`= ^:74;R4 ~: .:::II3 ( 2 3 ) Ct::'1UD.4P!itiTA MEASUREMENT (J ~SC ^ ~ /`1 TA't IF3 0 U PERMIT :F.:t i` .~+x~ ~ >xLfYuR . ~ R .'C- I 1E~+~:='6iY ~G?/Fi(t+91~i'' R- .. Z it GY f. i? A? c ~ tFFLU.:N f GNOS_ 'l E L!i. REQUIREMENT :~ ~. .:.~` •.•'. ^`a>G .:7)K:. ' i:.w -. f, .R LCJII S'I'1TdE 46h1: i:CI SAMPLE :•:!}•r•..^. :`:T:OC4' ?:^nrv:: ~~O>~IR ( : 3) P I '". `: ? N A L P. $ MEASUREMENT p" TAIVt-C 1 0 U ~ ..PERMIT '~=.~a~.a ~=~;•zrr+ll ~ a;:x~ .~ ~ ;:.. ~ ,x AfiiT~~.',:<~ ~a.~F:alj[..:;:ii:`~' ~ FI+- ~~T~R~L.Y fiAAH t:FfLUEAf GROSS YAL'1 :REQUIREMENT r64:'.:~ ~ :. a. ~:a~ ,..~ .. : ~'~~ ~ ~~ CoR,P ... . SAMPLE MEASUREMENT PERMIT ~ ~ ~ ~ ~ ... ;~?. ~ ~ 'REQUIREMENT: ~ ~ ~:;~:; ~..:~ ~.~ '..~:.. %~:' .. SAMPLE MEASUREMENT ~ ~~ PERMIT ~~ .. ,:... ~~~ . .., .. .... REQUIREMENT ~ SAMPLE MEASUREMENT .:: PERMIT ~: ~ ~ .:: ~ a~.'.'..: . ~~~ ..: : .: ~ .. HLQI~IREMENT ~. .: ... ~ ~. ~.: y.:.:.. ;. ... . SAMPLE MEASUREMENT PERMIT ~ . ~ ~~~~ ..;•~ ~ ~ ~ ::REQUIREMENTT ~ ~ ~~~- ~ ~ ~ SAMPLE MEASUREMENT i,•., ;~EQUiREMENt. :.. ::.. .. ,.,. NAMElTITLE PRINCIPAL EXECUTNE OFFICEA I CERTIFY I1NDE11 PENN-TY Of LAW THAT 1 HAVE PERSONN.LY E%AMIN ALI fAMILIM WITH THE INFORMATION S BM TT R ED MD TELEPHONE DATE JC1HM M WAL~TEHS' I EIN; MD BA V ED HE MY INOVIRY OF THOSE INDIVIDUAL$ IMMEDIATELY RESPONSIB SED OM LE FOR OBTNNING THE INFORMATION, 1 OEV EVE THE SUBMITTED INFORMA TON IS MAfJAC3ER OF MINT SERVICES TRUE, ACCURATE MO COMPLETE. 1 AM AWME THAT THE RE ME ~ 970 858 - 3808 98 01 D6 SIGNIRCMT PENALTIES FOR $UBMITTINO FKSE INFORMATION INC LUDING , THE POSSIBIl1TY OF qNE MD IMPRISONMENT. SEE to U.$.C. 1 1001 MD ]] . eIONATURE Of f iM O.s.c. E t]te. rA,nve..l.wr rMr wAA., nrr icEd, A+. w ro t/oaao R YCNAI EXECUTIVE TYPED OR PRINTED rgnmr:rwn Ntevlarrwnr,I bnrrnemmtll, rW6yv,l OFFICER OR AUfHORQED ADEMT CODE NUMBER YEAR MO DAV wnnv~..w r„.v ~~, ~~,. u Inoroti. si ~uscnnrn.a noq ~~: L.A.', nD ;1-7, F7" U4 PAiL5 CF T°.ST P°.!)C~~1!n":;. f;'[(CyAL 'f~1 ~., :1!( .. 'I•c •:T ^,o .4' T•; (!?~ ABJ ATT if ~i 1;'n'e~ i may (REPLACES ;.r~,1F ~- )..-~I I' - ;'f Am T~,'^jCFL D(:r,l~ F.~1.I, .1rr v1:ICl; I'~~ ','rIATC:...f ~ -,. ~i". h'~l•c". q~ (,YF. C-).^Tu~ (ir ALL J0305/yG1217-1295