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PERMI rTEFtiNAMFJAUDPESS /lnrluer <br />/hobo ,vamenLaronnn qeV/nrnp <br />NAME -:LG 1.1, GA ST LE S Q-a ~! F~ 1S11iA S.S~ ~ ~ - - <br />ADDRESS [~ 11~NL$~"&~~-L B.~$T i.NGL C.bSr~.USJSLI,- - <br />---'.LI`'LLE$S~IZd.Bll.gEE~THEET __-- <br />FACILITY _ <br />LOCATION--_- - - _- --_ _-- --_-- _-_- -_ <br />i'.!:: i;,V1D J. dACDOUGALL ES <br />NATIONAL POLLUTANT DISCHPRGE ELIMINATION SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT lDMR1 <br />(I-161 ll7-/fl/ <br />COG&50 23 <br />PERMIT NUMBER -DISCHARGE NUMBER <br />~; ' MONITORING PERIOD <br />- -- ~ YEAR MO DAY' ~ YEAR MO DAY <br />FROM TO <br />- 116711 /77-731 /71-751.' ~~' "(16-17/ (78-19/ (J4J!) <br />F - FINAL <br />PIT 13 DSCHHG 40 GRASSY CnEE(S <br />MINOR (SUBH NN) ROUTT <br />NOTE: Read Instructions before completing this IDrm. <br /> /J Card Only) ~ OUANIITY OR LOADING •~ - <br />'~' <br />-" I NCard Only/:. pUALITY OR CONCENTRATION <br />.a <br />NO. 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L L JI ~iD i;REASE ' - SAMPLE ' '~###### l' .7~ -r :' ^' ~ ~ ~###### <br />l rc ###+~#~ ~'.#~### L <br /> <br />Y I :: U d L MEASUREMENT' ~ <br />r ~ r ~ <br />:~ p <br />,~ ~e <br />'l <br />- n <br />, ~ ' <br />Cll. t]/] 1 O O , PERMR •r <br />~ <br />7 <br />' ~>ifT#~'~ <br />' <br />' <br />V q <br />~y ti• t"... <br />'r~ E$=1~ <br />' .~.~yq <br />~.„T T,~rr~~ <br />~ Qj~r ~~~:., t #~~~ ~# f ##A ~ ~~E~, ISDAL <br />- ~ <br /> <br />• ; <br />REOUIREMEN ~ <br />3p <br />' r ~ ~ - <br />~' - <br />r 1\ D <br />6. .+ 'ti 3 HAR17C: 7' # [ <br />NAME/TI7LE PRINCIPAL EXECUTIVE OFFICER I CERTIFY'UNDER PENALTY.OF VIW :THAT I !IAVE P <br />AND AM FAMILIAR WITH THE INFORMATION S"BMITT ERSZINALLY E <br />ED HEREIN <br />A IUMINED <br />ND BASED <br />- TELEPHONE GATE <br />- <br />Karla Rabuck ,. ON MY INQUIRY OF THOSE INDIWDUALS IMr.•FDIAT <br />OBTAININO'THE INFORMATION. ('BELIEVE THE SUB ; <br />ELY•RESPONS <br />MITTED INFD ISLE.FOR <br />PMATI <br />'- <br />Vi <br />P <br />id <br />t I$ TRUE. ACCURATE'AND COMPLETE.' I AM AWARE THAT THERE =ARE 51 <br />- <br />ce <br />res <br />en <br />- NIFICANT PENALTIES FOR'SUBMTRINO'FALSE'INPORMATION, INCLUDING <br />~-THE POSSIBILITY OF-FINE AND IIAPI(ISONMENT. SEE IB U.S.O~t~1001. AND ' <br />33 U <br />I <br />1318 <br />P <br />/ <br />Ih <br />G <br />S <br />C <br />d <br />hW <br />U <br />F <br />P <br />' IGNATUREOF RINCIPAL EXECUTIVE <br />698 754-2291 <br />~92 0~ 30 <br /> <br />TYPED OR PRINTED ~ t <br />er~emrvru may <br />r <br />. <br />. <br />. <br />. l <br />rna <br />lia an <br />n: <br />UO <br />/a,Q <br />, <br />e lP^V:a <br />rneor marimvm lmprvonmrnraJ4r.em 6inonrhroM Jxan.J ~ ~ <br />OFFICER OR AUTHORIZED AGENT <br />.NOMeER <br />YEAR MO OAY <br />COMMENT AND EXPLANATION OF ANY,VIOLATIONS/Rrlrnrnce a/larlachmrntr hoe/ ~ ' <br />1_It. t. U;iEASE: SEE FGOTtiOTE F/r FAGS 3 OF TtlE FENgIT. FOACIEHLY UISCflARGED UNDER CO-0035653. <br />EPAFOrIRD32D-I(RDV.g~eeJPTBYIDUSBdlttonSmeytJBUSed. (REPUCESEPAFORMTJOWNICNMAYNOTBEUSED) OOG12/910123-1657 PAGE 1 OF <br />