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PERMITTEE NAME/ADDRESS (l+drdv imWry Nra/fccurm dDrObunl <br />NAME TERR'Jt: ~;,•;e.b ~~M?9Y <br />ADDRESS TBRROR CRcL'K L7ADJOT <br />2840 NI.:H~AY 133. <br />r PAONIA ~~ 91723 <br />FACILITY <br />LOCATION <br />ATTA: KIrLLY PkLtZLFH, lPi:kAt1JN5 1,H <br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM lNPDES/ <br />DISCHARGE MONITORING REPORT /DMRI <br />11-I51 17-I91 <br />"D;;95nU~U <br />v PERMIT NUMBER DIBCHMGE NUMBEN <br />~. MONITORING PERI~ID ~~_ <br />YEAR MO DAY YEA MO I~-"DA~V'~f <br />FROM TO <br />/142Y7:~1?1-131 /7~-151 !16171 /1B-19/ !3637/ <br />~EGI P:JHD al '."U <br />(SUZh YC) <br />F - F;irAL <br />MINOR <br />Form Approved. <br />Approval axpl~~0 31-98 <br />"-` i70 GISC'1ARG& ~YY~ '~~~ <br />~~ NOTE: Reed instructions before eompletinp thb form. <br />PARAMETER !3 Grd Onlyl QUANTITY OR LO (s Gi nlYl ~ QUANTRY OR CONCENTRATION NO. FAEOUENCY SAMPLE <br /> <br />131 <br />371 146531 15d-51I <br />~ ~ 38.151 !<6531 I546I1 <br />EX OF <br />VSIS <br />TYPE <br />- AVERAGE MAXIMUM ~ j5 ~ MINIMUM- AVERAGE MAXIMUM UNITS rs1•sal MAL <br />. !5I-Bgl !5&701 <br />D ~ri A3E SAMPLE ~`~~`:=`.~ ,-.r##3 ##A #F r+,:sC .~ <br />; $ U A L MEASUREMENT <br />' <br />UD66 1 U 0 PERMIT a <br />rYr Y.. >k <br />::Ri. Y <br />ES=L <br /> <br />;: <br />~.~~~. <br /> <br />; <br />#iEIFR t <br />i:~#M <br />#a-: <br />EF.LY <br />ISU:~.. <br />PFLUEMT ~R75i YAL02 REQUIREMENT <br />hkR <br />NC=O <br />~aav <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT ~ ~ ....~...::,;.: <br />.w+...., :,: ...: ~. <br /> <br />~ <br /> REQUIREMENT ~.;'x`..... ~ . ~..r :. ~.'.1 >~~~ <br />~ <br /> SAMPLE <br /> MEASUREMENT <br /> ~. PERMIT <br /> ~REQUIREMENT~ - ~ ~ .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ., ~ . ~ ~ . <br /> `REQUIREMENT <br />,. <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT <br /> :REQUIRENENT• <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT <br /> :REQUIREMENT .~ ~ _ • <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT' ~. ~ ~ ~ ~ ~ ~ .. <br /> ~:REQUIREMENT~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 cERn <br />AM FA FV UNDER PFNUn of <br />IM WITN THE INFO <br />MI Iww TNAT I NAVE PERSO <br />RMATION SUBMITTED N NALLY EXAMINED MD <br />FAEIN <br />MD BASED ON TELEPHONE DATE <br /> ; <br />L <br />MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />~ <br /> OBTNNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS <br />TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME vj <br />~l <br />! _ <br />// <br /> SiGNIRCMT PENALTIES FOR SUBMITTING FAISE INFORMATION <br />INCLUDING 7 <br /> , ~ n O 9 DD r ~ Z <br />K Y FR I T71 p THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE tB U.S.C. 1 1001 MD J3 ~ - <br /> U,S.C. 1 t ]10. I/Vrlai. urisu dlr., mNnrr nIry YcN.d~ ~ • rp ro i I0,000 BIONATURE OF 1 CWAL EXECUTIVE <br />TYPED OR PRINTED rndnnrrimrn inpla++trrr ordllwN/lsmmdrrWey..rAl OFFlCER OR llTHOIIRED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Rs{rrenes s/l sftschments hers! <br />SdTTLEA9LE SOLIDS LIhIf A?E'LIt:S JNLf IF <= LO-Y't, 24-HR ?RE::LYe;Y~Si iS CL~T7'1,;J. IP CLAIl7 APPROVED 5Y <br />ffQCD, TSS b IkJ+! LL!IIt3 DILL NOT ri3 APPLIcD fJ 8£POfi'tED 'EASU&i15iiN1S--S 8 I.!+.lA, PG S AND I.B.lU, V; ,. <br />CT(]R NYATRG MA NI'CV pBT 0( l!1 (111p 1 1 ] R <br />EPA Fwm 3320.1 108-951 Previous editions may be used. <br /> <br />- - - - - - - - -- - - - - (REPLACES EPA FORM T30 WHICH MAY NOT BE USED.1 <br /> <br />--- - - - - - -- - - - - ~- - -~ <br />0120/970814-1_ <br />.~.-.._ ._ __ - .>~~ PAGE 2 OF <br /> <br />_ - e _ <br />