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PERMITTEE NAME/ADDRESS (Include facilrry Nmne2ocanon ifDi$erenr) <br />NAME ;C }'P<il~ crnrq~: Cflrn~pnpry,, <br />ADDRES3r? !, ; L~ • T ,. ~ c ~ ;~ P L sT <br />~ ~ Pln. Ply S° <br />cane; -n 91f,t5 <br />FACwrY <br />LOCATION <br />zT'Tfi: e.~;~:nF:r''. V9JI'1e Y•:~• <br />NATIONAL PoLLUTANT DISCHARGE ELIMINATION SYSTEM (NfDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />(1ae1 fn- Bl <br />-~n^ r 3 t'f 4 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM .. , TO <br />(Y421J _ (t1-13) 2aP51 R&Z]) R&T9) (3031) <br />Form Approved. <br />OMB No. 2040-0004 <br />- ~ ~ ~ Approval expires 0&31-98 <br />! _ .. e1 „ , <br />• S "1_914 T7 4TT. .T q°~r7^v <br />NOTE: Read Instructions beta co leting this form. <br /> (3 Card Onty) QUANTITY OR LOAD (4 Card Onty) QUANTITY OR CONCENTRATION NO. FREOUEN SAMPLE <br />PARAMETER (48-53 (54-6 r) ~ 36<5) (4653) 54-61) EX OF TYPE <br />(32J]) AVERAGE MAXIMUM S MINIMUM AVERAGE MAXIMUM UNITS <br />(eza3) ANALYSIS <br />64-6B) <br />69-70 <br />;OLiDS~ T.J.. T SAMPLE ..:R:r . ,-. ^r. t?rh ( 71 <br />(+ L `i 5.7 L 7 r, % MEASUREMENT <br />/O?15 1 ) ;1 PERMIT a .!~trs4R ~ ar `°Rt'~-4lR" Q _.. <br />Q •~ <br />~ TREY ,R~~-~ <br />E>'F! <br />t)T ;RJ <br />UF <br />^,S Ynl <br />7 REQUIREMENT ~ 8*..'=k - --R .~~, . <br />~( RTC GY' , <br />-`t~~ <br />R *"''~ . <br />, <br />. <br />, <br />. „ _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ... ~ =r <br />~ ti*~'~s4 : i ~ r~. - - <br /> REQUIREM~NT ~ <br />° <br /> ,. <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ :4p ~ ~;~ a, ~:;_~<; <br />~ , <br /> REQUIREMENT. <br />s ~ ~' ~''^ <br />-' <br />s., <br /> SAMPLE <br /> MEASUREMENT <br /> M ' _ ~'~~ ~~ <br />'~ ~ ~4 <br /> ENT <br />REQUIRE •td~ 6" <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT. ' ,"~',"° <br /> <br />- G . <br /> <br />`~~ <br />~ ~` „ ... <br />e ;,'s <br /> <br />~ - :~ <br /> <br />~`~~ <br /> <br />- <br /> REQUIREMENT ; <br />- <br />r ' %= ' tii,7 ':e.. <br /> SAMPLE <br /> MEASUREMENT - <br /> PERMIT ~ ~~ -~;- `~'~~) <br /> <br />REQUIREMENT <br />~~- ' . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT `' ' ` - - ~ - <br />' <br /> REQUIREMENT ,4`, rxr - - - - <br />NAME/TITLE PRINCIPAL E%ECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EIfAMINED AND <br />MITT <br />H <br />D ON MY TELEPHONE DATE <br /> <br />RlchaTC1 t <br />1i115 AM FAMILIAR WITH THE INFORM <br />INQUIRY OF THOSE INDNIDUAL <br />THE MFORTAATION <br />I BELIEV EREIN; AND BASE <br />ATION SUB <br />ED <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SDBMRTED INFORMATION IS TRUE ~ ~ - ~~ n <br />~ <br />. , <br />ACCURATE AND COMPLETE. , <br />I AM AWARE THAT THERE ARE SIGNIFICANT <br />E <br />G THE ~ ~~~ rr ~" <br />~ <br />970-870-27i <br />I ~ !~ <br />~ <br />~~ <br />FhvironmPntal ManaT~er PENALTIES FOR SUBMITTIN INFORMATION, INCLUDIN <br />G FALS ~ ~ <br /> POSSIBILITY OF FINE AND IMPRI SONMENT. SEE 16 U.S.C. 4 1001 AND 33 U.S.C. _ <br />SIGNATURE OF PRINCIPAL IXECUTNE <br /> <br />TYPED OR PRINTED 4 131 B. (Penercies urger niece s <br />medmumlmpnsonmem of beMee renrtes may brcluee Orret up ro s10,a00 end or <br />nBmonfhv ends yevs.) OFFICER OR AUTHORQED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence ell attachments here) <br />?.'.L"LP..1H[.! ;7LT.;,. T r,rir dAi'I='n cr'P >LDTc,27~+R o?FI'TP c7-:nrT_-c.. ~'~7. ^,. r,rr r•'i:, r.,TTore~gTq ^Tt. ~. <br />Jri cI1~E G !^ SAHC(' A^~L Y~IS ki!'~';roc~ T" pY~i~rLr r•Ysr•r~ i~ .1^q cury r•^~ ..nm-irv ~e air T.~r rr)c~otr('TTr) .~ <br />Form 3320-7 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) O n ~ e .t ~ q a ~ U~ 2_ 1 5 2 ] PAGE ) OF <br />