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PERMITTEE NAME/ADDRESS Qnc/ude FanGry Name/Locadon i/Digercnq <br />NAME C.(P.(~)' ;;~DjgF' (. f`.:,1l;~prl0': <br />ADDRESSEACLt: 'eI'IF ~0•PLox <br />FACWTY <br />LOCATION <br />A^f:. A•; "r 0e7 V\,1D#~ Y.P. <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM MPDES) FOrtn Approved. <br />DISCHARGE MONITORING REPORT (OMR; OMB No. 2040-0004 <br />Approval expires OS-31-98 <br />U~ f1T iR~ tiV) <br />~ ~° <br />P MI NUMBER OISCHARGE NUMBEN .. - .. ~ . T r ~ ~ a . <br />~~ Y~ <br />I -~~ Yr]AIITl101N0aFalTTD ^..P~~~„' ""'T °v""i"r +,T not <br />1 CHh1 MV UHT iCHT1 MV UHT <br />FROM ~ 7 TO 'T^. n~ ~^, -•,, .. ., ^.. .-rnpc,-o ~ ~~ r: r: r. <br />rzo-zrl Rz-z31 rze•zsl rzazn 2a-zel (soar) `NOTE: Read Inshuctions bolo o plleting this form. <br /> (3 Card Ony) QUANTITY OR LOADING <br />~ (a CeN Ony) QUANTITY OR CONCENTRATION NO. FREOUEN SAMPLE <br />PARAMETER ass3) s4-eT 3a-a5) alis3) 54-51) EX of TYPE <br />(32-37) <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNffS <br /> <br />(sz~+) ANALYSIS <br /> <br />(54-58) <br /> <br />69-70 <br />'EE'fLC~ Sj'ATK" 1."p° SAMPLE 4Kr=~C?4 rt:-p',:~ -+••±••.•a•- - / >~t <br />H a C °: '.', ~ J ~ A P H N I A MEASUREMENT <br /> <br />PCF'1t1 '~ '1 ~ .a <br />`pERM1T :IIt 41a GPQ1. ~2• `., <br />- ~ Rlikk I kRIdtR7Cr` - '!'R1 <br />~' (11S¢~ <br /> <br />.hL COhi t, !:T" PFL'1. , <br />QUIREMENT <br />.r,, <br />.~`~S- _ <br />r(~ ~ <br />~.r~ <br />,~.~ - <br />~ <br />r< .. - , <br />. <br />.`EFFvCT ~°7 raa 7DVY SAMPLE ~ ;:rrrY6ft 44xCr: ~ w..«,...t .. ~ -- T <br />% t) <br />C H r. p I M ~-'' • ' ~. ~ MEASUREMENT <br />rc^6C <br />- EBM11`'; <br />~ '#Q4 ET .~ <br />" . . '~~.r5 ~ ~ Qt1t1~~6ri rn_ : 7«}1Lr` ..~~~~; <br />`iF <br />•. C0t?N ~'!i*i -1~ 1n EM .. (1't:-x~, Mfl 1#[, (A R'- . <br />"' - rc~. 3 <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> ~AEQUIREMEN +.,;~ ,.-,:,,~= - - ~ - - ' <br /> SAMPLE <br /> MEASUREMENT <br /> RMIT' r ~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ~ "" ~.. <br />f ~ - <br /> REQUIREMENT " ~ <br />} <br />~ - - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - .t .~., <br />r <br />- _ .:~' - - - <br /> REQUIREMENT ~ <br />° ,~. .F <br />- - - <br />- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />- <br /> ~REOUIREMENT f~ ~, ~_ r ~ <br />NAME)TITLE PRINCIPAL E%ECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAq WfTH THE INFORM LAW THAT 1 HAVE PERSO <br />ATON SUBMITTED HERE NALLY E7(AMINED AND <br />IN <br />AND fl45ED ON MY <br />~ •: TELEPHONE DATE <br /> <br />INQUIRY OF THOSE INDNIDUAL <br />THE INFORMATION, I BELIEV ; <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION IS TRUE, ' <br />- ~ ~~ <br />~ ~ <br />/ <br /> <br />P,iChard MIIIS <br />ACCURATE AND COMPLETE <br />I AM AWARE THAT THERE APE SIGNIFICANT <br />/~ ~ <br />' <br />9 _ <br />~ <br /> . <br />P <br />TIES <br />SE <br />ORMAT <br />IN <br />NG TH ' <br />~~., <br />, ~ ~ ~ ~ <br /> <br />Ff1V)Y011 f'1F`r9 tal ~tijJ fT0f3rt' ENAL <br />FOR SUBMIRING FAL <br />INF <br />ION, <br />CLUDI <br />E <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE I9 U.S.C.41001 AND 33 U.S.C. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />970-870-2712 ~ <br /> <br />TYPED OR PRINTED 4 1318. (Panetties undr torus statutes mey include Vines up b Sf0,P00 entl d <br />mvimum im <br />dsanmentdbefween8monrhs entl5 <br />eerl) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> p <br />y D <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />.i C3 r.N.9 .")N 'l r'Te r!. ..: (>9 .,r 1aw~tALrr[ Oae.TY\'"rn N< A4 r°<vr~._,...r, .-orfgTa/9 e".91n r1r__'T-,y \c- rn•OYTCf-,r°. p?" <br />LO'aEST . f:F ~'i.7'"'° P.T' ^L~I' ;T%." qT':'+r° i1TP? lE T4~vs; rc;*• r .•~n.,~7r ;7e~ .. •.-r .pan .I<Tor; n•^<;T (-(,nc tar •(~Tr <br />r <br />~.C Tr• Nrr {:w <br />EPA korm 332o-1 (OB-95) ^Previous editions may not be used. - ~ ~ ~ ~ ~ (REPLACES SPA FORM T-40 RICH AI~AY NOT BE USED.)^ Q ~ ~ T 1 ~ q T ~ R 1. ~~ 1 ~ 7 3" GE OF <br />