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<br />PERMITTEE NAME)ADDRESSpncl.de FU(IliyJrpyeryocciian iJD(Q'erenq
<br />NAME
<br />ADDRES TRAFFEN RIYIIiG, 1MC.
<br />STHAFFk;B l!INF
<br />F.O. BOX 1H7
<br />FACILITY CRAZG CO e1626
<br />LOCATION
<br />n'I;N: Y. GOAGCA Ek.'Ieb`_. PHFS/CFA FGR
<br />+1 T
<br />-
<br />{~gN~'p
<br />q G ~y
<br />H
<br />~~~QISCHAfR GE MIONIYORING REPORT (DMA,~BI(NPDES}
<br />PE MI^ BER DISCHARGE NUMBER
<br /> MONITORING PERIOD
<br /> YEAR MO DAY ~ YEAR MO DAY
<br />FROM 0 C TO GC G' "
<br />(2P21J (22-231 f2~-25J 126.211 (2B-29f (30~3Q
<br />pINGA
<br />(SUER B4)
<br />F - EIAAL
<br />Fotm Approved.
<br />OMB No. 2040-0004
<br />Approval expires OS-31-98
<br />CC FAT
<br />FCYC TC CEEB CUICF
<br />~~~ AC CIECtiIEGF (( ~~~
<br />NOTE: Read Instructions betor plating this forma
<br /> (3 Carci On/y) QUANTITY OR LOADING (4 Cerd Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46-53) (54-61) (3a-45) (46.53) (54-6IJ EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />(62-eol ANALrsls
<br />(54-68)
<br />69-70)
<br />i•' is SAMPLE a a C: # # a e r # a a +C r r # # r 7 li)
<br /> MEASUREMENT
<br />(„-.IUO 1 0 G ~ P8R tF " ?t~IF#~#,~
<br />~ ~ ~
<br />-F' 4sa rat jar -
<br />';~ +~ ,r E]i#.!~ %~~.Ii-
<br />~FLDEyT G 0 ~ v LUE H~oAIR t>ki" ~ '
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<br />~I1s `:ti°~ aaa~i ~
<br />~' ~,. ,
<br />`~ ~ ~ ,:
<br />':;,IDS, TUTAL SAMPLE cma+## 410i>a4pp ##aoa,s ( ]y)
<br />":) P E Y D E D MEASUREMENT
<br /> '+ ~
<br />_:r'FLUENT GROSS YA J) °" ,.: ,.:'
<br />~-, ;
<br />-:~:~ ~ ~ ~~ .:,~ ~ i~ I G I a ,., ~- ~~..`,
<br />i:LIDS, SETTLEAc,LC? SAMPLE #r###, t~k a#r# ~ ( ~~)
<br /> MEASUREMENT h~'
<br />L/
<br />„~ ;uS 1 0 U `i.,
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<br />~ ~i~>r]1MII'>;' I° ~e`~1~~3 -Cfi/;', ~t,
<br />FFLUENT GRO55 YALU 6~
<br />~ `~-,
<br />Ts~ r sexu -, F
<br />I1GN, TOTAL SAMPLE #~#'~'#101 :rrr#T a0elee~ ( 15)
<br />(AS FE) MEASUREMENT ';~
<br />oLOas 1 o c (l~a~~ r~ ~ a~
<br />~ ~ t
<br />1i rs# ~>¢oo~r+a.~.
<br />Y 3,~ ~ .A rc>:/
<br />
<br />Fk'LUENT i;R055 YtLUF ~
<br />191~41alR . EN# ~v,}^
<br />tec# ;s
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<br />'IL AND GkiEASE SAMPLE ###### Oy0#1:# arrr#0 raa#>Gr 715) ",
<br /> MEASUREMENT
<br />I, JSk12 1 0 G _'~ iSERMIT=' . -:IF494r?1D "#AE+~,,- e+c# ws >a~T f~
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<br />iFFLUEnI UhU:;S VALCF '-~~UIREM~ saax~ '~ ~ ~ ~, (- k,' a
<br />. lG , E ,:~'',~~
<br />'LGw, . ~ Cll~i;LIT CA SAMPLE (. O3) 00;#re er.#010 #e00>sr
<br />F.6'. t ~ [ r. i I'. G.'+ i P L A A'I MEASUREMENT
<br />SUU51~ 1 U C PERMIT. ~ $$&4A~ .. ~~lC~6
<br />* dF ?00 "# 1F4+~*~,-r ,~~.t ara ~ EkII X51;71
<br />
<br />~FF'L'JE'~~ '~6C:i= YAlCE
<br />'REQUIRH141ENT
<br />3 AY6'
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<br />lGD
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<br />,x ,
<br />~i'LIDS, 1'C2AL SAMPLE ~cu:~.s# ~~~'°~# ~~~#00 ( 15)
<br />1' I S :~ G L V t G MEASUREMENT
<br />/oz55 I u u F',y hT v+o4>~~~, #Mtr~+k~. era ~a'~} 'rt~~. '~3~iC'~4~~-.:: i:&~~~t'i~-:> itil - 'ab~.8~
<br />:- [ r L L• ;, .•. ? % k: C 5 ` Y A I U t . RE0.F1N7 ~011~NT 'r!. e e # # ~ ~ . : ~' ! C
<br />~
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY EXAMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORM ATION SUBMITTED HERE IN; AND BASED ON MY
<br /> INQUIRY OF THOSE INDIVIDI~AIS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATON
<br />I BEL EVE THE SUBMITTED MFDRMATIQN I$ TR
<br />E
<br />
<br />
<br />
<br />. Gordon Peters
<br />,
<br />;
<br />U
<br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE ~~
<br />
<br />
<br />70-824-4401
<br />
<br />
<br />G
<br />
<br />
<br />4
<br />
<br />
<br />7
<br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1e U.S.C. § 1001 AND 33 U.S.C.
<br />§ 1318
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<br />maximum impnsonmem of baMeensmonths end 5years.) OFFICER OR AUTHORIZED AGENT
<br />AR
<br />NUMBER
<br />YEAR
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all aMachments here)
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<br />:ss TCTIIL IBCh LIkI15 WILL bE 4AIVEU, AAC SFTTIFlRLt. SGIICS LICI1 AFFIIEL' FCfi <=1CYF,i4tF FFFCIF EYEAT-
<br />.,cE 6URDF.~N OF FROGF 6EGUIRNNENTS UNDER I.A.?. TC~ RCNITCBIAG - I.E.?. CII 6 GBEA~E - OFF I.E.1.IC).
<br />~)1 o m 3 0.1 (- Previous a itloris may noI ~e used. R IC (=USED.) G C C 7 G/ C G C 1 1] -1 i i 4 PAGE I OF
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