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PERMITTEE NAME/ADDRESS pndude Facdm Name/Cnrunnn ~Di$rrcnn
<br />NAME =GLDR7^. CnAL COrPA!:Y, :,,:~,
<br />ADDRESSCO LC` N Y C N I v F.
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<br />FACILITY ~~ c P n C G /.'" 1 h U L
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES)
<br />DISCHARGE MONITORING REPORT (DMR;9j
<br />r: nnu~1A nna a
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM UV V! U1 TO OU U? .30
<br />1202n. (22-23) (2a~25) ~ (26-271 (26291 (JO.31J
<br />Form Approved.
<br />n I 4 U F: OMB No. 2040-0004
<br />Approval expires OS-31-98
<br />P - FISAL ):OS'A'
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<br />NOTE: Read Instructions before completing this form.
<br /> (3 Cam Only) QUANTITY OR LOADING '(
<br />T:Cerd Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46-53J (54-61J -
<br />~°' (3845) (46-53) (5461) EX OF TYPE
<br />(3237) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />r62tt, ANALYS/S
<br />(64 s8)
<br />s9-70)
<br />.' SAMPLE ..: cr r,;npr: rJ?L+:rO t: Kx f: +j+:c=:: ( I?~
<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINFA AND
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<br />'' TELEPHONE DATE
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<br />ACCURATE AND COMPLETE. I AM AWARE THAT THEgE ARE SIGNIFICANT
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<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.G. § 1001 AND 33 LLS G
<br />SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re7erence all attachments here)
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<br />may not be used. ~ -(REPLACES EPA FORh1~'T=40 WHICH MAY NOT BE USED.) ~ ~ y ~ ~ v ~ PAGE OF
<br />00031/OOOUO 007 1
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