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PERMITTEE NAME/ADDRESS (lnrlude FaciGn NamelLncatlon ifD~erenp <br />NAME <br />r,T i.l1.{;) C'?AL. CCtiii i. `tY, L. F'. <br />ADDRESS i L'7 : Y n ~ L t1 ,•. <br />5731 S.dTr HIGRwAY 1.'. <br />FACILITY P°.. ^,'! r. ~~^ rlih4l <br />LOCATION <br />:'iC .7. 'In5^'C'N GF':"521. MFGIC F.N <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) Form Approved. <br />DISCHARGE MONITORING REPORT (OMR; OMB No. 2040-0004 <br />(216) (rn 9) 'T `. '1? Approval expires 0531-98 <br />rrn-Tn cT -1 .-' nr- ~j;~,.; c, tYy) <br />PERMIT NUMBER DISCHARGE NUMBER F _ £I ~ } I C o F A •• <br />MONITORING PERIOD STQKER Cr,AL LOA^Otli/TAYL.I T Ch <br />YEAR MO DAY YEAR MO DAY <br />FROM QQ 07.42 TO 04 09 30 4>71p MGJ CI~Ct!F.RG` (~[~ `~''': <br />RO~zriliirtzz~zsl -tzassl tzs~z:) (zs-zo> hoar) NOTE: Read Inslruc[ions befor o pleting this form. <br /> (3 Card Ony) QUANTITY OR LOADIN (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREQUENC SAMPLE <br />PARAMETER (46.53) (6a-61) ~ (3B-46) (46-53) {{~61) EX OF TYPE <br />(32-371 AVERAGE MAXIMUM NITS MINIMUM AVERAGE MAXIMUM UNITS <br />(62691 ANALYSIS <br />(6468) <br />6970) <br />.'.TL hwL !~r.'LP..E SAMPLE ::::Cn•3a ( ')LL} RY+6G'xrn tr:hA~~-:. .. :: ti,k -k!, <br />* ~:.~ p• ?, MEASUREMENT <br />•'~I I)6t 1 U G PERMIT P4>fi lb!QR '• ~ REPO P.T FS=1 ` , ~ >d~~C~a #A#o~rs 4 ~>01~1 ` 1 E2}(L7 IISLIF? <br />r^•:I.• ,; <br />r~...,T ~n•T`5 V~LI REQUIREMENT a-. ~ <br />' a <br />"'I!+ST AY. .~r`.• <br />.~_~ <br />_ - ~ MIA',kF <br /> SAMPLE ~ <br />~'Y <br /> MEASUREMENT ~;5 i:~ <br />~ <br /> PERMIT K3 ti*. <br />a <br />r ~~ - `~ <br />,ti` " <br /> REQUIREMENT ~~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT "" <br /> REQUIREMENT _ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a` <br />xc <br /> REQUIREMENT ~ _ <br />~.. ~ . <br />"°~-~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT ?s' <br />,"~~'' - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '_'~' <br />}• <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r r a-' <br />a <br /> REQUIREMENT ~. ., <br />y. ,y> ~. <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY EXAMINED AND .; TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN <br />AND BASED ON MV '/ <br /> , 1 <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br />X <br />~ <br />' <br />2 <br />W1J <br /> <br />ACCURATE AND COMPLETE <br />I AM AWARE THAT THERE ARE SIGNIFICANT ; <br />~, <br />~ <br />, <br />„_,~~ <br />~' Ir.~-L <br /> . <br />. 1 PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE <br />` ~ <br />1'1n I 1 ~ POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. § 1001 AND 33 LLS C SIGNATURE OF PRINCIPAL EXECUTIVE 1 <br />)) ~ ] U -I ~ , . r ~) I l'' <br />TYPED OR PRINTED mas mumlim~sonmen(ol beMreeo bmonrns entl5ude lines u0 l0 310,000 end or <br />P years.) pFFICER OR AUTHORIZED AGENT <br />I . A <br />c DE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference alI attachments here) <br />"~TTLF~NLc SOLIDS LI?'IT .arFLlt` U~(LY TF <=i^Y~,2~PP ;°r?N EV:°`)^, IS CLAP"'"J. ?F C?.AI!" APPNGVF~ NY JtCG, <br />T55 E IHnk LI!fIT3 NILl. NOT ?t: APYLI`'C TO F:'FOPT'Pr `I:AS`;~crEH':.i ~ SEE I.6.3, PG. 5 FOA $dACEl: OF PROOF <br />~v~ •• ~ ~, VL Ia VUJ IIb.V CV• O• <br />EPA•Form 3920.7 ~(06-95) Previous editioris ~mey rio}~be used ~ ~~ ~ ' ~ " (REPUICES EPA FORM T=40 WHICH MAY NOT BEMUSED.) • PAGE OF <br />