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PERMITTEE NAME/ADDRESS pncludr Facdily NumdGocmion jD~ereap
<br />NAME Cc',LCaYU C7AL CrrF6',Y, L.:.
<br />ADDRESS`) L^4 YG Y.IH~
<br />SIJ1 STAT}:r1IGH4/Y 13
<br />FACILITY ~ •• i )~ ` } CO I31 6 4 ].
<br />LOCATION
<br />ATT"+: J. HArRO'%. r: F. t.c~?L °ANAf.FR
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPDES) Form Approved.
<br />DISCHARGE MONITORING gEPORT (OMRf OMB ND. 2040-0004
<br />IY-161 (,) 91 "I )IU)'
<br />Approval expires 0531-98
<br />PAOflD 55i 1 r1A7 ~ (~Ut{n i+w)
<br />PERMIT NUMBER DISCHARGE NUMBER p _ f'7tiAL ypFA'
<br />~~, MONITORING PERIOD I'rt'~-`'~'1CT '~rD ?(•/r~CP.°' .`iPNI SG CF
<br />YEAR MO DAY YEAR MO DAY
<br />FROM U" U7 Ql. TO 0U U± !^ ;. '. T I'I"C.1A?(:L {nAy
<br />aazn Izzs~l rz4.z3i.'. rz6w1 rze-z91 r3a3n NOTE: Read Instructions bet a completing this form.
<br /> (3 Cerd Onty) QUANTITY OR LOADING ~jd Cerd Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (4653) (54-61) ~ (38-45) (46-53) (54-87) Ex OF TYPE
<br />(3237) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />(6z CUI ANALYSrs
<br />(64-68)
<br />(69-70
<br />f I! SAMPLE ::a~Y>,'ori :xaaaraa RYd rf ~::t i~ ( 1?)
<br /> MEASUREMENT
<br />t'I ':UU 1 U G PERMIT D$#@P# 'kSl ><;'.~ F,5 ':'~ >~.`: ~~. II611pIR0?P 9.D ;, crvLa ~:.SITI.
<br />FrLIT£.~T •,C~ i Y?,LUE REQUIREMENT ~Y:'•:rl tsI#F!( . 'l MARInUK _•I.
<br />-•-L~CS• '1 r..r SL SAMPLE '.t7>FAn7 O>DICC^•. #~IIOi191 ( Tn)
<br />7 :1 S P E\ u ~ f MEASUREMENT
<br />1, :. ', 3L! 1 L` U PERMIT 9IIAIXgIR 4##ii4II R Ur.~ + ~ ?E,1 ; '1CF/ ;HA1'
<br />'''FL'JE,7 SNGS± VALIii REOUIREMENT noa#.-' "~~. 'n;7~bA ~'G DAILY !'X ""/L KOkTb'
<br />;uLIUS, `:FTTLEA.t?L:' SAMPLE eo;:fir:^c;: .; v`.r,•:::;r: `~ tr4430d ( L~)
<br /> MEASUREMENT ~ "
<br />`.).%S4~ 1 J 0 PERMIT 4sOS#II ri+rOtyb¢.-0 ?i.s <t %NM>R.~' ~'~£p~~ 0.~ C NCu/ ,:lAL;
<br />.:FFLU£.~T G:iU`;:, VALIIc REQUIREMENT ;; n^w:2 ;~.,:~" .
<br />~a",SODA ~~>~~ DAILY tlX "I/1. "IOhTF:
<br />1i'O;r', TCTAL SAMPLE "':-~~'%"' ~r:r,:Y!:r: rr!e4LIRQ ( )•?)
<br />(f~ F?) MEASUREMENT ,
<br />~' : Ui: S 1 l' U PERMIT ;: iZr II>7~ PR~S'r#;X4 q r, :.°: ~I(II1M .... $ . 7, Q ( IiCE/ i PAii
<br />FFLU°_ T 't :.0',5 9ALUr REQUIREMENT ~!$I~A -~iM'~`. DAILY CX °~ /I, COAtu
<br />G I i A 5-• r: - ~ r, t SAMPLE "Y'": ,.ru;:c:^:y ;:>xY+sjYaO j:qR$;ee:t ( i .i)
<br /> MEASUREMENT
<br />1T .3 '+i!G 1 U U ~ PERMIT II'f4rJn'd rx .~t.?L:. r r~t~: ~n#lMaj# ~ 1R#~ : LO C ONTZf: ikAR
<br />:FF:.OYt.T Vt1655 YALLIx
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<br />~ REQUIREMENT LD`^ ~
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<br />, ?6 C7NDUI? OP SAMPLE ( U~) ,':r•.rII9 #+?yKc[:'.: ~`::K~ar«
<br />'".."kJ TLF TF(ENT PLA NT MEASUREMENT
<br />:>~'U'_~(I 1 U O PERMIT HEFiJF.T Rt:P7RT :kd>l41PI~(^"? _.; 6~ 4cIIIIOtlI s :::Ya i EtKLY fNSTA~
<br />%'FLUF`~T SIi055 PALU~ REQUIREMENT 7UDA AY6 DA7LY LM% °JD ` i~-_s.~-=""
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<br />'i~'LII''S, '°UTAL SAMPLE -:.: rr ::'<; : f:.yn,': •, nfp ^,n(t Ri ( I r)
<br />;1 ~.'.: OLY ~~ L MEASUREMENT
<br />!!1:'iS 1 I) U PERMIT cfC44'rII ix[:Q9St:i E ~`."'- C+bd4#14 `s..~~
<br />Q~~~.. - REPORT ( T(iLY iPA,B
<br />~• F'~LU°" T t-F.OSS YALL'F REQUIREMENT ri"~:.+': ~ •
<br />~4 #YG DAILY rX 'l,/1. ~ .
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INF
<br />M UW THAT I HAVE PERSONALLY EXAMINED AND
<br />T ~ TELEPHONE DATE
<br /> OR
<br />INQUIRY OF THOSE INDIVIDUAL A
<br />ION SUBMITTED HEREIN; AND BASED ON MV
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />,
<br /> THE INFORMATION, I BELIEV
<br />ACCUR
<br />E A E THE SUBMITTED INFORMATION IS TRUE, ~ ,~~Jl ,ry r)~~„
<br />
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<br />AT
<br />ND COMPLETE.
<br />PENALTIES FOR SUBMITTIN
<br />I AM AWARE THAT THERE ARE SIGNIFICANT
<br />G FALSE INFORMATION
<br />INCLUD
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<br />POSSIBILITY OF FINE AND IMPRIBONMEM SEE t6 U.S.C. § 1001 PND 33 U.S G
<br />SIGNATURE OF PRINCIPAL EXECUTIVE
<br />'~7U ~]
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<br />TYPED OR PRINTED 4 t3t9. (Penettes under (hese slelutes may includa lines up to SIO,OfXI entl or
<br />maximum impnsonment of Serwean6monms end5
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<br />) OFFICER OR AUTHORIZED AGENT
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<br />wmm~rv I a nnu cnrLnrvH I a,rv tzr nrvr vwllA I wrvs (Reverence au attachments here) -
<br />:.TT.L}'~wL`_ SGLIL'S LL°Z' IfPLiES ^ALY IF <=1DY5.,149s' Pp?:CIP FYENT I'S CLAI'F(:. TF CLAI!: APPF.09ED HY NCCD,
<br />TS` E IRO.'. L_TY.ITS I:ZCL :,10'I F,E APFLIf^ TO kFPfTCTF'P Y°ASUttF"'i:!•T` - SEE I.A. I, PU. 5 FOR 5U9DEN OF F6C70F
<br />EPA Form 3320.1 (08.95) Previous etlitioris •may not be used. ~ ~ '(REPLACES EPA FORM~T~40 WHICH MAY NOT BE USED.) ~ ~ OOOS 4 / OA O4 O 3 ^100 7 V ~ PAGE 1 OF
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