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PERMITTEE NAME/ADDRESS Onclade FariGrv Name/Loreriun ifDiBerenrl <br />NAME <br />CULr.r'.,G C.iAL C7°P.4+.'r, L.?. <br />ADDRESSC` L7. ~ MI>; ~ <br />Yrl•r~'P CT! !'1641 . <br />FACILITY <br />LOCATION <br />AT".'5 v. ~. NA?;OK. =C^SF.L :q:,l.-~I: <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT (DMR; <br />R-I6) (1l~ 9J <br />r nr ns ~trt nnw <br />PERMIT NUMBER """"'discHAaGE NumeER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ U7 07 TO ~^ "~ 30 <br />l20~Z17dt-in-931 IPYZ5) (2&271 l26~291 (30-311 <br />Form Approved. <br />OMB No. 2040-0004 <br />.` I'~ .~. i Approval expires OS-31-96 <br />F - FLt.AL M,~ryT <br />PROSPECT SP.D PD/GOOD 5FR?H~ C5 <br />*** ao DlsceAkr,r rwrr <br />NOTE: Read Instructions befo completing this form. <br /> (3 Cartl Only) QUANTITY OR LOADING (4 Cartl Only) QUANTITY OR CONCE <br />NTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4653) (59-61) ~ _ <br />(36~45J (46-53) =j'~(54-67) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM NITS MINIMUM AVERAGE M~IMUM UNITS ANALYSIS <br /> l6z~fial (64-66/ 69-70 <br />L11L hV;, r. A'~ SAMPLE -•.: r7 •t nr,. ( :u) Cr*JIri3nYr r,;Y: Ihnr; :t :, h', ey :te <br />Y I :3 U .+ L MEASUREMENT <br />I"JU'.aU 1 U U ~ PERMIT aoAt GnP 't .`PC~FT 1 f5-j T-Tb" 44t+r0lnrz #17irWCat$ >I Gt~LI =~. <br />1 B I(LY <br />E I$UAI <br />r . "; <br />S.F"r'L,1^.. UI4Q~U YFL'Ji REQUIREMENT <br />165"i !!dY <br />HOs.E194' "-~" <br />- _~ ~ <br />.I, ~ <br />..,.,~ <br />6A;t# , <br />?` , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~' ~ <br />~ - <br /> <br />REQUIREMENT r <br />~ <br />` ~? ~ . <br />~~ _ <br />- - <br />' <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT ''°'Y <br />~"s <br />t, __, <br /> REQUIREMENT :e- <br />~ ~'--~' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 't <br />T-:- <br /> REQUIREMENT _ <br />- - -~" <br />;•! '" <br />^ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ •~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~ -~ ., <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - _ <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND <br />AM FAMILIAR WITH THE <br />NF - ) TELEPHONE DATE <br /> I <br />ORMATION SUBMITTED HEREIN. AND BASED ON MV <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />~ 1 <br /> THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE, t /, ~ '~ <br />` <br /> ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING THE ,~INy~1. <br />~ r ~~ rY <br />T ~ , <br />POSSIBILITY OF F <br />11 ,~~,. ~ <br />' INE AND IMPRISONMENT. SEE tfi U.S.C. g tOBt AND 33 U.S.C. SIGNATURE OF PRINCIPAL E%ECUTIVE 7~ 1 ~a I1.~ <br />~ l l ~ } <br /> <br />TYPED OR PRINTED g tat 9. (Penalties under (hese statutes may incWtle Grres up ro 510,000 antl w <br />maximum lmprisonmenrolbe(ween6m0nlhs antl SYeers.J OFFICER OR AIJTMORIZED AGENT , <br />NUMBER . <br />YEAR <br />~MO <br />DAY <br /> DE <br />vvlru Rio Hrvv rsrv~rvnliVrv Vr HIVT YIVLHIIVNJ (tterererlCe Bll aRBCOTBOIS nets) <br />~i `_'T'i LI: 41)LE SOLIDS LI"I'. nit F'L7e' ~".LY IF' <=1 r~YU, ?II T'4 ~P.?CIP EYEti? I~ CLAI!1rD. :F CLAI`! APPF.OY F.C CY 4~CU• <br />T55 G IHOH LIHITS -ILL MuT P% 4PFLI1':G ?!] ~iPCFT?;L i1F:ASUP.°.~£A'i5 - SEF. I.A.2, PG. 5 FC° OUHpEN OF PROOF <br />TPA~FOrIn~39Y0-1 (06.95) Previous editionsm`ay not be used. " ~ + ~ ` •(REPLAiCES SPA FORM T=4U WHICH M71V'NOT BE USED:) - ` `~ °j - ' `" `~ • `"' °' PAGE OF <br />OOC60/OCOuO~-3007 ~ <br />