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PERMITTEE NAME/ADDRESS (Include Pocilirv NamaLacprion ifONerenU <br />NAME <br />CC`L~:';f0 C•'.gL C'?°peRY, L. P, <br />ADDRESSCJL ~eY4 M": r: <br />x/11 ~T.AT? .'1iGHrAY li <br />FACILITY ~~ ~' t ' r.r . C t' 1 (~ 4 ~ <br />LOCATION <br />°T"' J. 46°YG;t- .: F: `. :'yni. +:t 4~r c. <br />NATIONAL POLLUTAPIT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (OMR; OMB No. 2040-0004 <br />!z-tsl n~- s) - T ~ n !- Approval expires o5-31-98 <br />r-. ~.rn gTpT nnr s tyi; ~~ !t -~ <br />PERMIT NUMBER .,~~e-•DiscHAacE NUMBER F - F7hAi nnPR' <br />,.:.- <br />MONITORING'PERIOD HEST FIT GFD PQtiL *^ 7AYL^3 [u <br />YEAR MO DA ~ YEAR MO DAY _ <br />FROM pp 07 07~TO 00 04 `s0 a:x# IIQ.pISCHAkCf. ~~' ~~~~°+ <br />rzo-zn~ ,zz z31 rza-zsI rzs~zn rzeasl /3o-311 NOTE: Read InsVuctions before'completing this form. <br /> (3 Card Only) QUANTITY OR LOADINGd'^ (4 Cerd Only) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER ( 653) (5467) 't%,'~~ ~ (38-45) (46-53) (54-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~ <br />rsz-s31 ANALYSIS <br />(s4-se) <br />(ssao) <br />IL ,. :,: GY.SA'.. SAMPLE an .•F r, aX ~ :; ,~~ ~:,y',rV<e# >~d 4r. ;.a .. :~r:.::;,~ <br />'J I :' II ,`. L MEASUREMENT <br />"Nl't, (• l 0 0 PERMIT A>SGnCO $E ~ 1 cc=1 .fA!C9++:: ` dl#f1#Ik4 #6>agCrs ?=' =r EElSLY ISL'A; <br />-°FL1; °_;.; '; Vi flgc YP-LI1! REQUIREMENT ~1i4~~'4~X KO-Q , <br />~`~~~~:'" r•:,1n:': <br /> SAMPLE . a '"~ <br /> MEASUREMENT <br /> <br /> PERMIT . <br />'~ <}. <br /> REQUIREMENT ? ~ T ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ''~ -" '~ -~ ; _ ~ <br />i ~. <br /> REQUIREMENT :'~~ _ <br />!: _ c. , <br /> ax <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ""~^""" - . ~- ^ <br /> REQUIREMENT ~ <br />~$ ` <br />~ ^~- - <br /> M _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT <br />- <br />~~} - <br /> . ~; w r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : ; ~. )'+-' - . . <br /> REQUIREMENT ~ '~} . <br />~ ? <br /> , , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , <br />~ ~~` -. <br /> REQUIREMENT ~ <br />'"~~~ " <br /> , <br />9<~r- <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND <br />AM FAMILIAR <br />T .=+ <br />' TELEPHONE DATE <br /> WITH <br />HE INFORMATION SUBMITTED HEREIN, AND BASED ON MV <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ~ <br />~ <br /> THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE. <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFlCANT '.. <br />r'n~i ~(J}'Lj~\~ <br />/ PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING THE _,y <br /> <br />L) A „ , T , <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE to U.S C § 1001 AND 33 U.S.C. + <br />SIGNATURE OF PRINCIPAL E%ECUTIVE <br />(~~ <br />'!` ")U I <br />I ~ ~ <br />lL' <br />') 7 <br />TYPED OR PRINTED Jes up to StO.We entl or <br />' <br />u <br />lP <br />m <br />e <br />e (OFFICER OR AUTHORIZED AGENT n.. ~ . <br /> ru, <br />m <br />m <br />mpnsonmem of benreen8m <br />onths <br />nd SYears C ~ NUMBER YEAR MO DAY <br />,. , ~ .,,.., raruvvr.I,vrv ~r nrv r vl~u{ I ILIrva Irreverence aII artacnmenrs nere) <br />_i:ITL54fiL£ SOLID: LC`.IT :FF'LIi'f ObLY TF C=1QyA,24NT+ PRi:CTi' FYtht IS CLAI"~F'G. ?e C1,DI+' kPPkOV?L' 1'Y YtCL, <br />TS~ E 1f:ON LI!SITS WILL VV. 'r.£ APY LI rD TO EF'PO RT fD "FASUNF:M EYT~ - SEE T. A. 2, ~:,, ri F'OR LIUA[l F.N Of' PHOC F' <br />EPA Form 3320.1 (08-95) Previous editions"may not be usetl.~ `~ ~ ~ ~ ` •(REPU[CES SPA FORM T~4U WHICH MAY N'OT BEMUSED.)" ~ ~ ~ v ,. ~ - a .... v , r ... v . PAGE OF <br />• Q.OQ7yi~t;.~Q07 2 <br />