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PERMITTEE NAME/ADDRESS (include Facility Name/Gormmn if Di~erenq <br />NAME <br />C~7LJ~YJ CGnI. C7;la`•n1iY, i.=. <br />ADDRESSCDLCIaYJ Y.C~F. <br />s"rsI :;7er° ~1IC~(»ar I± <br />FACILITY ~'~'~;":r ~-'~ `fltril <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />(246) (IA 9) <br />PERMIT NUMBER : .. DISCHARGE NUMBER <br />.:.~: <br />MONITORING PERIOD <br />YEAR MO DAY;'; ~ ~ YEAR MO DAY <br />FROM 0 0 07 ~ TO C i S}''/ ' 0 <br />RO.211 12223) l2a~26 f2fi 2]) (2819) (JO-]t) <br />Form Approved. <br />OMB No. 2040-0004 <br />' °"~' Approval expires 05.31-9R <br />(-,nt~c~ r4J <br />:r ~i: r.r arT r; ~.~sr I'r? I>o~.D <br />NOTE: Read Instructions before ompleting this form. <br /> (3 Card OnryJ QUANTITY OR LOADING (4 Card Onty) QUANTITY Ofl CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (5e-st) (3a-a5) (as-53) (54-st) EX oP TYPE <br />(32-37) AVERAGE MAXIMUM ~ ",UNITS <br />~; MINIMUM AVERAGE MAXIMUM UNITS <br />(6z-ra) aNaLrs/s <br />(6466) <br />(69-70) <br />''LIES, ?'):AL SAMPLE -r:]9<rc:Sfi AOISCxYr: ~ .. ',: r..regq ( ?'1) <br />-; •7,~ i• c r} n r D MEASUREMENT <br />~ J ; ? I. 1 0 5 PERMIT ~Gr44MYq f~7tRtt? C [: '. r- f NC F. ~ ~. A ~' <br />°Fi.r :'.t "-HUE VSL!1} REQUIREMENT - <br />" r.: ,•t .u;w-;„ 3dDA AYC. GAILY NX I. DIS!'v <br />/ }.z,: SAMPLE +X>znrt^tr,. +214:5*4'.. 019101~^:tJ# ~ I IJ <br />. : =. L -! FC `~''! r q ~q;• L ~ MEASUREMENT <br />::: +` 0 1 0 U PERMIT CI Kt40:4ft G?kmeOlP S L`GIS q~ . <br />wa. <br />. <br />kEPokT <br />< <br />NCE1 <br />~A: <br />~.FFL!.":.~T ~~:/:;S YALL'i REQUIREMENT q0+q~,~ 4 <br />,,~`" - <br />~3#~:fli. lVG" OAT Y I!$ "~~/i. 17 R!'H : <br />':. (!w, IA CtIN DI)IT UH SAMPLE ( (1 ~ GOO#GO ':#eS :: Ye .' '~{r CI ~«' <br />;'HNU '1'k ~i r. vhT PtA}i~ MEASUREMENT <br />'~UU;J 1 U 0 PERMIT kEPOkT I~EPOP° +Ortl~li9!. "r'~""t0;tpl0luEk+4' ~iM'dU'4 i+ < ::'~'~ c :7CF/ [NSTA! <br />FFLUEtsT `.~AO~.S YAL('E REQUIREMENT 3QDA RY!; Dq ILY "'E N;, .."r,, '~ ~'" - p+. r.•Y; pSSC4+ ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <br />~ <br />~` ~ ~" <br /> REQUIREMENT <br />~ ' '" <br /> ~: -; ,. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT •~ ~*;r - <br />§~ -• <br />• • <br /> REQUIREMENT ~5~ , <br />t4 ~•f -- _ <br />" " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - + '~. ~~ <br /> REQUIREMENT ~ - <br />~' <br />~ -' : <br />a`<i ~ i-' <br /> ~ <br />. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .; .,is. .i, 7„' ;, ~ . <br /> REQUIREMENT _" .; _ _ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALtt OF LAW THAT I HAVE PERSONALLY E%AMINEO AND -"ti TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN', AND BASED ON MY f ) <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE. .L <br />~ <br />' <br />' <br />1 <br />~ <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT ~ - <br />(/j <br />)- <br />~ <br />l7. <br />~- PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING THE _ (1 <br />~ v~4 <br />~ ~ <br /> <br />J I ~ / ~l r , `( 1 ~ <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S C. § 1001 AND 03 U S.C. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />"I <br />J )~~ <br />.,I ru I' ~ <br />' <br /> <br />TYPED OR PRINTED 4 1319. (Penarties untler these sraMes mey include lines up to dI0,000 entl or <br />maximum lmpdsonment of peMeen6months ands years.) OFFICER OR AUTHORIZED AGENT <br />I AREA <br />Coo <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a/I attachments here) <br />"J:':I?O'tI^G P.PvUIRE'9EhTF _ii:r 1.'-'.1..", .^;. 5. nf1?pE:N OF PkuOF REQ11,jNE"'E!iTr _ c.~ I.A.2r 1SG• U. <br />EPA Form 3,720-1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-90 WHICH MAY NOT BE USED.) UO fl7R fro O~,I PAGE 1 OF <br />° ..r`~ld.. ~ Y <br />