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PERMITTEE NAME/ADDRESS (/nclude Fnciliry Namr/LOeurion ifDeffereny <br />NAME <br />C('L•'IAYU C'InL CJ"i•R,t1F, L.t~. <br />ADDRESS(-O ih I; Y ~~ w I ,; c <br />5'!dl SI"ATF: HI~H':AY Ii <br />FACILITY ' <br />LOCATION <br />''f fr; ~. iFr; ,"O' ]F.t .i.4i ~A G!T_Fd <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />(2-t61 ft7 91 <br />rnn n.: ~t:~ ntr ~ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM pQ .O7 Eil TO CO L'O 1P <br />(20~2It .:E'l22=231 (2<-251_...'.. (2fi 271 (28291 (JO-3tJ <br />Form Approved. <br />OMB No. 2040-0004 <br />'• T': ,1 ~ ~ Approval expires OS-31-98 <br />'. T?.CL05 FOG[T 'f0 ?AYL'~F CP~'i "' <br />`-~4 NO DISCHAR ~F ~{}r' <br />NOTE:Read Instructions before c~leting this form. <br /> (3 Cem Onry) QUANTITY OR LOADING "~~;+<~ ^(eiCaid Only) QUANTITY OR CONCENTRATION NO. FHEOUENC SAMPLE <br />' PARAMETER (a6-53) (54-67) '~ (3&45) (46-53) (54-67) EX OF TYPE <br />(32-37t AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALY$IS <br />sao <br /> <a2~fiJ1 (s4-se/ B <br />'t:L AYP °pvA`., SAMPLE :oYr~. ( 7TH ran o>pr>.o ,t<Xr rl r,. rr:t :: ,r: ,. <br />V I :~': n L MEASUREMENT <br />'i4Unh 1 `J U PERMIT IPSi1P+9L4~'`- _8EP~7~~;~'i F.`•=1 '~~~ <br />. - R~1t0~~ Orb@+X~ ,( t::SO `s-: 3 L£RIT fI~I?3I <br />'~E'!,J E'%1 UhO::; VR'_.C.r REQUIREMENT ~ ~. ~~gY' 1!AX t:0=D . <br />- <br />~ •. ~r, r,;:~ty <br /> SAMPLE <br /> MEASUREMENT R: ', <br /> PERMIT -~ - a ~. ~ , <br /> REQUIREMENT -' ,.~~ - ,___.'_,` ., -T. -~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />. <br />~ ` '' °-~' -'' <br /> REQUIREMENT ~ ~ ~ ~~~ _ - *~-' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~i ~ - - <br />- <br /> REOUIREMENT "' )~' _, <br />~ ~ - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -"s"- -~ <br />~~~ <br />~` - <br />§ <br />~~~r <br /> REOUIREMENT ~ ' <br />' - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT rnt _,: ~ - <br />~ <br /> REQUIREMENT ,. ,"~ «r,,;',== <br />- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ...:'u' yr: _ _ ~. <br /> REQUIREMENT ~ , :, +~~'-.,_ <br />NAME(TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAM <br />IAR W <br />TH THE <br />FORM LAW THAT I NAVE PERSONALLY E%AMINED AND <br />T <br />ON SUBMITTED <br />RE <br />N' <br />D B -'"~` TELEPHONE DATE <br /> IL <br />I <br />IN <br />A <br />I <br />HE <br />I <br />, AN <br />ASED ON MY <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING 1 <br /> THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION I$ TRUE. ~~~~t~~t <br />'~~ <br />~~' <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PE <br />S <br />T - <br />~//+'r'! <br /> <br />~ NALTIE <br />FOR SUBMI <br />TING FALSE INFORMATION, INCLUDING THE <br />~ /~ ~r <br />B <br />I <br />' <br />__) E <br />I-I:. t~ , , t POSSIBILITY OF FINE AND IMPRISONMENT. $EE 18 U S C § 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE /V' <br />F,c U ~ /. i .' <br />~ <br />TYPED OR PRINTED marlrtwml~mnalnsanme ~ot beNae n6 months erb 5ude lines up Ip Sf0.000 entl or <br />p years.) OFFICER OR AUTHORIZED AGENT A <br />pE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />"'1TaF+',: a''JLZL'S LIrMI7 AFC•L7Fs nhLY IF C=I~YP,24EIF F'R.E:CIP ePrfl'" IS CLAI!1FD. IF CLA7" AFFA04F.D EtY YQCG, <br />T~ ': IitON LI"ITS f:ZLL NlT ~ -FFLI°D T^ .rir.FOF': F'D !:cAS'JRE`F'~7:5 - 5YE I.A. 2, PG. 5 FOR ?(JRD£M Of FHOCF <br />EP:4 •ForirE'3920-1 •(DB=85) Previous eiiitions may not be usetl ~ "' " ` (REPLJSCES EPA FORM'T=40 WHICH MAY NOT BE USED.) ~ PAGE OF <br />ooa9.b,~~,9os-i.ao~, z <br />.~ .~. _ .. _ _ _ _ ~~a> .- . <br />