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. r....v-.. ~ - f <br />PERMITTEE NAME/ADDRESS (/nrlude Farilin Name/Cocaion ((D~erenr) <br />NAME 5ENr'CA CURL CCPFAhY <br />ADDRESSDHA~G'R D <br />HAYD6N CC 81649: <br />FACILITY <br />LOCATION~AYDEN CG 81630 <br />FROM <br />ATTA: G. NUU AEC4h, CEhIHBAL :1AhAoEA <br />AINATION SYSTEM (NPOES) Form ApprOVed. <br />REPORT (OMR~ OMB No. 2040-0004~r+ <br />n%- sl t I h C n Approval expires OS-3T-98 <br />'~ ~ (SU®8 ifi) yy <br />DISCHARGE NUMBER P: y . !Y ~ ~ L tlC U 1', <br />PERI00 ~~.fl[7 TESTiKG FCE L11A <br />YEAR MO DAY ~ t'_`~' <br />yy uy a.u !~O LI-CBAi6L ) toX <br />rzs"zr/ rze"zvl (3031) OTE: Resd Instruct~'I~ons befor completing this form. <br /> (3 Card Only) QUANTITY OR LOAO1 <br />~ " (. Cerd Onty) QUANTITY OR CONCENTRATION ~ ~ ~ NO. FREOUENC SAMPLE <br />PARAMETER _, <br />(46-53) (59-61) ~ (38-45} (46-53) (54"61) ~ ~( OF TYPE <br />(3z-37f AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM -~ UNITS <br />j62G31 ANALYSIS <br />(64-66) <br />(670 <br />iC~U STAIR! 488A ACC SAMPLE ;YG~73Gr? 9Aro;'y ~;:~fiY•^.• ''~~t'~^'' ~ i3) <br />CLkIODAFHNIA MEASUREMENT <br />T Ah.f6 1 U U - PERMIT fii1a93711 i1 TI'TOap;.:~ OL9 ~ , ,~#4~7A '-. <br />' ..-~~DlALY E Efi~ ~R,~~ ' elk j`$. <br />[•.FFLUEHr GHQSS YbLUt REQUIREMENT ;~;fit,., ",F CEl7 <br /> SAMPLE }, <br /> MEASUREMENT <br />~ <br /> PERMIT - ~ :nx a(~ ~ ~ <br />- •-• - - <br /> REQUIREMENT ". <br />~ <br />~~ " <br />- <br />~ <br />y <br />' - - <br />, <br />-* = ' <br /> .,- <br />a r - <br />_ <br />€} <br />e~ <br /> SAMPLE <br /> MEASUREMENT . +'?;~ <br /> PERMIT. i~;' v ~"". <br />~ <br />- <br /> -RE_OUIREMENT ~ 'i• ~S <br />fi~'r~~' , - ~ <br /> SAMPLE r`" "~ <br />;>~:: •: <br /> MEASUREMENT ~•, <br /> :=PERMIT <br />REQUIREMENT - ~ r •;: ~` ~: . <br />~'~ , - <br /> SAMPLE <br /> MEASUREMENT <br /> "-PERMIT. <br />' <br />- - ~~'`. <br />` <br />~ <br />" ~,y, ",~-" , <br /> REQUIREMENT _. <br />- - <br />+ <br />" <br />~fi ~ . ,~ <br />~u <br /> <br />~ <br /> SAMPLE - . <br /> MEASUREMENT i <br /> <br /> R_ EQUIREMEN,T: -- ~ - ~ ~ ~ ps ~~"-g ~ 1 ~ k~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> REQUIREMENT" ~ - ~~ ~ A~~ <br />~ _ <br />• ~,,, <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />MILIAR WITH THE INFORM <br />A <br />F LAW THAT I HAVE PERSO <br />ATION <br />TTED HER <br />BM NALLY EXAMINED AND <br />AND BASED <br />EIN <br />M TELEPHONE ~ DATE <br /> A <br />M I <br />SU ; <br />ON <br />V <br />' <br /> MOUIRY OF THOSE ININVIDUAL S IMMEINA7ELY AESPON SIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEV E THE SUBMITTED IN FORMATION IS TRUE, ~~ <br />\ <br /> ACCURATE AND COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFICANT ~ <br /> PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING THE ~ ~ <br />r <br />~ ../ <br /> POSSIBILfrY OF FINE AND IMPRISONMEM. SEE 1B U.S C § 1001 AND 33 U.S.C. SIGNATURE OF P INCIPAL E%ECUTIYE ' ..1( . i <br />TYPED OR PRINTED marmum~nnsdnment of bemnreen emrmhs enC 5ude lines up Ie Sr0.000 erld w <br />ears) <br />p OFFICER OR A MORIZED AGENT EA- <br />NUMBER' <br />YEAR <br />MO <br />DAY <br /> y D <br />GOMMENT5 ANO EXPLANATION OF ANY VIOLA (IONS (Re/erenCe all attachments here) <br />str, PA BT I.A.4 FC8 LE7AIL5 CP TEST PAL7CEDUAE. REFC6T LCfIEST DILUTICI+ (2 EFFLUEKT) rH1Cfi IS LETE11 7C SGX <br />OF 7E'ST OHGANIStlS (LC:U) AND ATTACH ACUTE TCYICITI TEST fiEFCiT FCii! TC DH A. <br />EPA,Fortn 3320.1 (08-95) Previous editions may not be used. ~ (REPLACES EPA FORM T-40 WHICH MAY NOT~BE USED.) , aQ1a ]/ 99 C e 2 ~ ~ I E S 3 PAGE 1 OF <br />`'~?- . <br />