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PERMITTEE NAME/ADDRESS pnclade Facility Name/!-nmrion ifOrBerentl NATIONAL POLLUTANT DISCHARGE EDMINATION SYSTEM (NPOESJ <br />NAME S E M EC A C C A L C C C I A h Y DISCHARIGE MONITORING REPORT (D(MR;9! <br />ADDaESSpR`YEIt D 00000('al 0' '3 1 <br />H A [DEN GQ B 16 j9 ~~ PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY <br />LOCATIONdAYCl.Y ". 16)11 <br />A'rTy: G. BUD BkOMN, GENERAL 9 <br />FROM <br />MONITORING_ PERIOD <br />YEAR MQ~. , DA Y, YEAR MO DAY <br />yy v7H ?'mV ~ yy US 1U <br />(20~2t) (2223) :(2i.15)~~ (2G21) (2829) (30-J1J <br />Form Approved. <br />21 L Y 0 R OM8 No. 2040-000414 <br />Aoproval expires 05-31-96 <br />(SUBH i~) <br />F- F I F A L ,'ErYi U T T <br />CISCRAFGE TC SAGE CiEEA <br />~+~~: NG [1:CHAFCE )~) nrL <br />NOTE: Read Instructions befon,777co___m___ plating this form. <br /> (3 C'err/[Ony) QUANTITY OR LOADING ''~ <br />'° ~'<Card Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-61) (3B-45) (46-53) (54-61J EX OF TYPE <br />(3237) AVERAGE MAXIMUM UNITS MINIMUM ~ ` AVERAGE MAXIMUM UNITS <br />(62c31 aNALysls <br />(B4-se) <br />69-70 <br />Ptl SAMPLE ""``~'`'- ['+Da## A4aIIII~P ( li) <br /> MEASUREMENT <br /> ~~-~~ <br />UG400 1 0 G PERMIT oaa#a# , ~ b~ ~'~ IE~f4+ - C 1~J~/ YSIT <br />EF'FLUEZ;T Gk055 VALUE ~REOUIREMENT - .. <br />~{~; a:~X111E~- ry„I _J ~-~~~. $Q lS1148 <br />SOLIDS, TOTAL SAMPLE ~`~~~,^~ 'raaa#9 caaaa#; <br />~ ( 15) <br />SUSPENDED MEASUREMENT `!' ~ ~` <br />" <br />w IAI ` e:-. <br />DOS30 1 U O PERMIT aA`II~al ##i### s tir. r~r,~y ; ~. ~C$f ' iAA~ <br />tE't'LUENT GROSS YALUI: REQUIREMENT r>sw .~~`. ~~~ •. ~}~ Rj_ CG/L ',„ ~J~I <br />SOLIDS, SETTLEABLE SAMPLE ~~;'x"jr '"i4 rn tt <br />~~ " ( 2`-) <br /> MEASUREMENT ` <br />~~ <br />UOStiTj 1 U 0 : - PERMIT, V#9##77 #aaaaa 2 <br />~ i-0'.t ### ~ t j~A.B•1 I ~ii~ <br />EPfLUhNT GROSS YALUE ,FiEOUIREMENr ~ ;aot~ a~- <br />Zk0!J, TOTAL SAMPLE aoY^c'~ t~to::7::s a0aaaa ( l5) <br />(AS FE) MEASUREMENT <br />- <br />~ <br />U ]U45 1 U D <br />EFFLUENT GRCFSS YALUF . PERMIT-~ <br />REDUigEMENr'; .II#~#a7Y# 4a :IIita t tKtr <br />;x>rt: a~ ##~. + ~ <br />~ <br />'~ ~ _i>----, <br />~j <br />~~ :{!~. <br />EG/ I ~, J <br />'~~~ b~f+~~" <br />:~~~ ~ "~~'' <br /> , ~ <br />OIL AND CREASC SAMPLE ^^'u°":: ;»yr,:,r:j cIICaaa #aaaaa ( 75) <br />- MEASUREMENT <br />Uj5U2 1 U D "~PEFiMIT A#a9#fi aaaaeg S tIIII aaasa#,,'A; `~' ~'`~, ; ~ll )~~b.' <br />FFPLUENT GSQ59 YALlaE ,REOUIREMENT <br />~ tt'+9 "'''_ ? ~ *~y~ ~`~~~,~ tG/L '~'- ' <br />FLOY, IN CONDUIT Ci SAMPLE 1 UJ) oa oaII #saaaa a.:ttdt <br />'rNkU TRBATdENT FLAN7 MEASUREMENT <br />SUUSU I U U <br />EPFLUE\T GROSS YALUF .'PERMIT-. <br />,REOUIREMENT R8Q4b? <br />300LI ,A4C lE:POFIT <br />fliIl! FIX <br />FCU aaCai ~ ~'~t+a#.,~ <br />r. ~; ~~r~~y!~K A"_ '~~+ <br />Lsit ~~' ~~'LA <br />; <br />SOLIliS, TOTAL SAMPLE '}a'fII^aA '''ivryvO uaava# ( 15) <br />UIS~OLYEC MEASUREMENT <br />7U19S 1 0 0 <br />PERMIT ~ ~ w~~~~~ <br />;'-'- aag c rmr: a - :'~ ;r> -.,~4l7 ~ $`; );71E)"' <br />FFFLUEkT GROSS YALU! REQUIREMENT- ~ ;,' ~~ = tt>7 oy ~'' <br />_.~ r <br />~13YY rc.x <br />rG/t ` <br /> <br />~ " <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO <br />AM FAMIUAri WITH THE INFORMATION SUBMITTED HERE NALLY EXAMINED AND <br />IN <br />AND BASED ON MV TELEPHONE DATE <br /> . <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I REDEYE THE SUBMITTED INFORMATION IS TRUE, 1 <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALT <br />ES FOR SUBM <br />TP <br />G F I'\-+"`.^+~- <br /> I <br />I <br />N <br />ALSE INFORMATION, INCLUDING THE <br /> POSSIBILITY OF FINE AND IMPRISONMEM. SEE 18 U.S C § 1001 AND J3 U.S.C. SIGNATURE OF PRI CIPAL E%ECITTIVE <br /> g t319. (Penekies untler mesa statures may include lines up ro Et0.000 end or ~rTHORIZED AGENT <br />C <br />O A <br />TYPED OR PRINTED maximum impnspnmem of beMSan6mpnlns ends years.) OFFI <br />ER <br />R A <br />r' CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) ~ ~ - <br />TSS ~ INON LIMITS TILL BE AAIYED E SETTLEABLE SCL1C5 LZFIT APPLIED FOF <=IDYR,2yii ~,(i6tIE E~E117: 7:5 E <br />IKON LIMITS YAIYbD FCE )IUYk,24kk PHECIP EYFNT SUEUhCT TO BURCEN CF FiCCF IM I.3.,1.,y~U,il C GiE1SE - SEE <br />io_i_n_ sna rn YT4YCitlY' _ 1-0.1 s -,..• <br />EPA Form 3320.1 (08-95) Previous editions may not be used. (REPLACES EPA~FORM T-40 WHICH MAY NOT BE:USED,) .. <br />PAGE ~ OF <br />