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PERMITTE~ NAME/ADDRESS /Include Faoiliry Name/Gocarioe i~D~erenU NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) Form Approved. j' <br />NAME <br />5LNECA CGAL CClfAhY DISCHARGE MONITORING REPORT (OMR; <br />(zasl (n~s) <br />CISOd OM8 No. 2040-0004 <br />~ <br />ADDRESSD j[AY EM D <br />Cfp04(~11 <br />C70 F~ <br />(SUb5 6Y) Approval expires 05-31-98 <br />.' <br />H~.YUEk ~ CO J1D39 PERMIT NUMBER DISCHARGE NUMBER F - PIF/i ItGDT? ~' <br /> / <br />~ ' <br /> ` <br />, MONITORING PERIOD Sf:D• PCAC LSCHG TC 1FA55Y CFn. <br />FACILITY <br />ON q~~GTC~- ~1 YEAR MO DAV YEAR MO DAY ~' <br />LOCATI <br />n k Y u E N <br />C O 81 t 3 G FROM <br />--iry. <br />~t.sl- <br />~+-!r <br />TO <br />y y <br />:. S <br />J u <br />~: ~ =~ ' <br />hC C 7, C k A F G E t ~+ ' <br />~__ ~ <br />r. T T b : ~ . BUD B H 0 Y N , Gc F c k A L M A M A C. F H (za21) (zz~z3) (2d~25) rzsaa rze-zvl (30-31) NOTE: Read Instructions before completing this form. <br /> (3 Cerd Ony) QUANTITY OR LOADING (4 Certl Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4653) (54.61) (38-45) (46-53) (54-67J FJ( of TYPE <br />(32.37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />Is2~c3) ANALYSIS <br />(64-68) <br />69-70) <br />f'L(14, 1N l'iJNDU1T OF SAMPLE ; <br />[ <br />Z ~ ( 03) aaaoua ~FCxO~Y =+~z~~~ <br />~ <br />~[t tiU T''-tATHEN] PLANT MEASUREMENT (. •~p <br />` ~ O•?+ <br />~ 1>^s <br />`,UUSU L 0 I ~PERMIT~. REPO!!Y RE;aQRS aamaaW aa~o;0 t4l4iat L :CY G iCE/ YIQ'~AN <br />EFFLUt1.T Gk0S5 VALLE REQUIREMENT 30[§A AyG DAjlT .>yk !GC +'f Lt M.CITE <br /> SAMPLE G, <br /> <br />MEASUREMENT `~ <br />'Y / <br /> PERMIT; - <br /> "REOUIREMENT ~ - <br /> SAMPLE <br />MEASUREMENT ' ~ 1,. _ - . <br />r`CY'~A, <br />y ~ <br /> PERMIT ~~ +^^` <br />~ . <br /> RE~l11REMENT ~I ti " - <br /> SAMPLE f' !~~ ~ <br /> MEASUREMENT ~ <br />(M ~j/\ - <br />,L§.Il <br /> 'PERMIT v '` ~` <br />~ 3" ~ - - - <br /> REQUIREMENT ° ,..-~ F *w'", <br /> SAMPLE <br /> MEASUREMENT <br /> "PERMIT ~ - _y '~ ~ - <br /> REOUIREMENT ~ <br />R _,,~ ~ <br />.y,N . ~ " <br /> SAMPLE <br /> MEASUREMENT <br /> "PERMI T <br />~ <br />."-~ •f ~ h~ <br /> REQUIREMENT ' <br />~ .4..'3` „'t.".: ~ " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -n '`-~` ~ ¢ - - <br /> REOUIR <br />EMENT ~• ` " s~3r---` " <br /> _ _ a <br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY EXAMINED AND <br />ATION SUBMITTED HEREIN; AND BASED ON MV TELEPHONE DATE <br /> INQUIRY OF THOSE INDNIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATION IS TRUE, <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />FORMATION <br />INCLUDING THE ~ <br /> , <br />PENALTIES FOR SUBMITRNG FALSE IN ~, ._ <br />~ <br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE t8 U.S.C § 1001 ARD 33 U.S.C. SIGNATURE OF PRIN AL E%ECUTIVE <br /> <br />TYPED OR PRINTED 4 t3t9 (Penetties untler (Hasa smtutes may include lures up ro E10,000 entl or <br />maximum imprisonment of between6mpnfhs ends years.) OFFICER OR ALIT RIZED AGENT <br />CODE <br />NDMBER <br />YEAR <br />MO <br />DAY <br />GOMMENT5 AND E%PLANATION OF ANY VIOLAI IONS (Heten:nCa ell atteCDmenrs here) <br />TS:, L IRON LIMI7S Y111 5F. iiAIYF.D AMD SETTLEABLE. .`rCiIDS LI°iI eFFLItL FCp C=IOY5,7uNF FFECIF FYENT: 7_5 b <br />LBUt1 LIRIT'S URIYEL fCF )1L'Tk,Z4Hh PRcCIP E': EST SUFd~C? TC cUnUEt~ CF PFCCF IS I.A."e. CII t GFFASE-QEF <br />1 !. me •••4T'•![+Y: !`.•-CC T 1 c <br />I <br />EPA Form 3320.1 (OBAS) Previous editions may not be used. - (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) C D i U 3 /'J 7 C E c 7 -1 L• 5 3 PAGE 7 OF <br />