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PERMITTEE NAME/ADDRESS (lnc(ude Facilirr Name/[nrnrinn ijDifferenq <br />NAME SF:NF'C8 <br />ADDRESSD l,. A Y E H <br />AArD;•:N <br />FACIUTv <br />CCAL CClPlpY <br />D <br />CQ'_. <br />~~(- U7 ~0 I <br />LOCATION A Y D e N <br />CL E11b30 <br />ATTN: G. F1UU EIPU~A, GE(:EndL riANAGEP. <br />JAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDEBJ Form AppfOVed. <br />DISCHARGE MONITORING REPORT (DMR; OMB No. 2040-000(1 <br />rzasl nr~ 9) '41 N U n <br />Approval expires OS-3 -yg <br />'PERMIT NUMBER 'y ~ DISCHARGE NUMBER ~syd ilY) j~ <br />MONFiO PERIOD ~ UI.,, F 7C TElf/EI.E CFEEN <br />,~I7AY YEAR MO DAY <br />TG a0 ,LIECNAB6E ~__~ iwa <br />'0"2IJ•,-C` "]) (14-151 (26"DJ (1a 19} Goal} NO ead Instructions before completing this form. <br /> (3 CerU OnyJ QUANTITY OR LOADIN (4 Card Ony) OUAMfITY OR CONCENTRATION NO. FREOUFNC SAMPLE <br />PARAMETER (46-53) (54-61J (38-46) (46-53) (54-61) EX OF TYPE <br />(3?-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(68601 ANa[rsls <br />(64-68) <br />69-70 <br />FLV4, iN CUYUUIT CF <br />THi1U 'I'ifEAT <br />EM <br />L SAMPLE <br />ME J~ <br />' <br />G6 <br />SU <br />C <br />D~ <br />~s ( 03 aoaar ctr:; ::t~so <br />D <br />H <br />AMT <br />T P ASUREMENT (~ <br />. <br />i . <br />p rt <br />SUUSO 1 0 1 :: -PEEIMIT ®EEUg2 AEPGR7' `: 4 axaa a>or ,u <br />~- / <br />6FE'LUE;;T ~kOSS YALUE #fE0U1REMENT. 90DA ~t6 DdIIY M~ fGU a aaa4 ~ ~~j.6 <br /> -- ~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> taEgUIRBLt~rxr "~ , . ,~ <br /> r <br />It <br /> SAMPLE <br />MEASUREMENT <br />~ <br />~Ov <br />v ~ <br />S <br /> ~ t ~, <br />te. u ~$, <br /> ~ . <br /> ~HEElOI~iEM~t$T, t ~ ~ ~ <br /> .- <br /> SAMPLE <br /> MEASUREMENT <br /> ~R <br />i - ` •. -' , ,..~ ~} i", . - "e <br />' it i <br /> .Y <br />F <br />. <br />'R~QU~?~ENT ~ <br />„_ <br />) <br />, , „ <br />~ r> <br />Y ~ ,:. <br /> SAMPLE <br /> MEASUREMENT <br /> ~o~~~iE~tr " ~.~ ~~ , ., <br />' , <br /> I <br />~ ~ <br />: <br /> SAMPLE <br /> MEASUREMENT _ <br /> SIT '-~ ~ . <br /> U e4 <br />y <br />~ <br />A. <br />J <br /> ~ . <br />i <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OFI <br />AM FAMILIAR WITH THE INFORM IfW THAT I HAVE PERSONALLY EXAMINED AND <br />ATION SUBMITTED HEREIN <br />AND BASED ON MY TELEPHONf DATE <br /> : <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICAM <br />PENALTIES FOR S <br />BMt <br />INCLUDING THE <br />.IITTING FALSE INFORMATION <br /> U <br />, <br />. <br />POSSIBILITY OF FINE ANO IMPRISONMENT. SEE 1a U.S.C. § 1001 AND 33 U S.C. SIGNATURE OF PR CIPAL EXECUTIVE <br /> § t3f9 (Penellies under esa sreMes mey include lines up ro St0,000 end or A A <br /> <br />TYPED OR PRINTED <br />menmum impnsonmem d( en6monrhs entl5yeers.) OFFICER OR HDRIZED AGENT <br />NUMBER ' <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/e2nce all attachments here) - <br />TJS LIMIT MILL UE Bl19~U ANU 3ETTLEARLF. SOLIDS LIMIT APFLIEU FCA C=l0YE,24Htc FAtCIE E1lt7~ 7~5 d <br />~:TTLEAALE SOLIDS L1RIT pAIYED FGA >l0YR,2QRR PiECIP EYEYT SU6.]ECT TC AUAUEN OF FFCCE Ill I•l.i. C1L E <br />~~EC ~v_ r n v r <br />EPA,FOrm 3320-1 (08-95) Previous editions may not be used. ~ - , ,-, {~~,P ~.. GES EPA. OEiM T-40 WHICH MAY ~O.X @E-USEO.). n n n ~a • o n r r - ~ _ ~ c c >t .. ~~ . PAGE • OF <br />