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PERMITTEE NAME/ADDRESS (lnrlude FarrLry Namr/Comnon ifDij7erenU <br />NAME SdNE:CA CGAL CCCkl6Y <br />ADDRESSD R A I. Y R D <br />AAYCEM CO 8163'a <br />FACILITY ~ 1 - D ~ - C <br />LOCAT101>~AYDEd CO d163U <br />A'".i:: 1„ cl;u Et,C~At., CENESAL F4AMAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARJGE MONITORING REPORT (OMR~9! <br />..~,, ///~~I ~ ERMIT NUMBER ' qGE NUMBER <br />. 7`~ MONITOQI~JG PERIOD <br />YEAR ~ MO OAY ~; ~ ~ YEAR MO OAY <br />FROM ~-~--Y- - <br />f10-2tJ (22~1J) -_ - (2621) (28291 f30-J I) <br />Form Approved. <br />OMB No. 2040-OOQ4 <br />I S G N Approval expires 05-3t-98 <br />Isuea ~:rl _~ <br />f - !. 1 b0111i <br />CIS CE ^.C CFAS_Y CfFElI <br />o' rc [IS~AAFCE 1;_t asa <br />OTE: Read Instructions 6efore'cbmpleling this form. <br />soot c <br /> (3 Cerc/Ony)~;QU~4 <br />f1TITY OR LOADING _ dOnlyJ OUANTIIY'OB~GONCENTRATION <br />~~~ rvv. <br />EX rmcwcn~. <br />OF <br />TYPE <br />PARAMETER . <br />(46-53) ~ (5167) (38x5) (46-531",, l5g-67) ANALYSIS <br />(32-37J AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM 'UNITS r~.~l ( <br />6q-68J 69-7D) <br /> <br />1 h <br />SAMPLE 4A0 -C 4000 <br />Q~ f ~ -. ~OOi <br />V ( ~~~ /~ ` <br />. <br />"1f 1 <br />I <br /> MEASUREMENT O J <br />. Y <br /> ~ a vagbi; <br />° j . 45, <br />UI)uUU 1 U 1 FF. .. _ <br />o, q ~ <br />.s ' ~1~9 <br />tFFL'Ji~el' GRU55 YAiUE N~ '<" ~{j~xNi11S UC <br />F .U <br /> S <br /> MENT <br />~ <br /> ME <br />$E <br /> <br /> <br />y~. n. r 1.1 <br />~, <br /> <br />- <br />W+. <br /> •IEOtlIR~t}~, , <br />~ ~ . <br />- i --~ r <br />~ - <br />-"~ <br /> SAMPLE <br />MEASUREMENT d ~ <br />~ ~ <br />V i ~ ~ <br />~f I <br />` <br />/~~ <br /> Ql/. \ C V . \.. < <br />/Z U is -1 t,1 ~ <br /> ~j.~~ <br />J 4y S Y <br /> ~ <br />IE3E(YiFiNT h ~. D h <br /> SAMPLE <br /> <br />MEASUREMENT <br />- ) <br /> /.. <br />- <br /> <br />. <br /> <br />. <br /> ~ <br />~PE ~I~;`v~. ~ ,~ <br />- <br /> REQUIREM€ ~~- ~ ""'~~ <br /> SAMPLE ~ <br /> MEASUREMENT <br /> ~- <br /> ~ ; o <br />": -„ <br />., <br /> F~~Q 111EMENT <br /> SAMPLE - <br /> ASUREMENT <br />M <br /> E <br /> '~,~H~11T ~~ ~' ~ <br /> REOl~1FSEM~NT #`` ~~-t: <br /> SAMPLE <br /> ASUREMENT <br /> ME <br />PF,IiMIT~~ ", ~- , ,"~- - ~- <br />k1Ek";411t~EMENT - „~ <br />,X <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICEfl I CERTIFY UNDER PENALTY OF <br />AM FAMIDAR WITH THE INFORM LAW THAT I HAVE PERS <br />ATION SUBMITTED HER ONALLY E%AMINED AND ~ TELEPHONE <br />EIN; AND aASED ON MV <br />' DATE <br />_ <br />INQUIRY OF THOSE INDIVIWAL <br />~ THE INFORMATION, I BELIEV <br />p N~ ~ J a p M Q S S IMMEDIATELY RESPO <br />E THE SUBMITTED IN NSIBIc FOR OBTAINING ) <br />. <br />FORMATION IS TRUE. i n , <br />NI <br />ANT / <br />- <br />ACCURATE AND COMPLETE. <br />~ I PENALTIES FOR SUBMITTIN <br />/~ <br />I <br />MPR I AM AWARE THAT TH <br />G FALSE INFORMATI <br />S <br />ISONMENT SEE IB U ERE ARE SIG <br />FIC <br />~C./`.t // <br />ON. INCLUDING THE 91GNATURE OF PAl CIPAL EXECUTNE 7 a h S 1 U <br />4 1001 ANO 33 U.5 C <br />C <br />~ <br />~( <br />V ~ ~ <br />s . <br />. <br />. <br />POSSIBILITY OF F <br />NE R~ND I <br />(Ponett~es urMeY III!$B SI8INB5 mey include lines up ro f1QBCd end or <br />4 tat 9 OFFICER OR A ORRED AGENT A NUMBER YEAR MO DAV <br />TYPED OR 'INTED . <br />mesimum impnsonmenrolfptweenBmonths end 5yeers.J <br />COMMENTS AND EXPLANATION OF ANY VIVLAI Iurva tneren:ncn m1 euacnmmns ..o. of <br />i'5S F- IKON LIMITS YIIi CF. WAIYED C SET2LEArLE SCLlCS LIl'IT AFFIItU FCF <=1C£h,~RfF kRECIk E~EA7; 755, <br />IRON ~ SfTTLEAfLh' $CLib;; LIMITS rAI~LD FOA ~lOYF,i4H5 PRECIF pYEA'i SUEJEC: CO Y.UFCfp CF FbCCf I11 1.A.i. <br />_ _ccc T c n Tn • Q PAGE OF <br />___ _ .... __..__ __~ meet wnvv vow cnvu~r-an wMICN MAY NAT RE USED.I ..n nn. ien n~.~a_n1ccS ~ l <br />