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PERMITTEE NAME/ADDRESS (!nclude FRCilinovamr/Cocation i/ORrrenq <br />NAME :,ChF.CA CGAL CGI"FAE.Y <br />ADDRESSU i? A a E h D <br />HAYDtiN CG 81639 <br />FACILITY <br />LOCATION~e70Eh CO tl1630 <br />~TTN: (;, bUC b3CwA, CE?~ESAL CAN6GEN <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Fofm ApprOVed. <br />DISCHA6 GE MONITORING REPORT (DMA OMB No. 2040-0004r <br />r+h~Bl C I i+C h Approval expires 0331-9R <br />(SUER Nli) <br />PERMIT NUMBER DISCHARC.GE N.HMBER E' - F I ! ~ I EIC~ 7'i <br />MONITORING PERIOD Cli b i, :i i C 4 f T T F _° 7 I i G r C F ~ ~ e h <br />~' YEAR MO DAY :' YEAR MO DAY <br />FROM Y yy v.• :~_ '~:~>r ht: II~CHAfiGE ~„_~ ~~~ <br />rzo-z+l nz-zal na.nel nfi~zn Q&29) ra>sn NOTE: Read Instructions before completing this form. <br /> (3 Card Onry) QUANTITY OR LOADING. Onty) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-61) (38-45) (46-531 (54-61) EX OF TYPE <br />(3237) AVERAGE MAXIMUM <br />UNITS ~ <br />'MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />ANALYSIS <br /> rez.~) r64-68) ss-~D <br />.nEYFl;CT SSATkE 70A1 SAMPLE ;:Vn~~~ oso~zr^ ~-_:~_-~~: t~KaKe ( ;~) <br /> <br />~IIl, CEi{IUUA4HNIA <br />MEASUREMENT <br />7 ~O I <br /> <br />rcl3e s l c PEAMIr * a; <br />- KaX. s« ~oe4oo+a pRe~ ra- irlg <br />. <br />SLL CUi1HEKTS BELGr REQUIREMENT '`''t+ ~T' <br />~ ;;„„ ~~, f~~•.. CE17 , <br />:tFFtC: STATBF /DAY SAMPLE "'~~'..'I~ VO>0 YI~A i>;+C ~ KKOA ( ,j) f <br />CriR PItSEPHALES MEASUREMENT >IOU ^ <br />I,/ wtp <br />fCNbC S 1 G F $MI'I, 04 0 4Ai <br />~ +1+1t y~j.0 :.: IPA p #~I >M 9 FF- {: TIiB <br />SEt; CGrtYlEhTS fELCII ~k`QE1REb1~NT ~ ~' K1(~~ ~~ CEl7 <br /> <br />SAMPLE _ <br /> MEASUREMENT <br /> ' -'$E96d1?~' . . , ~ - <br /> <br /> SAMPLE <br /> MEASUR <br />EMENT <br /> IIvY <br />~H <br /> EMENT <br />~~Rl1 ~~~- '~ ~ ';a , .+ '~' _~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERN117• : ~. ar <br /> '•13EQ~IRENi~la1T' .' ~, I . - ~": <br />~' .~ '. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> pE~?UTAI=HENS ~ ?rat <br /> SAMPLE <br /> MEASUREMENT <br /> s ~~-eEAMIr ,~, Y v F~ .~ <br /> R~arit~~~` ~ ~--~ ~ ~~° <br />NAME/TITLE PRINCIPAL EXECUTVE OFFICER I CERTIFY UNOER PENALTY OF L <br />AM FAMILIAR WITH THE INFO AW THAT I HAVE PERSONALLY EXAMINED AND <br />N S <br />BMITTED HE <br />E TELEPHONE DATE <br /> BM <br />INQUIRY OF THOSE INDIVIDUAL A IO <br />U <br />IN; AND BASED ON MY <br />R <br />5IMMEDIATELY RESPONSIBLE FOR OBTAINING ` <br />~ <br /> THE INFORMATION, I BELEV E THE Sl1BMITTEO INFORMATION IS TRUE. <br /> ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMITTING I AAI AWARE THAT THERE ARE SIGNIFICANT <br />FALSE INFORMATION <br />INCLUDING THE ~~ ~ ~ <br /> <br /> <br />POSSIBILITY OF FINE AND IMPRI <br />, <br />SONMENT. SEE to U.S.C. § 1001 AND 33 U.S C. <br /> <br />SIGNATURE OF PRI IPAL EXECUTIVE <br />,( <br />` n <br />IV <br />~/ <br />TYPED OR PRINTED me i umlPmnasanmenl of behveen fimBOnths entl Sutle lures up to E10,000 entl or <br />) <br />pn years OFFICER OR A NORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . C DE <br />OVMMhN I5 ANU tXYLANA I IUN Uh ANY VIOLATIONS (RererenCe a// a((aChmen/S here) <br />EPA Form 3320-1 (OB-95) PrevioUS editions may~not be:Used: '. (REPLACES EPA FORM T-90 WHICH MAY NOT BE USED.) <br />L <br />00084/99Cfi:7-I8~53 PAGE 1 OF <br />