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PERMITTEE NAMEIADDRESS (include Facility Name/[ncafion ijOr$erenu NA' <br />NAME S~NECA caALccnFAi~Y <br />AODRESSD:{A~BR 0 I <br />MA1UEti CO 81E39 C <br />FAGLITY ~ ~' U,' U { ~~~ <br />LOCATIO~AiUEN CO EItjU FRpM <br />AT'iK: G. SUD HFOaM, GEMSRAL MA!iAGEK <br />MINATION SYSTEM (NPDES) Form Approved. <br />REPORT (OMR;91 ti ~G H OMB NO. 2040-00~ ` <br />Approval expires OS- <br />(S11Pfi 6~) <br />DISCHARGE NUMBER ~ - k I U I L ECU 1 T <br />• RIOD ;.I~CflAF4E lC,.,G~ASSZ CElEN <br />.. EAR MO DAY .-~.~~ ~ w.~ <br />5 ~G °•4r NG t •iL1 ~ '~ tas <br />rzs zr) !i'8~79J 13d~31J NOTE: Re. ~d'uctions belort_~aompleting this form. <br /> (3 Card Ony) QUANTITY OR LOA (4 Card Ony) QUANTITY OR CONCENTRATION ~ 0[ FREOUENC SAMPLE <br />PARAMETER (46-53) (54-61) (36-45) (46-53) ,.(54-67) "~x ~ ~~, ;, OF TYPE <br />(32-37) AVERAGE MAXIMUM S MINIMUM AVERAGE MAXIMUM UNITS <br />l62~ra1 AWALrs/s <br />(64-66) <br />69-70 <br />NI ,R E <br />Y I S U A L SAMPLE <br />MEASUREMENT a# #c~ ~ 1 '1U) ##a#~+; .card ~. #sa:a=; <br /> <br />~ „ <br />j~I C{~ <br />r <br />t.4UGt 1 U 1 ~_pERMIT. ~ '~-,-_-„ E5=1 <br />• ?RQ ,3 sea -~ <br />• iCf/~. ~. <br />effLUEkT GROSS YALUE -~EgUI~EMENT ~C=0 ~ _ ~~ • epee • <br />~: ~ CY7N ''`~~ <br /> ~-n <br /> SAMPLE ,14',.. <br /> MEASUREMENT <br /> pERMFT'_ ~ f <br />~ r ~ <br />~ ','' yrr' ' ~^ <br /> t~~)E1 ~7 .. <br />'_ I <br />~ 1(1' V i k ~ V P L 'Q ~ 4t ~~' .:• <br />•• ~ r ~ }`S <br /> SAMPLE <br />MEASUREMENT ~ i l~ <br />~,~,~ ~ t ~ K ~ V` ' ~ <br /> Y MlT a ~. x s <br />~ <br /> ~- X11 ~M~r~Y~ ~ ~ ~- <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> ~ i <br />•.. <br /> l7i~M~kT <br />gC ..~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> N`f <br />~I <br />~ <br /> 1i~WI <br />fvi~ <br />I~ - <br /> SAMPLE <br /> M EAS <br />E NT <br />U <br />R <br />E <br />M <br /> ~ ~ <br />(~ <br />~ <br />~ <br />y <br /> i~EgUlFEfa6Nfi , . v - . <br /> SAMPLE <br /> MEASUREMENT <br />~I=HMIT. ., ~ <br />F __ <br />~' <br /> <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF [AW THAT I HAVE PERSONALLY EXAMINED AND ` TELEPHONE DATE <br />AM FAMILIAR WITH THE INFORM ATION SUBMITTED HEREIN; AND BASED ON MY \ <br />INQUIRY OF THOSE INDIVIDUAL \ <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> <br />THE INFORMATION, I BELIEV \ /, <br />I <br />E THE SUBMITTED INFORMATION IS TRUE, <br /> <br />ACCURATE AND COMPLETE. 7 <br />~' <br />1 AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTIN G FALSE INFORMATION, INCLUDING THE <br />POSSIBIUTV OF FINE AND IMPR ISONMEM. SEE 1B U.S C. 4 1001 AND 33 U.S.C SIGNATURE OF PRIN PAL E%ECUTIVE <br /> 4 1319. (Peneaies untler these slelules may include hoes up ro 510.000 entl w OFFICER OR AUT ORIZED AGENT AR <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED maximum ~mpnsonmenf of 5elwaen6monMS end Syeers.J O <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />TS:; E lAOR LIdITS ~I11 8E NAIYEO E SETTLEABLE SOIICS LInI4 APi'LLEi: ECF <=1UYH,2/JEF FGYC]F kVfA1; '155, <br />IduN E ~aTTL6A6LE SCClllS LIHi75 itAIVEC P08 ~lOYP,iUH9 PFECIf E4El12 SI;EJkCT TC BUELEI C! i6CCE I! I.A.1. <br />c T T i n T <br />' ~ .1 " r Col nr!FC GOA F/lOA/ T~l1 WMICN YAV NAT RF I IAFO 1 .. .. .. .. w ...~. PAGE . OF <br />Ana r___- o.nn ..nr.nm o.....:,..... ..a:.:,..... ......, ....r. ... ..,, . ~ . _... . <br />