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PERMITTEE NAME/ADDRESS Onclude Facility Name/Locarion ifDiffecenq NA~ <br />NAME FICKcfY1IFe FACCEYSIGG, LLC <br />ADDRESS•y t: ii t L iti r I ti E C <br />1111 UAEbTiiCCC CFIYE' L <br />FACIUni:YAA5YI1if IF >t7711 <br />LOCATION. C C S I C 71 <br />"L=,°r"~ FROM <br />ATTN. Al. Gt_FrkY- M•AkAC,fH <br /> <br />"ZONAL POLLUTANT DISCHARGE ELIMII{ATIQK} M (NPDES) Form ApprOVed. <br />2040-0004 <br />OMB No <br />. DISCrZAR GE MONITORING PO 17;9J C L } C P . <br />Approval expires 05-31-98 1. <br /> <br />PERMIT NUMBEFI ; HARGE NUMO ~;? - } F i L P. C A S <br />MONITO G PERIOD ~ E C: i. i'? I C _` E >• A C E 7 i C 1 C 6 <br />~ <br />~ <br />YEAR MO DAY <br />YEAR MO <br />. -_C <br />act AC ~~ <br />CIICgl~fif <br />IL4i <br />TU <br />, <br />rzowl rzz~zsl rza~zsr.. ~ ire rzfi vl ae-z9~ (3031) NOTE: Read Instructions before cpmpleting this form. <br /> (3 Certl Only) QUANTITY OR LOADIKIS' nN/ QUANTITY OR CONCEN flATION N0. FHEOUeNE SAMPLE <br />PARAMETER (as-53) (sa-s l) . I , a-45) les~53) . ( •sr) EX of TYPE <br />(32.37) AVERAGE MAXIMUM .~1NITS MINIMUM AVERAGE ~ ,_'~'A+XIMUM UNITS <br />l6asT) ANALYSIS <br />(64-68) <br />69-70 <br />~GL, S-uAY SAMPLE p{rrr:,,::~^. r~iL^fi>? .. ..::70# I IS) <br />(2U Lf.U• C) MEASUREMENT y <br />UIIU A U G ~..', 00 >a - 9 +!'. ;ac wrreoos FEf(, .3 "ia <br />'1ISIAFcC'f,PAC~ ~NF19 s~ -~ ~' <br />+ cr,:? :0 <br />. EY: ~~'t CC/1 61~G. <br />FY SAMPLE. "~Z'r}'"~'` ;0000 ~.A~r>7 <br />'? ( Ia) <br /> MEASUREMENT <br />cuuc A u u ~~~~ `t <br />- o o~e~ ~;: ~ aa; s~so>~ea -,~~ . ~° , <br />r <br />I'1iC: CYe 17 <br />L:SIhFcCT .. <br />REdI11R NIEIJI'- ,~$' ~ <br />"-`" '4~`,~ sto4 ~ -.. <br />~ -' <br />~ ~ SC <br />*`~ . <br />, > • r. , - <br />SOLIDS, ?C1'AL SAMPLE C~c~OL~D OLIPICr?0 4 ( 1S) <br />' U S P f: 6 L t U MEASUREMENT <br />~U7jU A G 0 PfiRMIT # , <br />- <br />, CC4 ~t404 7.~.. FIEF ~ :: ,~:'!,,; ~`_./- . ' ~•',.: <br />~:SINtLCT,YACS CPF1T =1?ES~UIREMENT ., <br />. <br />,. <br />_~'" ~:4`" +CO.c ~~~#,~r°' : 7. 11~' -C/1 ~~' ! <br />TL ANL C;fiEASE SAMPLE LGO~O9 CYdLIC ~ <br />•~ L I I'i) <br /> MEASUREMENT ~ 7 <br />.i5y2 A U C ~~ PERMIT ~~ :- Ct0 :' 10040 0 ~ :M, ~ -~- <br />~ b/~' = <br />LISLI4FECI <br />PACS CCF11 '~~4UIfiEMI:E17~ ~ - <br />~~` <br />S <br />~ ~ a;ao p' '~~ir`f`~~ FC/L ~~~ <br />- ' ~~ <br />, , <br />. <br />e <br />., <br />FLC'.', lti CU HDUIT CF SAMPLE 1 Ci) >tsaoa o; az~r°% S•'•tG>: <br />i is ;; U 'f ~ E k'I A E b T F L A A I MEASUREMENT <br />~uuSU n U C P):HAIiIT , ` <br />''.A GCB H ~s o b ~q ,~o sac 4Ri f91'! <br />DISLtiFh-C'I,k'i1C9 CtlFC1 RIi4bIREMEMI; , <br />`~Q ~` ~~' ~ = ~"y`"~ PGC ~ ~ ~ ~~ RLC: ~`T°" ` <br />CLIFr_MK, FECEIL SAMPLE K~C>rL04 OYQ499 ''~i >rv9d ( ~_) <br />;; i. N c !i A L MEASUREMENT <br />7uu~~ A u C PEf3M}F7~~ ~ 4 ?~ ~ aat aoar,o+o~~ ~. ~ t ~-_ / C1/" lrl~~ <br />DI~I:rFCi,PnCS Cf!PL1 R~QUIgEM1rNT "~ >: ~~'~~ . CCC+~ -~C.~~ 'bi~~1G ~~("~ ]CCI'I ~ ~41f2t <br />%IL AhU c'h EASE SAMPLE 4L;}'I 'Y' I 9ll) ':x~a>:» AO#CL t.ttt+: <br />Y I .i U A L MEASUREMENT <br />r4 v1, :. A U C --',PERMIT. ~ 0 ~' v ;&.~,:. E<=t aao40 A- ~, oax 1.5 75ait, <br />L~uI~.E~c:,FA:.s cr~rllp`uIR><Met~T _ ~'Xf~rc=c xs=:: <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM WW THAT I HAVE PERSONALLY E%AMINEO AND TELEPHONE <br />ATION SUBMITTED HEREIN; AND BASED ON MY DATE <br />INQUIRY OF THOSE INDIVIDUAt; <br />• ~ ~ ~ ~ ( THE INFORMATION, I BELIEV $ IMMEDIATELY RESPONSIBLE FOR OBTAINING ~ <br />E THE SUBMITTED INFORMATION IS TRUE, e <br />IFICANT <br />E SIG <br />{ ACCURATE AND COMPLETE. I AM AWARE THAT THERE AR <br />N <br />n PENALTIES FOR SUBAi1TTIN <br />M k h ~, ` ~ POSSIBILITY OF FINE ANO IMPR G FALSE INFORMATION. INCLUDING THE 1t O/~ ,~~ , <br />ISONMENT. SEE 16 U.S.C. § 1001 ANp 33 U.S.C. S GNATURE F PRINCIPAL EXECUT E C V ~V O <br />TYPE OR PRINTED marimum(~~ronmant'or0.~ee ~6 mBOnrhs entl5ye rs.) s up (o E10,000 entl ar OFFICER OR AUTHORIZED AGEN~ <br />E <br />NUMBER <br />YEAR <br />MO <br />DAY <br />coMMtrv I S Arvu rxrLArvA l Irv ~r ArvY vIULn l Ivrvs (nererence au amacnmenrs nere~ <br />~~~ L'eY AYLkAGE IP h:Ch:ST !!CtiTNIY AY6. CUAIlG F`_!i1CC ri?FCt+11L. CI1 t: ChFASE ~ REF I.E.I.C, I. S. <br /> <br />i <br />~. <br />i <br />i <br />EPA Form 3320-1 (OS-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED:) PAGE OF <br />.. ,r:a„a.r~y,-~,-:.,-._.~:., . - . oacasiucc~~:c 1 <br />