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PERMITTEE NAME/ADDRESS Onrhrde Facibh~NamaJCocation JDiJferenq
<br />NAME Ki:1 tl, I••C.
<br />ADDRESSki~.°.i~:i 'ill.".i::C::+ Cr•CPh "ltl!
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<br />GcA!.C JLh~';IiA CC Ei`_Gi
<br />FACILITY
<br />LOCATION 1, F:. ~„'. L;~.lr ,._ rice
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR~
<br />f2a51 (n~ 9)
<br />CC'JCG~c_`;S Q A
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM U4. L~ _"1 TO L'~ Lr =•'
<br />(20-2 (22.431 (2a-251 (25411 f2e-4H) (3aJp
<br />Form Approved.
<br />OMB No. 2040-0004
<br />• ~ F• ~ F Approval expires OS-31-98 •
<br />(SuFr ~C) •
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<br />[C:•1-I*IDiG:, F6nCfF :iL: i~.nl
<br />NOTE: Read Instructions before bmpleting this form.
<br /> (3 Cerd On/y) QUANTITY OR LOADI (4 Card Only) QUANTITY OR CONCENTRATION NO. PREOUENC SAMPLE
<br />PARAMETER (46-53) (54-61J (3a-45) (4653) (54-6T) EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM
<br />~11TS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />(s4aT1 aNALrsls
<br />(64-se)
<br />(59-70
<br />' ~~' SAMPLE . , >~~ I t ~ )
<br /> MEASUREMENT
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<br /> SAMPLE
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
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<br />T LAW THAT I HAVE PERSO
<br />ON SUBMITTED HERE NALLY E%AMINED AND
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<br />AND BA TELEPHONE DATE
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<br />H THE INFORM
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<br />INQUIRY OF THOSE INDIVIDUAL ATI
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<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
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<br />~ THE INFORMATION. 1 BELIEV E THE SUBMITTED INFORMATION IS TRUE,
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<br />I ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
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<br />F~ +-~ ~ PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDIN
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U S.C. 4 1001 AND 33 U.S.C SIGNATURE OF PRINCIPAL EXECUTIVE 7 ~ . J (,(~ '/
<br />TYPED OR PRINTED ~imumf~m dlsonme ~ol benroan~B months entl5utle lines up fo Sf0,000 end w
<br />p years.) OFFICER OR AUTRORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relevance a//attachments here)
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<br />EPA Form 3320.7 (OS-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) C C 1 7 7 / C C C 7 1 1 - 1 t i i PAGE L OF
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