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PERMITTEE NAME/ADDRESS pnc(ude Facihly NamvJGocation jDi$ertntJ
<br />NAME r~rLO+TU COAi. COCFANY, L. P.
<br />ADDRESSCO LOi Y0 !"IKE
<br />SIJ1 STATE RIG9iIAY l.i
<br />FACILITY C. t F. v •' A !-O N 1
<br />LOCATION
<br />!.T'f^: J. v. RARCO':, GfAt:ti.5L 'RYA,
<br />b41
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR)
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<br />"~-~~'>`~, PERMIT NUMBER ~ HARGE NUMBER
<br />' ~- ~ ,. MONITORING PEIiI'OD;'
<br />FROM
<br />`TO
<br />(263]) (16~P9) (3631)
<br />Form Approved.
<br />"I N 0 R OMB No. 2040-0004
<br />Approval expires 05-31-9R
<br />(5UlTR KN)
<br />P - PISAL lIQPAT
<br />E'. TAYLi:i POL'D TC TAYLOR CA£EK
<br />~~'=' .J CIS('F'.APGF. ~`r,.>,Yr,.
<br />NOTE: Read Instructions before completing this form.
<br /> (3 Card Only) QUANTITY OR LOADING - -rR'I .Tja CrW Onty) QUANTITY OR CONCENTRATION N0. PREOUENC SAMPLE
<br />PARAMETER (46-53) (54-61) h~:,' (3B-45J (4653) (54-fi7) EX OF TYPE
<br />(32-3]J AVERAGE - MAXIMUM ~ UNI75
<br />j, MINIMUM AVERAGE MAXIMUM UNITS
<br />(62631 ANaLVSts
<br />(64-6B)
<br />69-70
<br />1 ~ SAMPLE r.'=:tn•;: •e :s-et~~.-, pnll#pi".`- ( Imo)
<br /> MEASUREMENT
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<br />. TIIA>'fL~#3`. -0 ;.•~+% '~' "~ ~`t''~• ..~ s BRgLY 1T5IT(
<br />c:FFLUE'?rT G>tU55 YALUf REQUIREMENT. -
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<br /> MEASUREMENT
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<br />(AS F'E) MEASUREMENT
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<br />NA rs
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY EXAMINED AND
<br />ATION SUBMITTED HEREIN
<br />AND BASED ON MY TELEPHONE . GATE
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<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBIE FOR OBTAINING ~ ~ D /
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<br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. j'~y p
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<br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT ~
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<br />PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 10 U.S.C. 4 1001 AND 33 U.S.C. .-
<br />
<br />f$IGNATURE OF PRINCIPAL E%ECUTIVE Q ~'1 G!~ 1/- //. /...
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<br />TYPED OR PRINTED ~ 4 1319. IPenetties antler these statutes may mclutle lines up ro Et0,000 tmtl or
<br />merimum imprisonment of Uetween6mpnrns entl5yeers.) 'OFFICER OR AUTHORIZED AGENT ' A
<br />,cop`
<br />NUNIBER
<br />YEAR
<br />MO
<br />DAY
<br />GUMN1kN I S ANU FXPLANA I IUN OF ANY VIOLA I TUNS (HefB/e/ICB ell BftaChmentS hale)
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<br />SE'PTLE.4nLE: SOLIUS LIf?IT A?FLIP'[: ONLY IF C=lOYti,2UNf: PkfCIP P.YENT IS CLAIEtFD. IP C.`
<br />fi APPROYF.D 9Y '~G+'C,
<br />T55 e ;ROY LIr.ITS 41ILL NOT yF APPLIED TO Rs:FORTF.D '~RASt?P.ERENTS - SEE I.11.2, PG. R BURDEN OF PP.OOF
<br />TOi wO wT
<br />EPA Form 93261 (OB-95) P,Cevious editions`may riot be used. ~ ^
<br />.~(REPLACES EPA FORM•T-40 WHICH,MAY' NOT.BETUSED~)°v ~ `"~ ~ ` ~ ~~~ ~ ` V ` ~ ~
<br />PAGE OF
<br />-' " ~`4310004C3-1907
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