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PERMITTEE NAME/ADDRESS (Include Facility Name./Location ijDigerem)
<br />NAME
<br />_' C~rLCKYO CGAL Crl' dA1iYe L. P.
<br />~ADDRESSC O L O Y Y 0 l I K F.
<br />171 STA?E HIGRGAY li
<br />FACILITY'1hEKEH CO 816u1
<br />LOCATION
<br />N "PTA: J. D. HAHMOY, GiN%:<4L M?'J A;: tF:
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FOfm AppfoVed.
<br />DISCNARGE MONITORING REPORT (OMR; OMB No. 2040-0004
<br />/z-rsl l1 ~ e) ~ r p (} a Approval expires 0537-98
<br />rntf!-Ii~4i'R1 nnT a (SL'NR N4)
<br />~. PERMIT~NUMBER DISCHARGE NUMBER f - FI !SAL HOFAT
<br />:~:
<br />MONITORING_•PERIOD STRpFiE9 f~L'LCH TG GGOD SP175 CP.
<br />YE;4[iI IMO DAYy~r YEAR MO DAY __
<br />FROM Oq Dtt ,~' TO DD 05 30 %'~`'~ tip] DI3Ch/P,:% )__~ ra::;
<br />Izazr) Izz-z31: ~rza,"-~s-7!' fzs-n) (zes91 r3asp NOTE: Reatl Instructions before completing this farm.
<br /> (3 Cerd Only) QUANTITY OR LOADING (4 Cerd Only) QUANTITY OR CONCENTRATION
<br />r N0. FREOUENC SAMPLE
<br />PARAMETER (4653) (54-67) (38-45) (a6-53) (54-67) EX OF TYPE
<br />(3Z-37) AVERAGE ~ MAXIMUM
<br />' UNITS MINIMUM ~~ AVERAGE MAXIMUM UNITS ANALY3/S
<br />70
<br />69
<br /> a- rsa601 (64-68) (
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINEO AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN
<br />AND BASED ON MV
<br />
<br />` ~ f TELEPHONE DATE
<br /> ;
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOP OBTAINING
<br />THE INFORMATION, 'I BELIEVE THE SUBMITTED INFORMATION IS TRUE: ( ti •.
<br />1
<br />^~ .~R/(~S'V"~
<br />Y
<br />/" ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />PENALTIES FOR SUBMITTING FALSE INFORMATIO
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<br />~ N, INCW
<br />ING
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<br />1'f71 y ~~~ ~ ~ POSSIBILITY OF FINE AND IMPRISONMENT. SEE 10 U.S.C. 4 1001 AND~33 U.S C
<br />e SIGNATURE OF PRINCIPAL EXECUTIVE i 1. r T U~ /!: m7
<br />~ r. .7 (.. l1
<br /> g t319. IPenenies under these sbrutes may include lines up ro 510,000
<br />nd.or
<br />~ OFFICER OR AUTHORIZED AGENT 'ARC
<br />TYPED OR PRINTED maximum impns^^ment al baMreen6m^nths ends years.) ',~'~.~
<br />' ' ~ NUMBER YEAR MO DAY
<br />
<br />COMMENTS AND EXPLANATION O F ANY VIOLATIONS (Reference all attachments here) "4 '
<br />5'.'fTLE".BL° SOLIDS LI:".IT A?PETE, ~~'ILY TF <~lOYR,2gY1R"fl#ICIP EYEMT,ZS CLAIhF.D. IF CLAIM AFPROYED RY Y,^ICU,
<br />1'55 t; IKON LIMITS MILL NAT U6 AP?LIF.B TO HF.POkTED MC55URE7fE1tTS - SEE I. A. 2, PG. 5 FOR BllHDEN OF .?ROOF .
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