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PERMITTEE NAME/ADDRESS QMi4 F.eWryNa~WLeranm UDpnnp <br />NAME SEh::CA C',)AL COM"rA1;Y <br />ADDRESS D d R 4 i; K D <br />KAYi:en cu 81639 <br />FACILITY <br />LocAnoNNAyUnA C'J d1o3U <br />A:I'h: ~. eUD PN:?.fi, ~:..r::r,AL "A&AG°R <br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM (1VPDE3) <br />DISCHARGE MONITORING REPORT /OMRI <br />1-16/ 77-191 <br />PERMIT NUMBER DISCHARGE HUMBER <br />MONI RING PERIOD <br />YEAR MO DA ~„ YEAR MO DAV <br />FROM Y I Jl .:'TO 7 ! ~ [ <br />r1a1/I ru-13r 114-1 r16.1n as-19~ r3a3/1 <br />Form Approved. <br />[. I e C 4 A F f; `' '? 0? P L N9MB;~o. 20t4~-OQ04 • <br />(~ U F ~ h Yi) Appravelle><p3rre>j05-31 a98 <br />f - rz~er. <br />"IiN9A v <br />BI TE: Reed Inetructiom bslore completing this form. <br />PARAMETER I3 and Onhl QUANTITY OR LOADING !4 rd onhl OUANTITY OR CONCENTRATION NO. FAEOUENCY SAMPLE <br /> 146-53) 154-6/) 138~6I /46-53 F51-5I1 <br />EX OF <br />TYP <br />131-37/ ANALYSIS E <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs1-sm /64-661 169-701 <br />Pd SAMPLE {SA O+}V~ .:~}:Jt fir} ~ <br />~ t {af. {; r; ~ IZ) ~ I <br /> MEASUREMENT ~ <br />. ~ <br /> , <br />UOULiO 1 1 U PERMIT ulkra~.p a<:r:lrrv ., 6,5 OA>.`gOfi <br />~ ~,rt ?N / jN5IT~ <br />cFFLUENT GK057 VALU REQUIREMENT ~ Y~a~ w? NIN~p~'~: . <br />~ MAXIMU!' SII ~ 1IOATk <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERn Fr UNDER PENALrY of uw THAT I HAVE PERSONALLY ExAMwfD AND <br />E <br />1 TELEPHONE DATE <br /> <br />11~ P~ f ^~ <br />B <br />1 v~.J vVy~QS D ON <br />AM FAMIUNI WITH THE INFORMATION SUBMITTED HEREIN; MID BAS <br />MY INQUIRY OF THOSf IMDIVIDUMS IMMEDIATELY RESPONBIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS . <br />~~ <br />V <br />1 <br />(' TRUE. ACCUMTE AND COMRETE. I AM AWME THAT THERE ARE <br />INCLUDING <br />BMITTING FALSE INFORMATION <br />T PE <br />fOR <br />1 w ~ <br />LJ( O ~ <br />Ef ~ , <br />AGNIFILAN <br />NKTIES <br />SU <br />THE POSSIBILITY OF RNE AND IMPRIBONMENT. SEE 18 U.B.C. E 1001 AND ]] <br />v O <br /> <br />U.S.C. E 1310. lFYrWtlr. Ww n.,. mnmr. nrY ~A.A. rn.s w ro J 10,000 BIGNATURE OF PRI IPA( E7EEClJTNE <br />R A <br />TYPFD PRINTED <br />U ..e wnMxirvn YllPrliryrNllr ofNhwn 4nwnNa rH 6YrrA1 OFFlCER ORA ORIZED AGENT CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRererenee a// sttecnmsnts Here/ <br />'iSS o IdJV LIrITS YICL H~ YAIYED AND ~FTTLiA9LF.. SOIIDS LIt57'I AFFLIFC FC9 <=1CYF,:'9eR PrttCIP £VCYT; i(i~ c% <br />iBuN LI~I1'S YAIYEG Fan >l0Yb,2uHR PRECIP ''Yi;~T SUBJECT T7 °IIFCQM CF FFCOF IR 7.A.?. OIL E GRL'ASE-St.' <br />i_rl•1_D_ TDC Al1NT4(IR TNC-SF'W T. A_1_r,. <br />EPA Form 3320-1 108.951 Previous editions may be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) D 0 C u 9 / ° 710 ? 1-1513 PAGE lOF <br />