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„-. <br />PERMITTEE NAME/ADDRESS pnclude Faciliry NamdLocntion iJDi$nenq <br />NAME ^. P:. (:: v•S r,j P.: rn nD7(1gt,... ,• <br />ADDRESSc•A~~j, ~.~ ~Irr -~~wp? Yy <br />FACILITY C z. A I .: "'1 u t f 7 <br />LOCATION <br />ATTNt ACiG;,"c Vr,.7n•_ _p. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMfl~ <br />f2-161 In- e) <br />~~n~~rnn~ nv <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 99 !)fy 01 TO ~n '!! <br />!26471 (21-231 (24-251 (2627) (2d-ZB) (30J1J <br />Forth Approved. <br />T I , ~ OMB No. 2040-0004 <br />Approval expires OS-31-98 <br />F..; ..op ••C1 <br />^ 1r•:'f. C T/~ ~TTt •IIYi, r'n,Q 4.~Ca <br />`+ NOTE: Read Insiruclions bet plating Olis form. <br /> (3 Cerd Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. REOUENC SAMPLE <br />PARAMETER (4G53) 5461) (38-45) 48-53) (54-67) EX OF TYPE i <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ar/ALrs/s <br /> fasd7l (84-88 69-70 <br />~~'~i. ;•df :{ i'i:~C SAMPLE ':'-•k O:R4 ( .,~() ,.:..e-, ... 1. <br />:x r:.. ,... ,. <br />.. {.. <br />y j': I; A L MEASUREMENT <br />ttU:: f, F, ! ~~ ^ PERMIT CtLa gt49G p ~"-1 6!r#13p i '.n~,-AHR4itdR I ItR~Brth Mrf/ rTSURI <br />•IT <br />FF}~LIIxAT :-n-•^,^, y~ ( REQUIREMENT .: <br />Ilf9I' ~~. "!1-') .: "t iW~ .. <br />~~ V ... . <br />, : <br />- ~. T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - - °-~~- ~ *-`•" <br /> REQUIREMENT ~ ''"~" <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT.' + _ ;' f. -~=' ~-~ <br /> REQUIREMENT `~''~ ~ <br />. ; <br />~ -' •;~ <br /> . , <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - .. f,,;Q.;,,., <br />.~ :. , <br /> REQUIREMENT ''T` ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,~o <br />~ <br />~ <br /> REQUIREMENT .~-,~ „ ;T <br />.iv-'- _ - y ?~~~ <br />~;: ~ =K <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ - - " ~""~`~ - <br /> REQUIREMENT - ` ~ ~~~ - <br /> Si 4 v <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ''~'"~ - • I ~ <br />~ <br /> <br />REQUIREMENT <br />- - <br />~ <br />,,.>~ _ <br />~~~ <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY <br />OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY E%AMINED AND <br />ATION SUBMITTED HEREIN <br />AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDNIDUAL ; <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING ' <br /> <br />Richard idIIIS THE INFORMATION, I BEDEV <br />AC <br />RATE <br />T E THE SUBMITTED INFORMATION IS TRUE, <br />M ` <br />' <br />~ <br />• <br /> AND COMPLE <br />OU <br />E. <br />PENALTIES FOR SUBMITTIN AWARE THAT THERE ARE SIGNIFlCANI <br />I A <br />G FALSE INFORMATION <br />{HCLUDING THE ~ <br />. ,r. ~ / ~~~ / <br />Environmental A1ana er <br />P <br />ILIT <br />Fl , -- , -_ 970 -870-2712 7 28 99 <br /> OSSIB <br />Y OF <br />NE AND IMPRI SONMEM. BEE 1B U.S.C.; 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED 4 131 B. (Penalties untler Nese statutes may Include fines up to 510,000 e/M w <br />mazimum rmpnsonmenl of SeMeenBmanths and5yeam.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />:,EtTLr;A"it )Lj-.~ LT•-T w'q• c y ~') ar npc ._. -^rc <br />'V ~ f':)~ >]0 a 4. r r ryc ~~~~~ nr Tqe ^1: •p.••tT nOyp"y'fG~ rr r <br />CN`'AS£ .4n° "a."'r ~- AA!PLYi T p T qt c .ter-. .,, ~ .. , <br />I4 P.F?LII t D T' U SI ~ ! rc a••ray rn n^" [v •;r 'yo, "'naT~-TTYN^.-T ~'~°Y <br />EPA Form 3320-1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) PAGE OF <br />~n~t5/~~rnt2-t~2~ <br />