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Imo' <br />PERMITTEE NAME/ADDRESS (/ndude Pac;r;ry NamdLocarion ifOigzrmq <br />NAME ^Y P6:; crc.T,, ~., r(14f'R~~^rDY <br />ADDRESSgAI,LL qT.a~ ^~raLcv <br />~ F. v. nny f.n <br />~!~,'~;~ Co 91626 <br />FACILITY <br />LOCATION <br />?PT.`~ k~ECP~~• V:7,7SI1. V.F. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPOES) <br />DISCHA6 GE MONITORING REPORT (OMR;W <br />-ten TVnTli nri r-'I ,•~ r•~~ <br />PERMIT NUMBER DISCHARGE NUMBER r _ r• r t. p I <br />FROM <br />MONITORING PERIOD V J •: ^ F ° b - 07 V T^ ti: T <br />YEAR MO DAY YEAR MO DAY <br />~o Du Dt ` ro ~~ ^~ ~': sas en PTSr'411Pr,^ r '~ <br />(zo-zr) (zz-za) (z4-251 (zs-2i1 !ze-24) (3oau NO~E: Read Instructions befo~ ~eting <br />this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONC RATION N0. fREOUENC SAMPLE <br />PARAMETER (46-53) (54-61) (38-45) (46-53) (54-67) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNI S MINIMUM AVERAGE MAXIMUM UNITS <br />(62431 ~^1-ors <br />(64-68 <br />69-70 <br />!)Ii .4~Ji1 ., ii F. '•. '. SAMPLE ,nk,.;Rtrn ( '7q) ..~. .. trcnnr.•: rte.. +:i:,. <br />VISUAL MEASUREMENT <br />"ti :: t.~ 1 U B PERMIT P17~#9i0 ~"'-. ... r^.I .('t rf 4790nr~ IdtiRli4' O'.`r. Nt^If CSk~I'~f. <br />=FFL1iP:T ':°.^;$ YA(':} REQUIREMENT aS! ?!x~"" '77=0 - .. =~'..""` ~~'° <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' '"' <br /> REQUIREMENT " , - .x.' ~~'.~ '" " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ,4,. .. k`:.': --: <br /> REQUIREMENT ~ I,''" a <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT "~; ~ _ <br /> REQUIREMENT - ~ " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMtT - - <br />~ xe =;~., ~ I , <br /> REQUIREMENT - ~".. _ ~- <br /> SAMPLE <br /> MEASUREMENT <br /> ~-PERMIT - <br />~ ' '~. <br />^ :«+:~ .: .. <br /> ~ <br />- ~ <br /> REQUIREMENT ; ' ~*. . <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />"~ , «+ ~ - ~ <br />~~ <br />' ~ - =tc.,:_ , " - t <br />' <br /> REQUIREMENT - h <br />"+= st".:" <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXPMINED PIJD TELEPHONE DATE <br /> AM FAMILIAR WTM THE INFORM ATION SUBMITTED HEREIN; AND BASED ON MY <br />Richard hSllls INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION <br />I BELIEV S IMMEDIATELY flESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION IS TRUE, <br />~ / <br />/ <br /> , IC <br />E <br />~ - <br />! r~~~ <br />J' 970-II7D-2712 7 28 99 <br />Environmental Manager p <br />~ <br />C <br />AF TM <br />A ~~, ~,~ ~,. <br /> ENALT <br />IES <br />OR <br />SUBMnTIN NFORMARON, <br />NCLUDING <br />G FAL E <br /> POSSIBILITY OF FINE AND IMPR ISONMENT. SEE 7B U.S.C. 41001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 6utl~~nes up ro S+fi,ooo erM a <br />r <br />~ <br />nA <br />~a <br />m <br />um <br />m~rwmeM <br />~ <br />m OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED on <br />Olt <br />ee <br />nt <br />hs <br />tl <br />ay <br />r <br />fi m <br />COMMENTS AND F>(F'LANAI ION OF ANY VIULA I TUNS (Reference 81/BRaCnmenTS nele) <br />.^,%Ti LF,F!:L'~. i"l.i~~ Lia7^ ;TVc~ FRF >t~~Y", ?49R P^p'rrP '?VF-r--~~- '. 4, j, nr r:,r, vin rr', •ocyc. liT~. ~T• F. <br />';l?;ASo G3.7F' ~A°:~[.~ 7'.'(.:.Y;Tc, pr-•DiR°~ I° Y7:I+L" ^Il?ON Ic R`rSFn+;r!1, nm^^r+ -pw~:rrur r); ^,TDifY'?7n4ti-?. ,R, <br />EPA Form 3320-1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />Form Approved. <br />OMB No. 2040-0004 <br />Approval expires 0531-98 <br />~~r <br />- .. r ,1 o v <br />