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PERMITTEE NAME/ADDRESS (Include Faciriry Name/Locorwn ijDi$erenq <br />NAME `• ^v~~n•.• <br />CYP9v" ... ~ f'rnt>~r~T:ly <br />ADDRESS •„i G [. i ° T ~; H ° ~ - !' T a•r <br />i'. (1. ~iJY r u <br />FACWTY CNA ~~ CO R1626 <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPOES) <br />DISCHARGE MONITORING REPORT (OMR; <br />Rah) nn al <br /> <br /> ^~nn or T99 ~.- <br /> PERMIT NUMBER DISCHARGE NUMBER <br /> MONITOR ERIOD <br /> YEAR MO DAY ,YEAR MO DAY <br />FROM 99 ~4 J TO ~? 1f 1T` <br />(26211 (12.23) Ra 251 R6-221 RB-291 l3631J <br />~-~. ,.. <br />r^n-rp ..ul <br />C - P. .}. <br />Form Approved. <br />OMB No. 2040-0004 <br />Approval expires 05-31-96 <br />„ ~^n' <br />..,, -. ~~ r c,_c'(R Trl`.:.I,~CI/T.Lrv'"^ rrgv <br />NOTE: Read Instructions tielofe-C leting this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Cen'1 Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-61) (3845) (4B-53) (54-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM U - MINIMUM AVERAGE MAXIMUM UNITS <br />fs233) ANALY8/S <br />64-6B) <br />69-70 <br />GIL AND .:HF§''" SAMPLE . . ( oU) Od rA-•,. ,, nr .. - <br />'v I i 0 A L MEASUREMENT <br />4'J?r. 1. 1 i) ~ PERMIT OI+YIR 9r01R 6 "=1 ~4. AlOr!~~b t+f+7brh4 <br /> <br />- <br />T>S ~ ~ . <br />r'::k i '^'1rn p1r.rc <br />E FF[ REQUIREMENT > <br />t "rl ~ <br />.# '~,'."x-'- - .h <br />- i ll <br />~~T _!) s <br /> SAMPLE `.~ <br /> MEASUREMENT <br /> PERMIT ' `~ •.: <br />' ~ <br />• F , a <br /> REQUIREMENT <br />m <br />m~ <br />~• °~ ~'? <br />~:. <br />,.E - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '>; .~; <br />• r, + :t ;'• <br />~ <br />~ . <br /> REQUIREMENT - ~;; ~~ , :~.~.~ <br />- - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~'=`-' I <br /> REQUIREMENT j <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT.. .. . „; .. .. - ) <br />. <br /> REQUIREMENT _ I <br />_--.,°- <br /> SAMPLE <br /> MEASUREMENT <br /> PEFMIT~ <br />R <br />M -,- ~ <br />• - ,. ~ - <br />~ <br />- <br />- <br /> REQUI <br />E <br />ENT +} ~ <br />:: . _, •: <br />; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~ ~` ~ - <br /> REQUIREMENT~ ~ - - - `,~~°+,,,o~ 'r <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF Inw THAT I HAVE PERSONALLY ExAMINED AND <br />' TELEPHONE DATE <br />Richard hlilis AM FAMILIAR Wmi THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOP OBTAINING _ <br />e <br /> <br />THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE, ^ <br />~ j <br />' <br />' <br />r <br />/ <br /> <br />97U-B7U-272 <br /> <br />7 <br /> <br />28 <br /> <br />99 <br />Environmental 41ana er <br />y ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICAM <br />H - ; <br />- , y: ~ <br />.; <br />/.~ ~ <br /> PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING T <br />E <br />POSSIBILITY OF FINE AND IMPRISONMEM. SEE 1a U.S.C. § 1001 AND 33 U.S.C. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED merimumlimpnsanme~or 6eMSana6 maonrh,~and 5utl~e Srres up ro E/0,000 uM w OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND F~:PLANATION OF ANY VIOLATIONS (RelerenCe all attaCnmen[s Here) <br />:5;;:1'L::AirLt. SILfT= LI"I~" .~?*Yr~(1 pOg >i.')7!~Zrl`T7 FnrT-rn rpruT_err r. e.l~ ^^ Tqr Fl= .,r'_1r;TP~"!r4T5. (`TL <br />GREASE ;RAR ill°PLF' P'r l+,YiTS n;: v.?no~ rr YTcI°1.° SHrrk t~ nor cny r~~ ^,vTOTV .-e,~nr T..r ~yq~r. P,~PT?n 45-T.;'.~~ <br />EPA Form 33241 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) PAGE OF <br />n~n~o~n~nrtl ~-152? ', <br />