Laserfiche WebLink
I <br />i PERMITTEE NAME/ADDRESS(Include Facdm•NamelCumunn tJDrfferenU <br />NAME SE!lECA CCAL CC.:f/,`iY <br />ADDRESSDH~iiER D <br />HITG£h CU tl163'3 <br />FACILITY <br />LOCATIOI~AYUEk ~ - b1o3U <br />ATTN: G. 6GD BR04N, GlkBRA~AkIGEA <br />,.. _ <br />w <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SVSrEM (NPDES) Form Approved. <br />DISCHAR GE MONITORING REPORT (DMR~91 y 1 A U I OMB No. 2040-0004 <br />°~ Approval expires O5-3T-9R iC'r' <br />iil 0 Y IsueA MI) <br />TNUMBER DIS NARGE NUMBER F- ~ I ~~ 1 h V U I T <br />MONITORING PERIOD AC O T C ~ 17 T E 5 T I A G F C F C l ~) .~ <br />MO DAK~,~ YEAR MO DAY <br />FROM U _ ~~TO U ~ U ~~j_;~.~ i18rNlB4! ~]~[~ +;A <br />rzo zn rzz z3l r9r ~ rzesn rzRS91 13a3n N '{Tead Instructibns befo completing this form. <br />PARAMETER l3 Cerd Ony) QUANTITY OR LOADING Card Ony) QUANTITY OR CON NTRATION N0. FREOUENC SAMPLE <br /> (46-53/ (54-61) (36-45f (46-53) (54-61J EX OF TYPE <br />(32-37) ~~,. AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br />64 <br />68 <br />69 <br />70 <br />' h d fs2 s3) - <br />( <br />) - <br /> SAMPLE 0 +' S L p ( ~ _) . <br />C C k I 0 G A P H Y I A MEASUREMENT <br />TAY3h 1 0 ~ <br />0 <br />~" <br />~~~ +60A . ~ <br />C <br />~ ^.~ EE- I11~ i>t <br />EF'FLUt'NT GA05S ~ALUE <br />: r 00 ~K-YALCE I <br />~ I <br />`' ~ CE11 <br /> x _ : ~ <br /> SAMPLE <br /> <br />MEASUREMENT <br />- _ <br /> ~ <br />flE~' ~ ~. <br />~ ~ ~'+` <br />`~` <br />~ <br />~ ,. r r i>„- <br /> , <br />r <br />~ 'n: f <br /> SAMPLE ~~% -~ ' \ <br /> MEASUREMENT ~ ~~ ~" <br /> ti <br />, <br />~ <br /> - <br />~E0~11R~MEfdT ' <br />~t+ ~r 1 <br />~ ~~' ~~ <br />. ~ <br /> .~ <br />~, <br />z ~ _ f <br /> SAMPLE <br /> MEASUREMENT <br /> .,,P~A~}17 -- -,a, . _ s - <br /> <br /> !'4- f1 <br /> SAMPLE <br /> ME <br />A <br />SUREMENT <br /> . <br />~( <br />. te~ ~»- <br />4. 4 <br />~ <br /> <br /> <br />. <br />~ <br />i" <br />n <br />h T ~„L <br />5 <br />:, <br />i, ppp <br />~ <br />~ _ <br /> 9 MEN7 t <br />; t <br />~~a <br />" <br /> ,. <br /> SAMPLE <br /> MEAS <br />U <br />REM <br />ENT <br /> y <br />c- <br />C <br />~~LI~I~F ~, SY ~ Y 3A AC (. 5. <br /> ~, .. p' k s <br /> SAMPLE <br /> MEASUREMENT <br /> ~ .~ymj'~ '4 a '',~", I r.. <br /> y <br />y fk . <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF I <br />AM FAMILIAR WITH T AW THAqTT I HAVE PERSONALLY EXAMINED AND <br />U <br />1 TELEPHONE DATE <br /> HE INFORMATION S <br />BMITTED HEREIN; AND BASED ON MV <br />INQUIRY OF THOSE INOIVIDUALS.IMMF,DIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS TRUE, ` ' <br /> <br />ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING THE J <br /> <br />'] <br /> , <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE to U.S C. § t001 AND 33 U.S C <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~~~~/\\ <br />(JLJ / ` <br />U~ ~I <br />TYPED OR PRINTED § 1319 (Penel(tes antler IheSe slaruros may include lures up ro 5/0,000 end or <br />maximum impnsonmenr of 6eAraen6moMhs end5ynan.) OFFICER ORA THORIZED AGENT ARC` NUMBER YEAR MO DAY <br />wmm~n I a Hnu r crL.vrv,R I I~IV ~r nlvr vll'u n~lvs (Iterelence all a0acnmenrs nets) <br />~ih MAHT I.A.u f0E CE7AIL5 OF TEST PHOCEDU6E. bEiCAT LCfiEST CILUilCk (i EPFLUEA9) ~HICB 79 itTEAL TC `_C:. <br />L`F TrST I;kGAMISIIS ~LCSU) AYC. •TTACH ACUTE TCJIICITI TEST AEFUAT PUMH SC L'tlF. <br />EPA Form 3320-1 (OB•95~ Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH'MAY'NOT 9E USED.) -~ C O ZO I / 9 9 Q Q s ~ - S ~,rS 3 PAGE I OF <br />8 <br />