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PERMITTEE NAME/ADDRESS OwrV4 FrWry Nae/Laculen 1/DdG.wl) <br />NAME 1'HSPeF.6 MINIh;, 1hC. <br />ADDRESS IdAPPYR 'tIt:FI <br />e.oe Pox ld7 <br />crlr,Ic <br />co e15z,s <br />FACILITY <br />LOCATION <br />~1'Tf~7 ~. UOfiL(?:r cpTghE, PlicS/.: k. .: !'. :, :I <br />LIB <br />N 1 TdBLNMDE ELIMINATION 9YBTEM (NPOLJ`7 ~~~'1'. 4;))TOVed. <br />DISCHARGE MONITORING REPORT lOMRI <br />(z-r6i T7-F51 CI°C111iGE ZO COT~~"~k~y~CG.ooos <br />00 0 0 3 2 115 ~ (SUPA Np) APProv°Il°'~F4so5-at-s8 <br />PERMIT NUMBER DISCNAnDE NUMBER F- F T. A A L <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ TO -. _ <br />II0.zl1 l11-231 lz4751 !7617/ 175-z91 /30.311 <br />~IFC9 <br />NOl'E: Reed Metructloro before complefln0 th'n form. <br />PARAMETER l3 Ord Onlyl QUANTIri OR LOADING N and only/ QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> !46531 15A-5I1 f3B-F51 1A~53 /5661 DF <br />l31-371 EX <br />ANALYSIS TyPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS M3-sJ1 (6/-651 /69701 <br />r: SAMPLE ':~'' F~:'t ~ .:=i1C ~:Y f.: 4r}K+#. ~ ] 2~ <br /> <br />MEASUREMENT <br />B, Z <br />(~ j <br />p r <br />~ <br />/+'lill' <br />!JU4r0 1 0 0 PERMIT FiSt>YKFFG ,^.-Tf91Tri,%:T C6. fi~~. a64s;Ot?Kr. f}.0. Q@KLY INSITI <br />.'.Fr LUthT (;ROSS YALU :REQUIREMENT ~ ~ ~ CqK<KT ~lII.~.IY,VN ~ ~~~t±1~X1N•0!S S°J <br /> SAMPLE <br />. MEASUREMENT <br /> .,: <br /> <br /> <br />~ <br />,: <br />:. <br />~ ~ <br /> <br />. .:... <br /> <br />'~EQUIREk1EN7 .. <br />; <br />.:... <br />~ ~ ~ <br />. <br />.. <br /> SAMPLE <br /> MEASUREMENT , <br />; <br /> . <br />PERMIT ~ ~ ~ ~ <br /> . <br />'REQUIREMENT ~ ~ ~ ~ ~ ~ ~ ~~~ <br />~~ <br /> SAMPLE .. <br />_ MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - ~ ~ .. ~.~ <br /> SAMPLE <br />• MEASUREMENT <br /> . ~~ PERMIT <br /> .~REQUIREMEN7 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> flEQUIREMENT~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I eERTIFY uNDeR PENUrY of uw TRAr I RAVE PERSONALLY ExAMINED AND TELEPHONE DATE <br /> AM FAMILIM WITR THE INFORMATION BUBMITTED HEREIN; AND BASED ON <br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE fOR ~/ / /~ y ` /....--~ <br /> <br />{~. Gordon Petara OBTAINING 7NE INFORMATIDN, I BELIEVE 1NE SUBMITTED INFORMATION IS <br />TRUE. ALCUMTE AND COMPLETE. I AM AWARE THAT THERE ME <br />INCLUDIMD <br />SIONIFILANT PENALTEB FOR BUBMITTINO FALSE INFORMATION //f~,-,/ L "///~_ ~L-Y <br />9 <br />-824-4401 EJ <br />] <br />2 <br />esident /G®neral Manager , <br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SFE fe U.S.C. E 1001 AND 13 BIONATURE OF PRINCIPAL EXECLR1yE <br /> U.B.C. 1 f bf e. /MwTM. uNer IMr mroro. m.y NeA.ie IYfr. w ro t 10,000 <br />TYPED OR PRINTED rN rmArirlvn MprrrmNrfrerMn.rnsmAVNaAas6 yrrt<1 OFFlCER OR AUfHORQED AGENT CODE NUMBER YEAR MO DqY <br /> <br />t~ <br />.f; . <br />~!4 <br />„'~~ <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRdersnn sU stt~chments hod _ <br />_;; .5 b T):'nL Ib.?.~ LI."1Ti: =I1:. BE '~ATV;:D. .al:C SI:fTLF.Ar~El. ~J11T~ i.l` 1' AFFL~cr cCr. !-t ^yA~?4Yf: PF~;CIS 4vi'k~T- <br />~k.:i eURu6!• OF PhOOF nh:,OLnf*.dNTS UVDC:: I.A.Je PLRriTT£F. !^.II,T TAR F. [LI AEASCHAFIF MSAPiUh°.Ci IG RiC-L^: r'f' <br />i ' A 1:.. O k b : }' :' - ;~ r +' .! ~, p' •;.^ _ e - - T f' v ~ LLL3 P_.L T, n '. n, n <br />EPA Form 3320.1 l08-961 Previous editions mey be used. (REPLACES EPA FORM T•40 WHICH MAY NOT BE USED.1 0 O ~ 4 C / ~ 7 1:11- 1 5U iS PAGE IOF <br />