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PERMITTEE NAME/ADDRESS (Include Faci&q~Nomr.2ncarron iJD~erenq <br />NAME PICbEl'GIhf @SCCF.SSIt:t., 1LC <br />ADDRESSk ;, w ELK +! I K k <br />1111 ~Rt:t.7dCGL LFI'VE <br />f.`iAt7~VILLF IN G"1711 <br />FACILITY <br />LOCATION. S1Cd CC ELCyl <br />NATIONAL POLLUTANT DISCHARGE EDMINATION SVSTEM (NPDES) <br />DISCHARGE MONITORING REPORT. (DMR~9/ <br />G r ' <br />PERMIT NUMBER. DlscHaaGE NUM0~P6 <br />MONITORING PERIOD <br />FROM ~ U C ~ L 4 ~ U I ~ .L~~ G l: ~ L c ~ <br />(10-21) (1223) (21-1$J~ : _',p~-' (16211 f28-Y91 f30-31) <br />Form Approved. ~ ~ <br />OMB No. 2040-0004 a <br />C I it C :. Approval expires DS-3t-98 , <br />(SU%S .F.) ~~ <br />F - FIEF[ LA!':~,l: <br />PCU7F fIE7 7E:71kC FCF CC1A <br />'~~ MC Y]°_CMAFGE ~~ ~~t <br />NG~a~ead Instructions before completing this form. <br /> (3 Cerd 0~5 <br />0UANTITY OR LOADING y/ QUANTITY OR CONCEf; ION NO: FREOUENC SAMPLE <br />PARAMETER 3 <br />( ) (51-61) 38-45) (46-53f (54-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM ~ UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(6263) ANALYSES <br />f64-68) <br />69-70'~ <br />C5 51 P.1rL 4ENh ACL SAMPLE r fi0 `v•". r.::~~:, gI:A444 ;'+C iita ( j?) <br />l E F I G G A F i1 h I P. MEASUREMENT ` <br />~p..3d L U C ~J'pRMFF ~' ~ .' t~: I ,'. 4+IQ ~ EF~ Y~'~''• <br />FYLL_17 GkOSS YALUt AG~U(R8~F13~ : ' -~~ ~~~ <br />, "-~+:. ~Y YALCE F!7 r <br />C50 S?ATLE 964; F. ACL SAMPLE Ca,°.t':' ,IC>7C.'y ,Cr,:;r,.:: ;>;;;;r.i. ~ I:) <br />} S. ?' F F' I+ r L .: MEASUREMENT <br />Stibi: 1 L1 i1 PFnRMtT, 4 00 A >;1t=A :'= .. 44 440 4QQt4 P! EF' ] .flE„ . <br />:rfLUEaT 6h(r55 VdLLk AEGEUIREMENT , S-'. ;+, E!7 'x'~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ~ " <br />:. <br />a., <br /> RYQUIFi~ 5Mt - <br /> SAMPLE <br /> <br />MEASUREMENT ~ <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> p~g~1T ~ ,. ri. ~~?,' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> ~caUiRFMSnsr. <br /> SAMPLE <br /> MEASUREMENT <br />pER1NI1 ~ fi <br />~ ~ <br />. <br /> <br />r <br />~,QL118RFvT +c v"y ~. <br />"' <br />',fi, _ _ _ . " r - . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW.THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE <br />ATION SUBMITTED HEREIN; AND BASED ON MV DATE <br />INQUIRY OF THOSE INDIVIDUAL <br />I~er tr THE INFORMATION, 1 BELIEV <br />Ydt L S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION IS TRUE, C, / <br />. <br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE 31GNIFICANi ~,.,, 1/ <br />PENALTIES FOR SUBMITDN <br />M A r~ k Y POSSIBILITY OF FINE AND IMPR G FALSE INFORMATION, INCLUDING THE p~I <br />ISONMENT. SEE 19 U 5 C § 1001 AND 33 U.S.C. v GNATURE OF PRINCIPAL EXECUTIVE ~~ O Y1 ' ~ ~r <br />0~ ~ r <br /> <br />TYPED OR PRINTED 4 1319. (Penett+es under Nave s <br />maximum ~mpdsonmenrorbeMee /elufes may ineWde (ides up l0 570,000 entl or <br />n6months end5yearsJ OFFICER OR AllTNORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reverence au attecnments Here) <br />,.... I.A. Z, pF 5-7, fC} DFTAFLS CF 7E5: PHCCELUAE. nEPUF7 LCSG - S7A71°7ICAL FCIE1 E`-7ICATE kh1Cti IS <br />LtTBAL "iU 5GA CF 7E`_7 GFGd6'I5C5, Akp AITACh ACUTE 7C11ICJ7Y 1E:1 nF}Cn7 fC.hH 70 CCE. CfF]P~ CF All <br />•nN ncT -c ec T or cD~ -- <br />EPAForYR3320tT (08.95) Previous etlitidns-may notb@ Used ~ ~ (REPLACES ERA FOAM T~0 WHICH liAAY,}IOT @E USED ~ PAGE OF <br /> <br />L <br />,I <br />