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PERMfTTEE NAME/ADDRESS perM4 Fad~ryNsWlxanm (/DL~LwQ NATIONAL POLLUTMTDISCNMOE EDMINATION 9YSTW /NPDESf Fonn Approved. ~ NAME 1~''~L~MECA CJbL COCi PAmY DISCHARGE MONRORING REP011T (OMRI O B o 004 ~-fel 17-191 f1~U1'E s+L;T TE5TLNG ~~~1)~ 05-31-9 A pTO el IF 8 "~r A RESS DRAYE6 D f ~ Oc .y~ : (sDeR s~~) . , tl 13 dAYDEM CO e1639 ~ PERMIT NUMBER DISCHMGENLIMBER P _ PL!JAL . `~ FAaLrtY MONITORING PERIOD M I t10R Y,EA . MO .DAY YEAR MO DAY ~ LOCATIONYITDEt+ CO kilEl:l FROM ? ~ TO 9e p9 ]0 ~~~ ND T " _ ~E. ~ ( #~'a. h f f ATTYS Ge BDD 6RDYNe GEN BkAL tlA1 1AGER E: Re mail 1; vts( !as-sll rza-a9l l3o-311 NO r wm. np t -drr efo[y~?L51(nVN~ PARAMETER !3 Ard Ontyl OUgQ17TTY OR LOAD( - . !1 Grd Onlyl QUANTRY OR CONCEN U ~}.10; FIIEOUENCY SAMPLE /3I-371 /46-53) it.- ~ /5I-611 ~ 39-151 !4653 6I1 ~ of ' EX MALY515 TYPE AVERAGE ' " MAXIMUM S MINIMUM AVERAGE MAXIMUM UNRS rep-eal /e~e81 leg-701 LCSU STATItE ROHR AC SAMPLE :ya~;x:x aaala4a~ 44444a 9r4L1444 ( Zj) ~ CSHIODAYa1fIA MEASUREMENT ~ Or e •M3H 1 D D PERMIT -4ikQ4Yf0 !14'.., :. .. 40 .: .:.. ~ 'dt#1Ot .`fa ~.I.,.;,.. tef01~~4.: Ek- ;< t ~~~`~ % ~ i: ~;~:':': r EPFLUEYS (:N 95 YALU :REQUIREMENT . . .:.. . ... . .~#::' v :::: ::.. .... ......:. ':.f:...... ~ . y-;; ;:; `..: : . . a .:: ...::.. .: ..:::. '.~::... . :. , ..... . SAMPLE , - MEASUREMENT ~~ :. PERMIT:.:.: .. ~ ~ .. ~ , ..: ~ ,..: ... :~REQIiIREIiAENT . . ~ .: ~ A`:':'4..'rr.... ' ' . . ....: ~ ~ ~ ~' ~•' .. ':: c: ... . .... ...:' .. . :.~:: .. :: i:.::.: .. . ., .. SLMOI F :. '~-PERMIT ~~~. : ~ ~ .~. .~~ '.r': ~~..~ r: ~.. ,; €':;i'.":"i~: ..,:., .:. .: :hEnUIRENIENT: .::. .:. .. ~: ~.~ .... ~ ... ~ ~ a. ....>:.:.... .. ~.: ,;.:~..(::>..: ...Y•.....e::: :!..:: ... ~:: .r:.::~: ~:: .::: s~':.''~s:. i>~,.::!::~: ~: ~~".i. ~~: .. .:.': .;;~.:~.;~,: SAMPLE MEASUREMENT .>::~..:: PERMIT.:'.:~ ,. ; ~-:'. ...:.. ~ . .. .. ~ ~ ~ ~ ~ ~ ~. ~... ~: ~.:: :... . ~ : ~ s?:~ :.:;::''cir':~i:(i:•'r%i 'i':''..::~:i.`''`:.ir'r::gr ~.:~.1;:~ .REQUIREMENT ~~ ~ :.. .. .:.. .... ... ~ '- . '~ ~..... : u~.:,.>....~.::.;,~....: . : .. ' SAMPLE MEASUREMENT 'REQUIREMENT; ~,: . ' "fi"' ' '~ ~ ~~: SAMPLE \SUREMENT PERMIT : ~. ~:.::.: ~ .: .:...:.::.:.:.. .... lUIR.EMENT::. ?; ...: a: ~::~.:::.:;.:.i?i c"~.:<: - :~..: ~. ~~: . .. :. .:' f:'.::i.~:::.'::'.':~ :.::.: :. .:::::...::..:':;'.:.:i:... :::.. NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTI AM FA FY IMDEfl PENALTY OF M WITH THE INFO M uW THAT I HAVE PERSO RMATION SUBMITTED H NALLY EXAMINED MD ERON MD BASED ON ~ TELEPHONE DATE ; IU MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY flESFONSIBLE FOR -C J~(:'NA .S ~n~^ `~ ~ OBTAINING THE INFORMATION, I BEDEVE THE SUBMITTED INFORMATON IS . TRUE. ACCUMTE MD COMPLEEE. I AM AWME THAT THERE ME SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFOIMATION INCLIIDINO , THE POSSIBIOTV OF FNE MD IMPWSONMENT. SEE 1B U.B.C. ! 1001 MD 3J u.s.c. E r B1e. rP.wwa w. e... mm.a nrr ircxMF raw, w ro F/0,000 610NATlMiE OF INCWAL EXECUTIVE ARFA TYPED OR PRINTED rw armuvm.n inpi>vTmFnt eabwwr6mmeraW6YarrAl OFFICER OR IfTHORQED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe(rrsnce e// sttechments here/ SQL PART i. A.4 E'ER DETAILS OP TEST PitOCEDDAE. ftEp08T LOYP,ST DILOTIDR (~ EPPLDEYT) YYICk IS L6TEIAL.TO SOX OP TEST ORGAYISAS (LC50) AFSO ATTACH ACDTE 70IICIlI TEST BEPOBT POBl1 1D DflB. COPIES OP ALL rr a n A Form 33 0-1.108-9 repoue a moos may a uee , (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 0005{x/98091•-0433 PAGE OF, ~ 1 -_ ,