Laserfiche WebLink
PERMITTEE NAME(ADDRESS (!nc(ude Facilip~ Name/Locanon ifDi$erev) <br />NAME MIAhEC, ISC. <br />ADDRESS NOFTh THC`FSCb CFt:EK Clhb~ <br />1lE!t C01"FA55 CFIYE:, SUITE 1C1 <br />FACILITY GP.ANC JUI~C7ICh CO k:15C6 <br />LOCATIONCAccChGAIr CG E1513 <br />t TTA~_ .1_ F_ SRfYFr_ ff NC(II TT AG 4Nf_ <br />NATIONAL POLLUlANTDISCHARGE ELIMINATION SYSTEM (NPDE3J Form Approved. •. <br />DISCHARGE MONITORING REPORT (DMR; OMB No. 2040-0004 ~ <br />Iz-'sl il~~ sl C I N C F Approval expires 05-31-90 <br />rn ~<<~~ n (SUeF. YC) .Y <br />PERMIT NUMBER DISCHAROE'NUMBER f- F I k A I F 17 S F <br />MONITORING PERIOD .: C ri H G h I C F t 7 7 E `_ ]] F C E C F C C 7 1 <br />YEAR MO DAY YEAR MO DAY <br />FROM 1 Q1 T";'. 9S li J1 ,%+=~ 11C LI:CHAFCF ~ ;~'+ <br />(zazr) 11z~z3~ (14.25) 2827) (za2s1 Goan NOTE: Read Instructions before mpleting this form. <br /> (3 Caul Onry) QUANTITY OR LOADING <br />~ ( ny) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER !as-s3) !sa-sr) ' "s-a5l (as-53) (sa-st) EX of TYPE <br />(32~n AVERAGE MAXIMUM UNIT ' NIMUM AVERAGE MAXIMUM UNITS <br />(s2aT! aNACV3/3 <br />(64-68) <br />69-70 <br />;,:.FFECT s7ATRE )CAY SAMPLE V~#4~~ ~'~~'"'•:~ ~t'~"''" "'"'' < <~) <br />C H ii C L 5 I^ C A P H t• I A MEASUREMENT <br />TCFSh 5 0 C ~- ~~PERMlT <br />~ <br />• ~ <br />ey#'#, ~~~ 4'. ;X'. i3.C ~ "R#1t~PAA +6>Qi#4i EF- Yi"I'~~. ~IL~" <br />~kE' COYF'ENTS EELC. F <br />3 <br />REGUIREMkN7 a ~ <br />*'~;: +t~X~'~ EIS YELOE CeF? <br /> _ <br />~, <br /> SAMPLE <br /> MEASUREMENT <br /> <br />.;. <br />.:. , ~. <br /> PERMIT _ <br />•" 'x . <br /> "REdUIRI=MENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~- ~ (,'~ <br /> REQUIREMENT ~ ~ ~ ; ,. - <br /> SAMPLE <br /> MEASUREMENT <br /> ' -=PERMIT <br /> #)EQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> ".PERMIT' .; <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> <br />_ -PERMIT- ~ <" <br />~ <br />" <br />'REQUIREMENT - ~ <br />. <br />- <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERDFV UNDER PENALTY OF <br />AM FAMILIAR WDH THE INFORM LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE <br />ATION SUBMITTED HEREIN; AND BASED ON MV DATE <br />J M ~ f- u~ INQUIRY OF THOSE INDIVIDUAL <br />C3 ~J~p THE INFORMATION, I BELIEV S IMMEDIATELY RESPONSIBLE FOR OBTAINING ~ - <br />E THE SUBMITTED INFORMATION IS TRUE, <br /> <br />jjj~~~ ACCURATE AND COMPLETE. <br />J PENALTIES FOR SUBMITTIN <br />(J - <br />1 AM AWARE THAT THERE ARE SIGNIFICANT <br />G FALSE INFORMATION, INCLUDING THE O~ +.1./l /i p/ <br /> <br />OQ a Q <br />~ <br />•-~ L~j POSSIBILRY OF FINE AND IMPR ISONMEM. SEE 1B U.S.C. § 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE ,7V LT~~T <br /> (Xq entl a <br />inclutle lines up ro E10 <br />antl <br />r these slelules rre <br />P <br />tti <br />§ 131 e <br /> , <br />y <br />ene <br />es <br />e <br />. ( <br />tl OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED Syee~s.l <br />mesimum ~mpnsonmen[al SeAVeenSmanfAS en <br />COMMENTS ANU EXPLANAI IUN OF ANY VIVLA I IVrvs (FrererBnce a/l aRacnmene5 here) <br />5kE I.LI.S FGfi TEST FFCCEUUHE. bP7 HE5ULT5 Cf LF7tAII7Y CEFIYATICIS A5 "~EFFEC7^r CFC117E E bEFFCLLCTICA <br />CLnIVAT1Ch5 AS ^7CXIC7TY^ FPi LCYEST + FfFi A7 ~tICH °7ATI_7ICALIY SIGPIF LIEF FF7YEEF TE57 E CC ATFCL <br />EPA Form 33201 I08 ~5) • PreWOUS etlitlons may not be used. (R ~ ^Cl_S FJA `RM t- ~ 4fYHl Y NOT ~ USE .)` ` -" ~ 1 ~ ` ~ ` ~ " PAGE ~ 'OF r <br />. OOC6~/99G7]<-11C5 1 <br />