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PERMITTEE NAME/ADDRESS (!nclude Fuciliry NamdLarmlon IfDiffermrl NATONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPOES) FOrtn Approved. ! <br />NAME <br />'! I N f: S C <br />I N C DISCHARGE MONITORING REPORT (DMA <br />(z-rsl !+~-;sl <br />v <br />` OMB No. 2040-0004 _ <br />, <br />. <br />ADDRESSp(OR <br />H <br />'1 T '! <br />..! 4 Appreval expires A5-31-98 <br />Y <br />THO. <br />P50N CR2EK MINg.•i r'_O ~ t ~~+ (,UaR YC) T <br />2763 COMPASS DR IVB+ SUITP. 101 PERMIT NUMBER DISOHriRGENUMaER <br />< ^ c _ fIFAL PITH <br />FACIUTYGKAKD JU NCTT~i C.p fl1505 ,~" MONITORIN <br />RIOD C`1?f)viC 7F.T TPSTI MG fnk 001A <br /> <br />LOCATION, MO DAY YEAR MO DAY __ <br />T_ARi1pNDALF. ~':~ F1LZ3 FROM Ol 0 TO '30 ~ b4: NO P ~CNAAGpp. I f i?#` <br />A T T N 7 J . E . 5 T r` V ~ R C C~ 'i '.i L : I N v !: ~ : , Rza31 (za-z51 Rs-zr/ Rass) (soar) NOTE: Read InsVUCtions 6eforacompleBng this forth. <br /> (3 Colo' Ony) QUANTITY OR LOA G (4 CeN Onty) QUANTITY OR CONCENTRATION N0. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-87) (3815) 48-53) 54-61) EX OF TYPE <br />~-3~ AVERAGE MAXIMUM UNIT ,~ :y MINIMUM AVERAGE MAXIMUM UNITS (ezaTl (~6a 8S 69-70 <br />:EFFECT STATkr TORY SAMPLE OY.a ~:'SR!: 1~Y': :;;~~ d:##:" "'~'-<~•^.• ( 7"{) <br />I <br />CH.! CXHIOUA PHAIA MEASUREMENT ,. <br />C P 3 B S 0 0 ~_ ~ MI ~'-" ~ s~~!4( %%" I~AEi~ <br />~ F ti - - <br />iEe COHHFN75 BELOY NEO MENT ~ _ ~,''=::;3 ~'9 0'~;FO }~~~ "~ • . <br />"';~ ^c NT ~~r'E, . <br /> SAMPLE <br /> SAMPLE <br /> MEASUREMENT <br /> <br />ftaECS EMENT a <br />r <br />:'~„t <br />-- ",~- <br />., +`j'~`w <br />..,~. <br />.d~ ; tk-. <br /> ,, <br />, . <br /> SAMPLE <br /> MEASUREMENT <br /> ~FIMIT <br />~ m"" 4' <br />x <br />i' <br /> E U(REMENT ~ ~ >~> ~ <br />,r <br />:' <br /> SAMPLE <br /> MEASUREMENT <br /> ,'r cPBe~~t" -~ a .~ cam" ~r q - - I wk= i , . <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ' <br /> ~~ ~MENT +~` ~ <br />r~~~' h I rr4~„ .T (~.;. <br /> , ro . <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br /> B DUI t~T '" s~ '~ tt + ~ b - ~ <br />~ <br />' L~ <br />NAME/TITLE PRINCIPAL IXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF lAW THAT I HAVE PERSO NALLY E7(AMINED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORM ATION SUBMITTED HERE IN; AND BASED ON MY <br /> INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION, I BELIEV S IMMEDIATELY RESPON <br />E THE SUBMITTED IN SIBLE FOR OBTAINING <br />FORMATION IS TRUE, <br /> <br />~ <br />J ~ 1~G (L ACCURATE AND COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFICAM ~ <br />~ <br /> <br />'~r,~ ~ PENALTIES FOR SUBMITTIN <br />POSSIBILITY OF FINE AND IMPR G FALSE INFORMATION, INCLUDING THE <br />ISONMENT. SEE 18 U.S.C. 4 1001 AND 33 U.S.C. <br />SIGNA E OF PRINCIPAL EXECUTIVE <br />~ /oI <br /> <br />TYPED RPRINTED § 1318. (PereRies untler maze aGtutes msy inc/utle Linea up m Er0,000 entl or <br />mexlmum immismmem ol5enaeenemantha entl5 veers) OFFICE R OR AUTHORIZED AGENT <br />rnnF NUMBER R MO DA <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell eM7chments here) <br />:, LE I. B.5 fOR TEST PHCCEDURr'.. 9PT RESULTS OP LrTHALIT! DFRIV~?TOYS AS ~`FfFFCTN. GROYTH L AFPAODUC'!'icTK <br />DEdIVATIONS AS "TOYICITY". RP7 COYEST .'. P.FFL AT YHICH STATISTICALL! SZCHTP DIFf rETVEEM Tlo4T E CONTkOL <br />PA Foirri 33267 (0~95)v Previous editions may not ~ e used. ' " ~ (REPL`ACESTEPb 01iAAT WO'WHIC~f`I~AY NOT BE US~~.) - ~ ~ • v ~ N AG - dl-'I <br />00005)9?0211-1433 1 <br />