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PERMITTEE NAME/ADDRES$ (7nc(ude Faciliry Nmne/Locarion iJDijJerend <br />NAME F'IRItFC, IFiC. <br />ADDRESS NChTR TRCCP`Cb CEFEK MIKES <br />27tU CCMFASS C}]YF., SUITE lUl <br />GRANC JUSC'fZCF CO E1`_Oo <br />FACILffY <br />LOCATIONCARbCaL'AIE CC E1t23 <br />AT'LN: J. F. $TCYEF. CCNSULIINC FAG. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />(2-16) p]- 9J <br /> <br /> <br /> PERMIT NUMBER DISCHARGE NUMBER <br /> MONITO.RI ~ RIOD <br /> YEAR MO DA Y" ~ EAR MO DAY <br />FROM 7 ~ 9 5 1< .i 1 <br />(2427) (22-291 (24-2 51 (26-2]) (2829) (30.31) <br />Form Approved. , <br />OMB No. 2040-0004 <br />t I NC ft Approval expires OS-31-98 , <br />IsuEF Yc) <br />t - FiNlI FIT1N11 <br />IC~`f-YIb1NC FLFCFF SFCI FCFC <br />'~':" bC CISCFIFF6E ~4'I" <br />NOTE: Read Instructions befor~ompleting this form. <br /> !3 Card Onfy) pUANT1TY OR LOADING (4 card ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4B-53) (54-61) (38-45) (4653) (54-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM NITS MINIMUM AVERAGE MAXIMUM UNITS <br />(sz-ml ,wALYS(s <br />(84-68 <br />69-70 <br />Fn SAMPLE r.#L>ar,# 0'4C-'.><: ~CtCY#4 ( 1:) <br /> MEASUREMENT <br />UU4UU 1 U L pE)iMIT' IPO, ~3D; L>^ 30Q'>00# 9.0 NCF/ 'FAE <br />iFFLIJEUT GRGS_ PALL REQUIREMENT ,~- j ~" <br />.~ !>r#=? FLAY CCC `L' t <br />SGLIDS, sETTLEAELE SAMPLE -~,^„a #x*.v## ( ~`) <br /> MEASUREMENT <br />UUS4S 1 U C PERMIT 4 OO+G# ALY t09: LY# <br />~ ~:.,,~~~~~T ,5 .. _ jrC"E/" .~A~.. . <br />EFFLUENT GNO$_° YP.LC REQUIREMENT :LO•^.• ;+ @ (~ ~ "GAILY ti ! <br />C1L o GFEASE SAMPLE ~ ~ •, •^z :I:rtoort ##~>C#t ( IS) <br /> MEASUREMENT <br />LU~56 I 0 L PERMIT Art##a# Artt### rtt+H>b->b ?~~#`~ 1,0 ~~-~~a,~ iT1~'.~- <br />EFFLUE9T GRO$$ VALti ".REQUIREMENT -, I CG <br />FLO4. Ib CONDUIT CF SAMPLE A' ~ ~ C~ C%~rv,~ y~~~~V rte;.±` <br />Tlt r<C ThEATF1RN1 PLAb MEASUREMENT O <br />1tl I ~ <br />n ~( G <br />SCUSU I U U <br />`PERMIT <br />EFFORT <br />REFCRT a#~yrtpC #tttrt# #>at#it :r. <br />~flt~. <br />~$ <br />EFFLUENT Gk05$ VALL TLEOUIREMENi 3GDA AYG DAILY NY LC:' =rt~Y <br />SCL1C5, 'fCTAL SAMPLE =.tx~o~ ...,. ;~;^.. ( 75) <br />C I550I. Y t L' MEASUREMENT <br />7U1~)5 I U C PERMIT ~rP#o## arrt##a r~:: xrt#x#rt nFPCRi OPTIONAL ~~! `6~B•`: <br />cFt'LLENT GRO$$ VALU' ~REQUIREMENT ~ =:r-:==: E46 AYG " Yr5 !AY CG/I ,•~„ <br />CIL AbL GtiEASF SAMPLE ':; ~''``'v 1 '':U) ~„=:: ': •„'Y""; f'+Y>:i+ <br />Y I', U A L MEASUREMENT <br />C4C5b 1 U C =:.PERMIT' '#:94@4 0 E.'-=1 '~##>arrt ##0#L# 0#k><ti -'. IS" y.(p~. ]~..~A'" <br />EFt'LUEt+T GhOSB YALUI PEQUIFIEMENT IN51 FLAY FC=C X+++ <br /> SAMPLE <br /> MEASUREMENT <br /> PERM17~ ~ - <br /> REQUIREMENT ~ -" <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSO NALLY EXAMINED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN, AND BASED ON MV <br />~! <br />S-~sU~L- <br />J <br />b INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />I BELIEVE THE SUBMITTED INFORMATION IS TRUE <br />THE INFORMATION <br />. <br />• , <br />, <br />ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ARE SIGNIFICANT <br />, <br /> <br />2 <br />~~~ PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE 9 <br />. <br />~~ ~/L /yi~ <br />" <br />' OD O/ <br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1B U.S.C. 4 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE %% J T <br />4T <br /> <br />TYPED OR PRINTED 4 1319. (Penarties antler these smfules mry iMlutle fines up ro Et0,000 entl or <br />mevmum imprisonment of beMeenfimon+hs entl 5ysers) OFFICER OR AUTHORIZED AGENT AR <br />CODE <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference en ettacnments Here) <br />SETTLEAELc SCLICS LlfIT HILL RE ~lIYEC FCF. i1C-YF., ~4-kF. FFECII EYEFT-~EE I.A., FC ZY, FCF FE(CIFF!!EbTS. <br />~R'CRLC SFhPLING IRSiFLCTICNS-I.C.S, PG IX. 30 CFY AYG I$ tiIGFVEST FCNTh1Y AYG GCFIlG FFFICI EFFCn7EC. <br />EPA Form 3320-T (08,95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />00056/99Ci]"s-TICS 1 <br />