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PERMITTEE NAME/ADDRESS (include FcciliryNmne/LOr~ion iJDi$erenr) <br />NAME SF~Ya,:~ :uAL ~UJi':~LY <br />ADDRESS!) d A a t t v <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR OMB NO. 2040-0004 <br />aril pa~sl ..I f! D ii ~` <br />.~ 0 a 0 2 I ~ U .; , '. ;) Approval expires 05-31-98 <br />("~ <br />tl A Y L.h' N (; D B 1 ti J 9 PERMIT NUMBER DISCHARGE NUMBER f- r' l+'' y '~U U T T <br />L dCIfC.. nr:r Tt;TING F'OR'OOSA <br />FACILITY ~"O'"~'~ MONITORING PERIOD ~, <br />LOCATION! A Y U E 4 YEAR MO ~ Y YE4R MO DAY ~- . w <br />CO:B163~ FROM ~ TQ ~ ys ~^ J.. :f;;= :.J UI5CHANGE (__~ .:,. .. <br />ATP 5 : J . fy 7 J U k D'w 1. a (; E H E d A L N A !~~ G ° k fzazl) ¢z-zsl fz b as zrJ tzazs) (3x31) NOTE: Read lnstructlons before compleEng this form. <br />,. <br />PARAMETER (3 Card Ony) QUANTITY OR LOADING ~ ny) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />(46-53) 5461) 38.45) (46-53 (59-61 EX OF TYPE <br />I~3n AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />rezc3) ANALYSIS <br />s4-6B <br />69-70 <br />L~DJ ~ N[. v6„K ~~.1 <br />J i ;) 1 7 C A F d fJ I A SAMPLE <br />MEASUREMENT ~ `r <br />/ 1~ ;uAr~:=: t, t:~=::: ( ) <br />~ <br />~ J <br />t.~ <br /> <br />c t' F L'J c: V T G i(J 5 ~ Y A 1. U Q~OUI((EMksNT ~ ~ •006 , f#_bG ~',' "L p q .yl ; .r..;: <br /> SAMPLE <br /> <br />SAMPLE <br />MEASUREMENT <br />I i; a <br />NT <br />SAMPLE <br />MEASUREMENT <br />fin, <br />SAMPLE <br />MEASUREMENT <br />~ EM~NT <br />SAMPLE <br />MEASUREMENT <br />dAl'~ ' <br />.. _ .0 pEM~NT - <br />SAMPLE <br />MEASUREMENT <br />~+~E(i~Il ; -: <br />F$IBI EfJI~NF a ~ <br /> <br /> <br /> <br />~ ~ '"*t~'# ~" <br />~~ <br />_=st- "-.`."~~. .. <br />NAME/TITLE PRINCIPAL IXECUTNE OFFICER I CEflTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND 7ELEPHDNE DATE <br />^~ AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MV <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY REBPONSIBLE FOR OBTAINING <br />'OV.~1..1S ~~+•~ THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 1$ TRUE, <br />/~ ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT ~j///~~J <br />N, rl/~J(v ts~~ PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE ~r~ ~~ <br />l/ ` POSSIBILITY OF FINE AND IMPRISONMENT, SEE 7B U.S.C. 51007 AND 33 U.S.C. SIGNATURE OF PR CIPAL EJ(ECUTIVE 1 <br />N TYPED PRINTED ~mum~pASrnmem olb Meen6monfitt ~5ude fine up ro Er0.000 entl d OFFICER ORA HORIZED AGENT <br />rms.J NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all ettachmen4s here) <br />:r:i; I'AHT 1. A.4 FO?. 9i.fAILS UY TEST PROCEDURc. R6POET COYEST UILU~[IJA (`: -:FPLIJc:+.) >+NICH IS LETHAL TO <br />~~» JP !2S'C JHGINIS+tS (L~iO) AIYD ATTACH 6CUTE TOICICITI' Tr.sf itEYJr?T F7rt~ T.J lI?SJ:. COPIES OP tLL <br />rntPl oua ar•TU •ncr ~ ccc n. nn IZ RA <br />EPA Form 332o-7 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) ,.~ ;•, ,; i J /')) fi 5 1 3 -114 0 PAGE I OF <br />