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PERMFTTEE NAME/ADDRESS PnaYLirreyNw/L«ulan UDyF.n) NAME SENf:CA CDAL COiypA,vY ADDRESS L~AAJL+R D tlAIDEN CO U163~ FACILITY LocAnoNdAYDEN B~163D .~.. ;<}~}, ATTh: G. BOD BADJN, GENERAL'SilfiCER DISCNMGE ELIMINATON BYBTEM /NPDES) Form Approved. ~ , MONRORINO REPORT (DMRI ,. OMB•No. 2p1p -0004 , ~~~~ 17481 SED• POND D.>CGN T., owl~.a:T:I eS~. N'`^ 01.1 A (SUER NJ) APProve~~x~Ire;053 •98#, ABER DISCHMGENUMBER F - FINAL vv ,"A~. TO y!b L .il ##'~ ND DISCtlARGE ~~ ~;t: I>~>n .>u_>ol iTnan NOTE: Raad Inetructlone befor eomDbtlna thb form. PARAMETER l3 Card ontyl QUANTRY OR LOADING " T I.I~G>d Onlrl QUANTITY OR CONCENTRATION NO. FREOVENCr SAMPLE BI-371 106531 I5i511 & !38-05 14653 151-61/ of AVERAGE MAXIMUM UNI S MINIMUM .~ AVERAGE MA%IMUM UNITS EX Iez-Bal I64r5B1 169701 FLUYP IY CONDUIT OR SAMPLE ( U3) G##YRtQ 3;#### ~##### TRRU TR EA T!IENT pLA N7 MEASUREMENT SOUSU 1 1 D PERMIT. R£p3.RT $EU3i:T #Y~?C~...: .:. 91#~L?L~-z.: i:~=::trsi-`. : v~ir tlC£/ .\S2'~''f tFFLUENT GKDSS VALUE REQUIREMENT 30DA:AY>:. . vAI::T;;lt7.. HGD `•~':s ~ ..:.: ......... ~ ~ ~.: %Y~ 140N'7'K . SAMPLE MEASUREMENT . ~~ PERMIT . ~ ~ ~ .. .. ~ .. ~~.~:>~ ~ ~ ~ ~ ~ <, •. ~ . REQUIREMENT ~ ~ ., ~ ~ ~ ~ ~ >• ' <... .. SAMPLE MEASUREMENT ~ PERMIT .. .. ... ~ ~ ~ . :.. ~ ~ : ..':'T::P:.,,. .... .. ~ REQUIREMENT ~ . ~ . ~ ~ ~ . .rar..>'.'.:. .... r.: .. . . . , . . SAMPLE '~r. MEASUREMENT .:. PERMIT ~ ~ .... ; .. REQUIREMENT ~ ...... . ~.~ .: .. ^.;.. ~ ~ ::.. ~ ... :: ... . SAMPLE MEASUREMENT PERMIT ~ ~~ . ~~ :REQUIREMENT ~ ~ ~ ~ ~ ~ ~. ~ ~ .. ~ ~ ...~ ~ .. .. SAMPLE MEASUREMENT PERMIT .. ~ : ~ ~. ~ ~ ~ ~ ~.: ~:..:. . :' ' l REQUIREMENT ~. .. ~ ~ ~ ~ .. ~~ : .. ~; : .z ,.. ~•.. ~ .. .. .. :.. .. . .. .... .. SAMPLE MEASUREMENT ~ ~~ ~.. ~ PERMIT :. ~ . . ~ ~ ~ ~ . . REQUIREMENT. ~. ~ ..... ~~ ~ ~:. ~ : ~: ~ . NAMElTRLE PRINCIPAL E)(ECUTNE OFFICER I CERnFr UNDER PENUrr of L ww THAr I NAVE PERSONAUr ExAMINED AND TELEPHONE DATE AM FAMILIM WITH THE INFOR MATION SUBMITTED HEREIN; MD BASED OM Mr INQUIRY OF THOSE INDIVIOUAL9 IMMEDIATELY RESPONSIBLE FOfl OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATON IS TRUE, ACCURATE MD COMPLETE. I AM AWME THAT THERE ME j L/ SIONIFCMT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING !! ~ ) , THE POS9181LITY OF RME MD IMPRISONMENT. BEE 1B U.S.C. 1 1001 MD SB Y ' ~ 1 1 TYPED OR PRINTED u.s.c. 1 t Bte. lnn.mFF uwr fM., I61vro. ro.r AxAiM !~.• w ro S roaD M Y BIONATURE OF Pj11NGPAl EXECUTNE ~' enuueu,•e sun eve! eu sTlnu ne .uv v~n~ r Umu nun inp/ovrwnF P/A>rrwn enwrrA..nF6 rerA1 .r~...•..^_.______ _.. _~_ _.. . _. ,•,; ~.OFFICER OR AUTHORIZED AGENT _. ~ppE NUMBER YEAR MO DAY -__________. ..._. ..__...._.._..._._._..__~ .. .................., ,... or ..: ors .-. TSS E IRUN LI'lITS JILL BE IIAIYcD AND SEITLP,AnLE SOLIDS LIlff? APPLIED FOR <=l0YR.24RR PRECIP EY$NT~ TSS G IAUN LIMITS JAIPED FOR >l0IR,24iiH PRECIP SPENT '3UB.71?CT TO 9DRDEN OP PROOF I'1 I.A.2. UIL E GREASE-SEE )_a_T_n_ me NnurrnRrNr__ccc• T a i v_. Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 PAGE OF -o~,o~tseo9ir-o9za. :. i