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PERMTfTEE NAME/ADDRESS (include Facili0~ Name/Lomnon iJDij(ermq
<br />NAME BC1iIt. .R~:'.i};I?^~'; I,`''IT~:U
<br />ADDRESS BOKLg N'), ~ ,;r:;F
<br />P.U. 'm'[ :I~:7
<br />FACILITY PAD 41 ,4 C 0 81 r! 2 ~
<br />LOCATIONii 01i L L CO dl 4 29
<br />ATPNe Bi LLT 4" .. ~. CAL' r:a_ 4TR14' ".f4
<br />NATIONALPOLLUTAM DISCHARGE ELIMINATION SYSTEMI (NPDES)
<br />DISC~AR GE MONITORING REPORT (D(MF79)
<br />~n
<br />^ PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 9'a N O1 TO ~~ 06 3^
<br />(2(}21) R2"231 (24-25) R62]) (28-29) (30.31)
<br />Farm Approved.
<br />" T `f C R OMB No. 2040-0004
<br />Approval expires OS-31-98
<br />(;IIR° 41C)
<br />- Trr?cAL DELTA
<br />'`,"N~ OF 52 TO O~-cH T7AT_L DTCI'
<br />A NOTE: Read Instructions before Ctlm~tleting this Corm.
<br /> (3 Certl Ony) QUANTITY OR LOADING I4 Certl Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (4B-53) (59-61) (3815 (46-53) 54-B7 EX OF TYPE
<br />~2~n AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />(62eT) IwaLYS1s
<br />8488)
<br />69-70
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERnFV UNDER PENALTY OF LAW THAT I HAVE PERS ONALLY E%AMINED AND
<br />BA
<br />ED ON MY TELEPHONE DATE
<br /> AM FAMILIAR WRH THE INFORM
<br />INQUIRY OF THOSE INDIVIDUAL ATION SUBMNTED HEREIN; AND
<br />S
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br /> THE INFORMATON, I BELIEV E THE SUBMITTED INFORMATION IS TRUE, j ,
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<br />/ ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
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<br />,(~/~~ ~~JQ] ~~ ~/! PENALTIES FOR SUBMITTIN
<br />POSSIBILITY OF FINE AND IMPR HE
<br />G FALSE INFORMATION, INCLUDING
<br />ISONMENT. SEE 10 U.S.C.41001 AND 33 U.S.C.
<br />SIGNATURE OF PRINCIPAL EXEClTIVE
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<br />mevmum/mpnsonmenl of barwaenBnanl/u entl5 yee]s.) OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Hererence eu anacnmenrt nere)
<br />"°TTLEAHLE SOLIDS LIMIT APPLIES OVLY IF C10YR,24HR PR`:CIP FVSa^, IS CLAI'1F). T° C1.pIr" 4P?FOY4C r5Y ur;CO,
<br />~iSS F, IROk LI`1IT5 WILL N07 :IE 71PPLL,D TO P,EP08TED MEA;LTa4MEu?S-;P.E I.A.7, v, ~ FOa RU9GF9 OP P,^,~0°
<br />EPA orm 3320.1 (OB-95 Previous editions may not be used. ~ y ( EP CES E A F TjiO I Y O ~ E E .) 0()')11') / `) ~ O ~ 1 2- 12 21 PAGE OF
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