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PERMITTEE NAME/ADDRESS Onclude Faciliry Name/Gararian JDiBercnq <br />NAME S~YP.C1 CCAL CCCFihI <br />ADDRESSD F.1 k E R D <br />HAYDEN CU EtIE39 <br />FACILITY <br />LOCATIONHAYDEN Ca 91E30 <br />1TTN: G. bUD bflOMN~ GEhEnwL :I88AGcA <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />(1 16) (t ]- BI <br />,..COO CO( 21 C10 Y <br />PERMIT NUMBER DISCHARGE NUMBER <br />'~p MONITORING PERIOD <br />( YEAR; _;MO DAY `YEAR MO DAY <br />)M U tT~ I V'1 TO U U U ,1 11 <br />(20-211 '~~JT23) (1425) (262]) (26-291 f30-J I) <br />n 7 rl G h OMB No. 2040-0004 <br />p p ` Aoprova expires OS-31-96 ~' <br />`S U li !I • ~' '4 <br />F - FIi./I flCUTY <br />ACtlYE iEl:"YiSTIN6 AT 010E <br />~#~' !!~'~~CItCNai6R: ~~! Aac <br />NOTE: Read Instructions before completing this form. <br /> (3 Card OnN) QUANTITY OR LOADING (4 Card On N/ QUANTITY OR CONCENTRATION NO. FREOOENC SAMPLE <br />PARAMETER fah-53) (se-6 t) (38-as) ps~53) (sa-st) EX of TYPE <br />(32-37J AVERAGE MAXIMUM UNITS MINIMUM AVERAGE _ MAXIMUM UNITS!" ~'A~ySIS , <br />LCSU STATHG 4bbtl ACL SAMPLE YN>G^.oF a~VVta~ /1 <br />~ 3~t9>a~ ~"; >Ga ( ~U) <br />~ <br />r / <br />C6RIODAPHNII MEASUREMENT ll,/v O O'rG <br />TA173b 1 0 0 <br />PERMIT 4vwPV <br /> <br />_~ i9U <br /> <br />~ <br />• ~ - ,x <br />~ <br />Ti" <br />O9'~3>BA--~ <br />E F- <br />°- <br />„3 ( <br />P~{~.~ 5, <br />EPPLUEfJT GNOSS VALUE "REQUIREMENT riaO1P ~~~((_ ~r 8, a~ ~a.•. CE~7 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT- - ` 5 <br />'-i ~ Jr t~ <br />~ rd::..:. <br />~ <br /> REQUIREMENT r y~ <br />. <br />'fT» ", r~t~tr. <br />: ...,.a~- <br />? <br /> SAMPLE <br /> MEASUREMENT <br /> -PERMIT. - ~ - y <br />" ~` ~~ ~ x y~; ..~ <br /> 1iE0UIREMENT ~- - F~,t ~~ ~ <br />- z ~ -- - Y r -- ~ '"rt.,`.- <br /> -x'XS.._, s. sf- <br /> SAMPLE <br /> MEASUREMENT <br /> ..PERMIT-: ~. _ x ~'. ~; ;'~'-" T t;;; * ." <br />~ <br />~•. ~ <br />~ :- .~~ ~ ~. <br /> ~FiEOUIREMENT - ~Yr~ ~ <br />+ , <br />, "` ~~• <br /> , <br />-. <br />c , <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT -...: ~ .c_~ .•i`P _ .-~r~-~ -" ~`, `S-,-~: <br /> ~REOUIREMENT- ~ ~ - - '} ,`x _ -` ~. <br /> <br /> SAMPLE <br /> MEASUREMENT - <br /> ~~'PERMIT 7 ~ i° '~. ,,, v ~ t <br />~ ~ <br />~` ' ~° <br /> REQUIREMENT -' ~ ~ t s b i§ *~}` !r <br /> SAMPLE <br /> MEASUREMENT <br /> ¢P.ERMIT tig ; <br /> <br />~ <br />,.~.` <br />'° , <br /> REOUIREMENy' ~ ~ ~ * ~;J ' •' - <br /> _ <br />- <br />NAME/TITLE PRINCIPAL EXECUTVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY E%AMINED AND <br />ATION SUBMITTED HEREIN <br />AND BASED ON MY TELEPHONE DATE <br /> ; <br />INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ' <br /> TLIE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTING FALSE INFORMATIO <br />G THE <br />A/Y <br />/, <br />I <br /> N. INCLUDIN <br />POSSIBILITY OF FINE AND IMPRISONMEM. SEE to U.S.C. § 1001 AND 33 U.S.C SIGNATURE OF PRINCIPAL EXECUTIVE ~fl~ ~ <br />v <br /> <br />TYPED OR PRINTED § t3t9 (Penetties under Inese stelules mey include lures up to 510,000 end or <br />marimum impdsanmertt of henveen6monMS end Syoers.) OFFICER OR AUTMO IZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />SF.K PANT L.1.4 IFOA CETAILS OF TEST PkOCEUURf. 6EfGBT LOWEST <br />OP TEST 09G1MIS71S (LC`_0) FAD ATTICH ACUTE TCYITIY PEST EEFCAT <br />L <br />DILUYLGN (X EPFLUEii) ~N1CN l~ IETF.AI 7C 50. <br />FCEd YC D!!A. COPIES Cf Ili IfFCil1YIC- <br />EPA Form 3320.1 (08-95) Previous editions may not be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.)-. , ~ -',~`. •• PAGE ~ OF <br />