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PERMrTTEE NAME/ADDRESS N.aL~i irWryNr/L«nrw UDlp..oN)
<br />NAME TF:APP''R !(PIING, I,aC.
<br />ADDRESS `C HA PPFP 'CNF"
<br />P. u. Rox I~r
<br />CHAD 'I~ R1 fi).5
<br />FACam
<br />LOCATION
<br />ATTN: il'. GUgO7y P''TF.BS, P.qR:/~%'? M,3
<br />NAiIONµ POLLUTANT OISCHAROE ELIMINATON SYSTEM (NPDESI ' Form Approved.
<br />DISCHARGE MONITORING REPORT lOMR) ~ r OMB No. 2040-0004
<br />I7-161 17-I9I TN?
<br />r Q (] j 5 X / c I) n R +• ~~ Approval expires OS-31-98
<br />PERMIT NUMBER DISCHMGE NUMBER P• _r r e e T. w +r
<br />MONITORING PERIOD A^[.wv Ypw "'vi^'IN; pOR OCIA
<br />YEAR MO DAY YEAR MO DAY
<br />FROM TO 'fir F? T)T 4CHA ;rc ~ _' >t:;'r
<br />170.211 !77.731 1747b1 ~ /16-I71 17B•191 1363/1 - NOTE: Rssd Instructions befaP eompNtinp this torm.
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<br /> le6-531 /51511 /36-151 1~6-631 I5.r-sll of
<br />137-371 EX ANALras TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS le7-6J! !64551 169-701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OF
<br />. Gordon Peters
<br />'r ident /Ge~ieral Manager
<br />TYPED OR PRINTED
<br />nnuueurc eMfl GYPI ANATIDN DF AM
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<br />TENT'+
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<br />I CERTIFY UNDER PENµTY Of LAW THAT I HAVE PER!
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED
<br />MY INQUIRY OF TH09E INDINDUµS IMMEDIAT
<br />OBTAINING THE INFORMATION, I BELIEVE THE SUBS
<br />TRUE. ACCUMTE AND COMPLETE. I AM AWE
<br />aGNIFICANi PENKTIE9 FOR SUBMITTING FµSE IN
<br />THE POSaBILITY OF FlNE AND IMPRISONMENT. SEE 1
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<br />%AMINED AND TELEPHONE DATE
<br />ND BASFD ON
<br />ON918LE FOR /
<br />ORMATON Is ~,c..! G• 970-SL4-4401 ! 0 0 27
<br />f THE/IE ARE
<br />iN, INCLUDING
<br />1001 AND 33 SIGNATURE OF PIIINCIPAL EXECUTIVE
<br />.pro 570,000 OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY
<br />CODE
<br />SEP L.A.1, PP /-9, FOR OETAT.LS ~~~ ~T35'- ~ROCP.DURB. NEP7RT LC50 - STATTSTT°"i "'T°'- '°:Tf' +'~• ~f;Tr-t; IS
<br />L`.TItAL !"~] SOG 7P T£ST ORGANCS'1G, AAp ATTACH ACO?E TDZICITT TEST RPPOPT v7^'r r~ p~^, r-7rr^•: ns' aLl,
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<br />EPA Form 3320.1 108.951 Previous editions msy bs used. (REPLACES EPA F M T-401M1~ H MAY NOT BE U6ED.1 ~ 07I ~ / ^ ~ ~i t: ? I- 1 '; 7 ^. PAGE T OF
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