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PERMITTEE NAME/ADDRESS (include Focilirv Name/Gxation iJOjtyerenr)
<br />NAME CYP6:US YAtlPA VALLEY CCAL CC.H~.
<br />ADDRESS'tlh~'•L 1, 2EJ ~GUTN., <. ECK"A.h Pt:
<br />97 UU PAST ..Irr°9AL CI F'CLE
<br />d';GL°WOOL Cil aUIS~
<br />FACILITY
<br />LOCATION
<br />ATT'~: Y.UitY.IS G. Y,r.GLeY, GF'!iEHAL AT~Y
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR+
<br />(2161 IV~ 9)
<br />Ccn027251t 002 A
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM '~ u v v i TO u u u ~ ~
<br />(20.211 8223) (20-25) R6-Zr) Q8-291 f30J1)
<br />Form Approved.
<br />„ A O O 4 OMB No. 2040-0004
<br />t; U tl !i ~ W) Approval expires OS-31-9R
<br />F - FI4AL R0U ~':
<br />]^,ItiS: 1, PC; D T 1'C FCICEL C3EEK
<br />w NOTE: Read Instructions hefor~pleting this form.
<br /> (3 Cerd On/y) QUANTITY OR LOADING (t Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (4553) (s+-1571 (se-451 (46-53) fs4-sr) EX or TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />l6J~GTl ANALYSIS
<br />(64-69)
<br />69-70
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<br />(A`i FE) MEASUREMENT
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<br />M I S IJ A I. MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HERE NALLY E%AMINED AND
<br />TELEPHONE
<br />IN: AND BASED ON MV
<br />~
<br />~ DATE
<br />Richard MI I Is INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE. ~C-~
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<br />Environmental Mana er
<br />9 ACCURATE ANO COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT ~
<br />K/U 970-870-2712
<br />
<br />PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING THE /
<br />/ /
<br /> ,
<br />POSSIBILITY OF FINE AND IMPRISONMEM
<br />SEE 16 U
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<br />§ 1001 AND 3J U
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<br />§ 1319
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<br />inclutle lines u
<br />fo 510
<br />000 entl or SIGNATURE OF PRINCIPAL E%ECUTIVE
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<br />NUMBER
<br />YEAR
<br />MO
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />ALTENtiATP LI"!ITS FUR TSIi, IRON G SETTLF'.AHLE SOLIDS (LOC ~Or) APPLY OtiLY IF <= LO-Yf., 24-NR FF.ECIP P9ENT
<br />CLAI:'!:J• F,EE I.A. 2, FL 1N, F03 `!UF.DF.A GF PROOF RE;tiIRr`!Sy.S• OIL f GSEASE-Sc`. i"^':"hU".a F/, cG 2.
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<br />EPA Form 3320-1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T411 WHICH MAY NOT BE USED.) 00 018 / 00 0 4 ii 5 - I `_~ O 1 PAGE Z OF
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