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FERMITTEE NAMEIADDRESS Qneirifsel6'7NY.JLaemtm UDtBl.arl ~ NAnoNAL PouuTANr DISCHARGE EUMINATON SYSTEM /NPDES) Form Approved. '
<br />NAME DISCHARGE MONRORING REPORT IDMRI c, OMB No• 2040-000b
<br />CDLOYYD CDAL COHPANY L. P. !1-/si n-/sl TAT LOP. POND TD .n. ,gyn. L..I^.EK
<br />AooRESSCOLONYO HIKE cOGati001 7 OTO R Approve~e plrsa05:1-98
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<br />5731 STATe HIGHpAY 13 PERMIT NUMBER ~ DISCH.wGENUMeER F _ pIRAL
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF L AW THAT I NAVE PERSONALLY E%AMIN m AND ~ TELEPHONE DATE
<br /> ABI FAMILIAq WITH THE INFO RMATION SUBMITTED HEREIN; AND BA SED ON
<br /> MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIB LE FOR
<br /> OBTNNING THE INFORMATION, I BFLEVE THE SUBMITTED INFORMA TION IS
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<br />J D TRUE, ACCIIMTE AND COMPLETE. 1 AM AWARE THAT TNE
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<br />THE POSSIBILITY OF flNE AND IMFWSONMENT. SEE 18 U.S.C. 1 1001 AHD 9] _
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<br />SETTLEABLE SOLIDS LIMIT APPLIES ON LT IP C= 10=YR, 27-HR PflF.CIP P.VE9T IS CLAIMED. I?." ATM APPROVI'.D 9Y
<br />1IQCD, TSS 5 IRON LI"!ITS WILL NOT dE APPLIEG TO 3EPDRTeD HP.ASUREMENTS--SCE I.B.lA, 4~'AND I..B.1D, FG 6.
<br />PA Form 3320,1 108.96) Previous editions may be used. (REPLACES FPq FORM T40; V~HpIC~H_.. M'AV NOU~6 X16
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