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PERMITTEE NAME/ADDRESS (Include FaciliryxmwllncaGOn yDige,~q <br />NAME HLUf MJUEiTAIf• St:LPGY, I!tC. <br />ADDRESSDP.SF.RADO SING <br />3697 CJUNTY KOAD 55 <br />FACILITY RARGLY CJ d16Rd <br />LOCATION <br />aIti: .7L+PF DUHi:r;RT <br />NATONAL POLLIfiANT DISCHARGE ELIMINATION SYSTEM (NPDES) FOnn ApprOYed. <br />DISCHARGE MONRORING REPORT (OMq) OMB No. 2040.0004 <br />(SL'y:1 Nd) <br />PERMIT NUMBER DISCfineGENMFGRER c - FINAL <br />MONITORING PERIOD AC9TE NET TB~I'rNG F' <br />. Y .` O DA ~~ YEAR MO DAY ' ~7 <br />FROM TO 1 ''J~ 30 PPP. pp;.DI5C1+4nvE ~c. <br />-~ NnTRe Read Instructions before'CdTI <br />PARAMETER <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />LCbU .~TATRF.4t3Hk AC SAMPLE 4rtPaaP PeaPPa ... .. ::,~a~agr ( 23) <br />:: E !{ L J U A P'1 N I A MEASUREMENT <br /> <br />•.FFLUEN~T GROSS YALU ,_;; O:+ar,: - '" ~` <br />LCSU 5TA78E 9UNY. AC SAMPLE PS`P"xx ~`~°'+~r ~•- ~ ~ ~ O6 ( 23) <br />PIMEPNALES MEASUREMENT <br />~ <br />TANbC 1 J U ,,. r <br />~ <br />EH' <br />Ei"E'LUF.NT GROSS YALU :*^r<s -.~ <br />~ ~ ~ <br />a <br />: <br />~~'`. ~ <br /> ~, <br />~ <br />", <br /> SAMPLE <br />SAMPLE <br />MEASUREMI <br />P,P~LAN <br />0[5 <br />+it+# <br />etinglhisform. <br />gEOUENC SAMPLE <br />oP TYPE <br />ANALYSIS <br />a <br />4 <br />Y' <br />SAMPLE <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER ICed'Ay under penalrydlaw that this document entl ell etlechmerns were TELEPHONE DATE <br /> prepared under my tlirection or supervision In ecmrtlerice wiN a rysiem designed <br />SC p ~ ' r't J to assure that qualKed personnel properly gelher antl evalume Ne irAorma6on <br />' eubmMetl. Baietl on my k,qulry d the person a persons who manage the system, <br />L LL <br />L Y1 LJ <br />F I lc or Vme persona directly responsible br gathering Ne MAOmiation, Ne inbrmetlon <br />eubmilted b <br />to Ne best dm <br />knowled <br />e end belief <br />core <br />accurate <br />entl com <br />lete l <br />7D 7 <br />~j~ <br />~ <br />. y <br />, <br />g <br />, <br />, <br />, <br />p <br />. SIGNATURE OF PRINCIPAL EXECUTIVE .7 G.1 G Z ~ <br />TYPED R PRINTED I ern aware than Ihere ere slgniMant peneltles br submining take IMOitnetlon, <br />Includlno the oosslblliN Ol Rne and imprisonment br knowinc violations. OFFICER OR AUTHORIZED AGENT <br />r•.nnr NUMBER <br />YEAR <br />MO <br />DAY <br />.,ri; PART E.H..1, PJ YIII, FDa 08Tf,IL~ JF T°.ST PtTCCE.'JURE. ?-::PO"r.T LCSV - STATIiTICAL POItiT ESYIMATE 4HICH <br />i5 LETRAL TO SU1! OF 3EST ORGANIS"S, 4RD ATTACK ACUTE T!?%LCI'fY LEST it ^c PO RT. FORM TO DMR. COPIES OF ALL <br />Form Previous a lions may ba used. I 1 PART FORM PAGE OF <br />oD~e~oo~7i~;~t~3$ 1 <br />. _. ~. ~ ..:y. ,t....~~. .. <br />