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PERMITTEE NAME/ADDRESS (/nclyde Fanliry Name/lncon'on ifDigereni) <br />NAME <br />TaE!tTYhIL: CCAL CD'!F'ANY <br />ADDRESSFC:IDL C4§:°A Mlt+c <br />19515 ROiJT.T COUt:TY 6~AD i27 <br />FACILITY JRR lH£.•.}. CJ NU461 <br />LOCATION <br />JAK CiiF:t$F ;;C 804 r,1 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FOIm AppTOVed. <br />DISCHARGE MONITORING REPORT (DMR) OMB NO. 2040-0004 <br />°:':Oii <br />PERMIT NUMBER DISCHARGE~NUMBER c _ oI ~~ ~, <br />enu-T <br />MONITOI~I PERIOD .~ ~ !'..) ~ ~ ~~.'' , .. ,•': I N G ' C 5 U ~ 1 A <br />YEAR MO DAY' YEAR MO DAY __ <br />FROM TO 7 ... ~ :' i ^ i1 f. •.+: I I iu •~"k <br />d:.h: ;, [. U:4'v !: V}JUP. ViL ~, i h: .`•;i : J:.ST nvr~. nca„uiouwu~iia ucw~e wniNicuny wm wiui. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER - EX OF TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS avursrs <br />rF'FF.C[ STATk~: 1'.1AY SAMPLE rry:)•er:^: irirl=::o!1;: <br />~~ .•t:e-: <br />~ <br />~ ~ <br />( ~ ~) <br />~ <br />/ <br />'t .i CE HICG0.P9 N:A MEASUREMENT (: ~•l~ln <br />I , e i ~, s u u >~ ~t , .r , ~~ ' ~ dart a at+a c~ ~ ; _ <br />r7LY <br />K 1Rkyy <br />_ •'t CU.".M!r:NS~ ~IO~L'3~ <br />-... <br />~ A'~..:~c. __ <br />~ l „ <br />k,. ~=.~~, . <br />., .::..:... M ~ ~ <br />'I+r_ ~~:: <br />_:F'FcCT STATki: !^r!Y <br />`~ <br />~ SAMPLE ... :-«t ,....,.. p~ r.; •. ..rf,<~::•-• ( <' ') <br />~ ~ <br />/ <br />• <br />. <br />. <br />d i~ i I ~' F,' V'1 A L ti ~ MEASUREMENT ~~ i <br />i ~ r' h C S J C +b n _ a~~~3 r•' '1-. x ,i w''I, i~ik ` ` ; ~lMi +b~ - ~ RL F K RC'~ <br />;, . ~ s ,~. , ~ , ~.~ ~>kt, <br />rtY <br /> <br />SAMPLE <br />~; <br />%~ ~ s' <br />:. r '. <br />~:, <br />.'S~ ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICeniy under penalty of law that this document entl ell ettechlnents were TELEPHONE <br />prepared under my tlirection or supervision in accordance with a system designed <br />is i c rl a rd ;' i ~I 1 s to azsure that qualified personnel pmpatly gazhar end evaluate Ns inb Lion <br />submMetl. Bayed on my Inquiry of the parson or persons who menage Vhe system, <br />E n v i ro rune n t d 1 Manager or Nose persona directly responsible br garnering Ne Inbnnatlpn, the hfonnazlon <br />submitted Is , to the best of my knowletlge end belief, true, accurate, end complete. SIGNATURE OF PRINCIPAL EXECUTIVE 9 ~ ~ tl ~ ~ - ~ ~w <br />I eni ewdre that there ere slgnlftaM penalliea ror aubmltting lake Inbmauon, NUMBER <br />TYPED OR PRINTED inclutling the possibility of fne entl imprisonmem br knowing violations. OFFICER OR AUTHORIZED AGENT CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) <br /> <br />{ <br />$.. <br />~~~_ <br />~~~ <br />c "'i' ? <br />tT:_ , <br />iF <br />DATE <br />I MO DAY <br />;rc I.:+.~ F.Jit F°T.AIL`_S ')F r~sT PRDCF..DUraE A:!`°.iLLLl9F C~7:'r.~ilA.. hr?i•f.T L['w'';T ~'FFLCENT AT YiSICN <br />.,:ATiS°.ICALLY ~I~NIF RIFF jN LETfFALITY 9°.TJeFK 'EST ,i'.D C:~51'r+.uL 'M A:. 09iF:^VFL. 4::ACH C;{HONjC 1'OYlCIPY <br />EPA''Fbr '3320. ' !'1 37~9)~ Prevl6us e i lOhs m;~~+ ~ r i • v.• ' . O :, t u r. ~ c 1, :: r . THIS IS A 4-PART FORM PAGE OF <br />;;~;,,, ,,, OOP6d/000717-1350 1 <br />