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PERMITTEE NAME/ADDRESS (fnclyde Facd(Iry Nnme/faedos i/Dlgerenq <br />NAME <br />'+[. `: T.Y.':iL(' °GAi. ~~4i~L'•Y <br />ADDRESSp,11ULL Cn'.r_'K H;NE' <br />t151S };J9'I: CCWNTY H6AU MZ! <br />FACILITY D n ~: C h E :. ' C D t1 U 4 '~ .' <br />LOCATION} ~ K r ~ :, }; ;( <br />CO DU4b/ <br />n': N: .; r'.;1 itGE VpJU6, ':7^., PRE DENT <br />G <br />PARAMETER <br />AVERAGE <br />:.UUr 7-uAf SAMPLE <br />(1 ~J U ~ ,; , C ~ MEASUREMENT ~ ~~ Q <br />t)aj1U ~ D 0 ~' t [3R 1, <br />'.,« :, I:./INr"L'J.'t:T ~ NT~~~ Al <br />F ;J'wr 1J CJNDUII UF: SAMPLE <br />ia.IU T:'`;A 2'SENT FL6N MEASUREMENT ~.GO~ <br />I..4 w F..X / 1 K F L r7 r'..~ $11161*? ° ~I <br />SAMPLE <br />MEASUREMENT <br />SAMPLE <br />MEASUREMENT <br />SAMPLE <br />SAMPLE <br />SAMPLE <br /> <br /> <br /> <br /> RS <br /> „~~ <br /> <br /> <br /> f <br />i <br />"e a° <br /> <br /> <br /> <br /> <br /> <br /> <br /> .~ _ x . a~:, -f <br /> <br /> ~NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICediy under penalty of law that this tlocument entl all attachments were TELEPHONE DATE <br /> <br />k <br />`~ <br />~ ~ <br />h preparetl untler my tlirection or supeMsion In accordance wHh a sys(em designed <br /> a rd I <br />1 <br />i c <br />$ to assure that qualified personnel propedy gather and evaluate the inbrmation <br /> E n v i rc tune rl t s 1 Ma n a g? r eubmilted. Be.ed on my Inquiry al the parson or persona who menage the system, <br />or those persona tlirecTly responsible br gathedng the inbrmation <br />the inlannellon <br />9 ] [) t{ / Q- 2 ] 12 <br /> , <br />submidetl is, to the best o1 my knowledge end belief, true, eccurele, entl complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> TYPED OR PRINTED I em aware that there ere slgniArant penehles for eubmiNnB false inbrmation, OFFICER OR AUTHORRED AGENT NUM ER YEAR MO DAY <br /> Includln the sibili of Tme end im risonment br knowin violations. <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />1'~F'hUF..`If .A 9'r L'S t'.U.,'f hP: COLLECTP'U 5 aNALYZf.D ':OH"dL'i { i:r }. ti"Jit':IiU ,L'ARTrRLt E~c;A".[?LESS OF 1HESti'"3 F.ti <br />:.F'FLUENT UISChA:::;c :J0004i. NY:^.nAULTI' CAPACITY = C'.O1S ",U: O;±'~AUIC`:nF'T.CTI:' _ ~i•2 LPS POD-5/GAY. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FOrm ApprOVed. <br />DISCHARGE MONITORING REPORT (DMR7 OMB No. 2040-0004 <br />rl~;p~ <br />n7rl 77 's i` r ('J I)!f ~: NSA) <br />PERMIT NUMBER DISCHARGE NUMBER - C i tiAL flOU:': <br />MONITORING PERIOD . '~ r~ L'J ° :: T• '! `' A .°i U R F tl h `.7 <br />YEAR O DAY YEAR MO DAY __ <br />FROM 71 D1 TO O1 3 3 kr~ t~D DISCHAk:;E ~ ~ >°''^ <br />NOTE: Read Instructions betore'C6lrtpleting this form. <br />Y OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />EX DF TYPE <br />MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~~~/S <br />lfidn ~ ~,~ ( 1 I) <br />// [7 /¢nrT /inn ~/ ~lG~ <br />EPA Form 3320-1 (REV 3/99) Previous editions may be used. ~ THIS IS A 4•PART FORM PAGE OF <br />ODn76/00071 7-13~p.,. 7 <br />