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PERMITTEE NAME/ADDRESS (Tndude FaNliry Namv/Locmion ifDi$erenq <br />NAME Cy•.,..1 ,. vq„ .,.., .. ..^I;. <br />ADDRESS'~7 `I 4:i 1 ~ 1.. ~ ,- ~ ~, ...., , $ • 3 " <br />.. 11r_:L" r 1-Yr~ ^1 aft 55 <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Forth Approved. <br />DISCHARGE MONITORING REPORT (DMR~ OMB No. 2040-0004 <br />'~-'s/ /"- 01 ~ ~ i ~' ~ Approval expires 05-31-98 <br />^'1T~ 7154 nnF ~ (^nru .!al c <br />PERMIT NUMBER DISCHARGE NUMBER .. c T +~ + • v ~ h T° <br />MONITORING PERIOD "T.l° [ r "1r"^ T•n ~'rT7°L `' T ', <br />YEAR MO DAY YEAR MO DAY _ <br />FROM 'f J J TO ,.~ .. {3 .': +", nT cr-ggor;^ 1 ( .~`` <br />Iza-z11 (zz-z~) Ra-z5) (zs-zrl (ze-zsl I303t1 A' NOTE: Read Instructions before completing this form. <br /> (3 Cvd Ony) QUANTITY OR LOADING (a Card Ony) QUANTITY OR CONCENTRATION NO. FREOUEN SAMPLE <br />PARAMETER (45-53) 5461) (3a-45 (48-53) (54-5f) DC OF TYPE <br />(~-37J AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />/sz-c0 aNAL>51s <br />(se-5B <br />69-70 <br />ti'. ; ~ Il : ; SAMPLE ^` ~: r.: : {: F . •c C t'c ..t .Y,....: <br />nT <br />( T <br /> <br />> '''1 <br />MEASUREMENT <br />O I~O ,^ <br />(.7'~ <br />O 2 <br />3~ /~ Q <br />G~1 <br />J1LI't~ u ~ k` PERMIL '~~; 4@@@ 'r? ~@¢'@#. 9t5 r@ {~ 1~~1~=~ :~>~8..aa <br />'. e i'LU.', ~ f J n'"S ~ v n • ~` <br />- REQUIREMENT <br />,~ <br />.. <br /> <br />- • %is <br /> <br />. <br />~- <br />r ^, ~ <br />=3QpR.":Ri.. . <br />DIItG'['.!!x M <br />^•/L - ~ <br />RIQ . <br />a <br />" <br />°I.'7nr c~ _Jvrl'~(~ ^" SAMPLE 73) <br />( dfYh.~: '!: f-!Y f: CYAN +~±_i,: i~-; <br />3 <br />T ~. ;I. iR c: ~~~.; `''7^ niJ iT MEASUREMENT + <br />O, 1 .+ <br />. O ~~ ~N/I/f <br />] U ~) 5 D 1 r! 7 PERMIT RE P43Q •;', "- - ~ ~ ~It~~ !t iti `-+~ '~ ~~ k" :5 ~, ~y($'~~ 1~ <br />';FSLUvM? ~~~14; YgLfl _ <br />_ <br />REQUIREMENT <br /> <br />i ANU ., ,F <br />SAMPLE <br />.. :Q 3~- <br />( 911) <br />... ./, <br />f•;..t...r.. <br />k;'.:..; .. .~ <br />D 2 <br />~/ <br />l II <br /> <br />JI ~!IAL <br />MEASUREMENT l <br />(yp fk <br />V <br />:'c~F,b 1 7 ~ ~,~~,, ~ @@@@'Xm t o;=1 @a@@@e ~ @@a+saa tr@tAAr)@ e ~~•_ v Rt'k#.1' YStl;R'L <br />';'FLUENT GR~53 VgLOF ~~#EOl'1 NT i"*i}'I~ llk>t VrT=D ,. ,r "" <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMII•~:: ='tn . , i1A ~, - : ')r.,'r - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~- 'z- . - - <br /> HEQUIREMENT _ ~ * '; <br /> SAMPLE <br /> MEASUREMENT <br /> `d PERMIT ~~ - ~ ". <br />~ - `t <br /> REQUIREMENT ~ " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ - .. <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMIUARVYRH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY E%AMINED AND <br />IN; AND BASED ON MV TELEPHONE DATE <br /> <br />INQUIRY OF THOSE INDMDUAL <br />S IMMEDIATELY RESPON <br />SIBLE FOR OBTAINING ^ <br />/ / <br />` <br />/ <br />~ <br />I;ichard i4II15 THE INFORMATION, I BELIEV E THE SUBMITTED IN FORMATION la TRUE, ~ ~ <br />/a~ <br />/ <br />/~~% <br />/ <br />/ <br />/ <br />/ <br /> <br />_ <br />' <br />ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMITTIN <br />1 AM AWARE 7HAT TH <br />G FALSE INFORMATIO <br />ERE ARE S~GNIFICAM <br />N <br />INCLUDING THE i/ <br />"'T-" <br />1 <br />[ <br />~ <br />G <br />_~ivironm~nt~l I <br />tana~er <br />' , _ 970 870-271? 6 ?4 99 <br /> POSSIBILT <br />OF FINE AND IMPR ISONMENT. SEE 18 U.S.C. 4 1001 AND 33 U.S.C. <br />d <br />( <br />b 510 <br />00 <br />M <br />' SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED rre9 up <br />e <br />, <br />0 er <br />or <br />a 5u <br />mum /m^nsonme~ 6eMeen 8 ~b en <br />p Teers.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference en ettacnmems here) <br />~eLr:.RNIITd [.I1Tr c. ., li T.: 7~ r„~,I r '~L''h if.P i] r'lq ( ~ r..r <br />T, I L ) ;-, ~r,v ~..rY rc ~- t ~_v^~ 7q_,.n aux... ~. ~. .,. .1.._. <br />T~ ~'..A TM e. J. ~"' T. ~.~• ''~, ?4r PJft "17 gtlcy 7F ~?Tnc ov~TTgc~^n'^-. ~T[. '~~varv_.-rc ^-I :l......~w.., per ~ <br />...~ <br />EPA Form 3320-1 (09-95) Previous editlons may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ^ D i) Q / T ~ n ~l T ~_ 1 ~ ~ , PAGE .I OF <br />