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PERMITTEE NAME/ADDRESS Qnclude Facility A'omrZoration if Differ¢nr) <br />NAME <br />TFAPPhF lIIYIeG~ ItwC. <br />ADDRESSIR6E:PER MIhE <br />P. C. ~CX 1N! <br />FACILITYCn AIC CG E16ib <br />LOCATION <br />ATTn: ,I. cnRDr,H LV?Ff~ DRi^,/C P• YCY <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NODES) Form ApprOVed. <br />DISCHARGE MONITORING REPORT (OMR; OMB No. 2040-0004 <br />rz-1s/ r1~' e) t! I RC F Approval expire505-31-9H <br />"T (SUE& YY) <br />PERMIT NUMBER DISCHARGE NUMBER F - F I n A L C C f A: <br />MONITORING PERIOD LISC HAFCE IC `-ACE CEEF11 <br />YEAR MO DAY YEAR MO DAY _ <br />FROM OC C4 p] TO OC C :0 +~v NC CI~CHAECE (~( iii <br />lzo-zl) (zz~z3) lzaas) (zs~zzl f28~291 (3o-31) NOTE: Read Instructions befor c mpleting this form. <br /> (3 Card Ony) QUANTITY OR LOADING ~ (a Cerd Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (57-67J (38-45) (46-53) (5461) EX OF~ TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />rB2 rot ANALYSIS <br />(s4 6a) j <br />s9-70 <br />IL ANU ~RiaSE SAMPLE L"0+;'`^~~ ( 9U) +~iii80 1CL~L.~:-', 9iiLLY <br />I S U A L MEASUREMENT <br />4U66 1 L G .-~~ ~K '€, 'v~~~R1~~`e° ES=1 •OOi4RA "~~#rF~~#~ ,~r~#+fiLtJ1 0 ;:~ ,r <br />>Ei3! <br />I5UaI <br />FF'LUE:"t GkU55 YALUE t~. .:rr I - ~''~' - ' AC=O ~4 <br /> SAMPLE <br /> MEASUREMENT' - <br /> -..f • ..,- - ~ ~ .t ~-, <br />{at I' - . ~ - <br />L-.. <br /> { ~ yx <br /> saMPLE ~ - <br /> MEASUREMENT ~ i <br /> ~ ~ <br />' - <br /> A~~l4i~IPT3T - r <br />- ~ e p. <br />R ~P, ~ ~.r <br /> <br /> <br />SAMPLE ~ <br />,F~ ~ 0 <br />1 <br /> MEASUREMENT +~ 4~ <br /> ` <br />:~ ~ ~ <br />~ .. ~~15r+yL ~T ! 'f+; ~ t x tA,~,~h ~+ t z~ } i°•~ <br /> ~ <br />x <br />ri* !,. <br />`k' . n 4 <br />YI' ~~ - 1 Iv <br />~' <br />I <br /> SAMPLE <br /> MEASUREMENT <br /> n <br />~~t N~ I rb .• <br />f) <br />. <br />F <br />! xTj <br />~~" <br />J <br />~ ~ <br />i' <br />` <br />t ~ r a, <br />M <br />PM <br /> ~ <br />I y <br />i7 . <br />~ S <br /> SgMP1,E <br /> MEASUREMENT - <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> V` M <br />V`] ~ ,0# I t <br />{ <br />: St <br />j <br />'E n • { <br />~ii~ <br />~ <br />~ <br />r ~ - i <br />k / <br />f.Yi ~ ~(! ,A <br />k <br />f~. <br />4fi' i ~ of i <br /> <br />r <br />(-• •~ <br />- <br /> raa!, <br />~*£ ~ <br />. <br />q <br />r6 n <br />l~t <br />=? '/F 1 + <br />f ~ <br />. <br />r. ~ I . <br />ai. <br />4'il' '~ •~t=° ~S ~g <br />~- <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTI FY UNDER PENALTY OF LAVlTHAT I HAVE PERSO NALLY EXAMINED ANO TELEPHONE DATE <br />AM FAM ILIAR WRH THE INFORM ATION SUBMITTED HER EIN; AND BASED ON MY <br />INOUIRV OF THOSE INDIVIDUAL <br />THE INFORMATION, I BELIEV S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION IS TRUE, <br />~ C, ~~[~..~ <br />Mi. Gordon Peters ACCURATE AND COMPLETE. <br />ES FOR SUBMITTIN <br />PEN <br />T I AM AWARE THAT THERE APE SIGNIFICANT <br />G FALSE INFORMATION <br />IN <br />UDING THE 97O-S24-4401 OO O7 Z- <br />AL <br />I <br />President/General Mana 8L POSSIBILITY OF FINE AND IMPR <br />P <br />retties <br />nder these <br />4 1318 , <br />CL <br />ISONMENT. SEE 16 U.S.C.410D1 AND 33 U.S C. <br />stat <br />s ma <br />include Imes u <br />to Ef0 <br />000 end w <br />t SIGNATURE OF PRINCIPAL E%ECUTIVE <br />. ( <br />e <br />u <br />TYPED OR PRINTED maximum impdsonmem of behvee y <br />p <br />u <br />e <br />, <br />nfimonNS end Syeers <br />) OFFICER OR AUTHORIZED AGENT A <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . OD <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />TS;i 2; TOTAL I&ON LIlIIS MILL Eth MANED. AYC .SE7TLFAELE SCLIC_ LI!!IT AFFLIEC FCF <=]C1fE~iuEk ifECIF E~EY1- <br />5EE bUHt,QY OF PBGGP EPQUIFEMEYTS UNDER I.A.3. TD5 90hITOGIYG - I.e.3. CIL E t;EEA~: - ;EF ].E.].(L). <br />EO"A~O~m3326-1206.95J"PI'BVioUSt4liGt~/D>~p6[De1158(1. - - - -(HEPWBESEPAFOHMT"iFDyYF11CfiMAYROT9E"USED.) PAGE OF <br />GCC91/GGC1l:-ltiw 2 l <br />