Laserfiche WebLink
PERMITTEE NAME/ADDRESS (Include Fari/irt' Name/Location if Different) <br />NAME <br />TkArFER CIHIHC~ ]HC. <br />ADDRESSI R A P P E R P, I N E <br />E.C, kSCY lE7 <br />FACIUTYCY.AIG CC N1b10 <br />LOCATION <br />6 T'1'd. L'_ Cn uLfl [LT [C.. DL'LC/L L'• Yl•D <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR, <br />f2-16) p]- 9) <br />•~ ' c <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 0 0 C 4 O 1 To G C C E ~ C <br />(20@11 (22-23) f2d-151 (26-2]7 126-29) (JO~Jf) <br />Form Approved. <br />OMB No. 2040-0004 <br />17I HC R Approval expires OS-31-96 <br />(SUEF Gi) <br />F - FI~BL PCcFi <br />CI SCtibFCi: '[C FLCPE t;LiCR <br />'il'~ NG CI_CNAFCE t00 <br />NOTE: Reatl Instructions befo! Erripleting this form. <br /> (3 Card Ony) QUANTITY OR LOADING (<Cerd Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4653) (54-6/) (38-45) (4653) (5461) EX OF TYPE <br />(32-3]) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />f6zru) ANALYSIS <br />(64-68 <br />69-70 <br />`IL ANU GRt:A:;E SAMPLE :/il4:*~% ( U4) V>CO~fil C'Sif=:°: -,:"+Sail <br />L i U A L MEASUREMENT <br />vObt, 1. o G -`. vat ~ '~ o>a~a+oa. '-fr~~;nFt'! "' E'=I v~~r~l~~a .. .. m:~crm»s, o~L~c~>7o ~ ~::: c 11 '.25uAL <br />F'F'LUkt~T t;FC55 YALLE A~t14~1AN5EN7 PC=G ~~; <br /> SAMPLE <br />-~ <br /> MEASUREMENT 'Z./ <br /> ~ . <br /> ;p,dfT . <br /> AE_pUIF4GME=Nt , <br /> SAMPLE <br /> MEASUREMENT <br /> a~ <br />~ <br />E <br />p G ,, <br />°` <br /> u <br />~~l <br />tvr <br />F{~ <br /> SAMPLE <br /> MEASUREMENT <br /> ' <br /> ~~atiRerlr ~..` r r. ,,; ~~, <br /> SAMPLE ,~ ~~' <br /> MEASUREMENT <br /> <br />.~~ y <br />'M':'t <br />L~ <br />t <br /> <br />~~ <br />li i <br />w. <br /> i~. <br />44 _ .y <br />t ~_ ~' ri <br /> SAMRLE <br /> MEASUREMENT ~ ~ ~ - , <br /> ~ <br /> _ YM <br />!y"i d ~'tY . 6_ k 7..~ <br />Q . <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />:--'iv1 ~F 4 - a' <br />~.F~ <br />F ~ ~ <br />~. . <br />~ <br />r. _ <br /> <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY EXAMINED AND <br />ATION SUBMITTED HEREIN; AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INONIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ~ <br />/ <br /> THE INFORMATx)N, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. ~ <br />~ ~/~ ~ <br />~C. /~/ii(.~- <br /> <br />W. TdOn Peters <br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />TI <br />NG FALSE INFORMATION <br />INCLUDING THE <br />ENA <br />R <br />UBMDT 970-824-4401 GG ~~ 25 <br />Pr ~ ant/General Mena eI <br />Es , <br />ES FO <br />I <br />P <br />L <br />S <br />POSSIBILITY OF FINE AND IMP.RISONMENi. SEE 1B U.S.C. 4 1001 AND 33 U S.C. <br />510 <br />h <br />i <br />li <br />000 SIGNATURE OF PRIN IP L EXECUTIVE <br /> <br />TYPED OR PRINTED § 1319. (Penetties undo/ t <br />ese smrums may <br />nclude <br />nes up ro <br />, <br />entl ar <br />maximum tmpnsonment or belxmenfimonths and SyBers.) OFFICER OR AIRH~R ED AGENT <br />COD <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMEN~ AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachments here) <br />~'f5~ 6 TOTAL IRCN L1l17S SILL i'@ iiAIYEU~ AKC SET4LFPFLk °_ClLLc: LIEl: AFFLII FCF <=ICYF~i4fF kFECLI.EYEh1- <br />~SE.: PURDEN OF PHCCF'EE(1UiREhENTS UHGER I.A.3. F2FhITTEE ML57 '1P.nF. ALI FE~ECIiAE(E FEAC6FF° 1C EkLLCF Fli <br />~~f9A ~or`m`~94b`-Y'(bg='~b7 PIAviQils e11i6dhS~m'd~t'hot6eJs~f."" "" ""(REPLACES EPA FORUfTaoWHICFfMAYtaOT9EU5~ t!= * ""'" PAGE OF <br />-. 00113/OOCI]I-1E~4 2 Z- <br />