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PERMITTEE NAME/ADDRESS Qnclade f'aailim Name/Lota=ion f DijferenU
<br />NAME T. Y. k'':~i:; 'i n'ka 'inLL'. v_ naL rC?..e.
<br />ADDRESSyINrS 1. ,?~.J Cif?}', ~i _C?`;A9 i'I;
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<br />FACILITY
<br />LOCATION
<br />F 7TN: .1UF8I`.; S;, R.~,'GL~Y, GENERAL ATNY
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
<br />(2-161 l11~ 91
<br />rn~n77 54 0;;5 n
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM U V U tl U 1 TO U U V tl 31
<br />lznzt) (22-2]) (29-25) /26~2)J (2629) (]0-JU
<br />Form Approved. '"I' -,~ i
<br />OMB No. 2040-0004 h~,..,{Ij'i
<br />"' A JOA Approval expires 0531-98 ~!9,',,
<br />F - FINAL H
<br />:!iFE 1, FO!JD D TG FGI['FL CREEL; ~~
<br />:: i==) :i0 DISCHARC,c ~`( ~"~'~`
<br />NOTE: Read Instructions belore completing this form.
<br /> (3 Cerd O
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<br />OUANTIT FOR CONCENTRA410N E ENC
<br />FREO MPEE
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<br />PARAMETER S
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<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />Ifiz-5'6 ANALYSIS
<br />(6a-68)
<br />69-70
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<br />NAME(TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO
<br />AM FAMILIAR WITH THE INFORMATION BUBMITTED HERE NALLY E%AMINED AND
<br />IN; AND BASED ON MY TELEPHONE DATE
<br />Richard hSills INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE,
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<br />Environmental Manager ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />E INFORMATION
<br />INCLUD
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<br />BMITT
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<br />~ ~N 970-670-2712
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<br /> POBSIBILITY OF FINE AND IMPRISONMENT. SEE to U.S C. 41 WI AND J3 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE ~ ,
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<br />TYPED OR PRINTED g t319. (Penerties antler Ihese slalules mey include Imes up ro E10,000 entl or
<br />maximum impnsonmem of belween6momhs andsyears.) OFFICER OR AUTHORIZED AGENT
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a118ttachments here)
<br />aL'i'EkNATi LI:!ITS ee^C~R TSS D 'iETTLEA.:LE SOLIDS (LOC '_)') APPLY ONLY IF <= IO-Yn, 2U-HF PREC7P FYEN2 IS
<br />CLAIMED. SEE I.A.2, PG 1H, FOR bURD°y OF P400F ke,JUIRFCrN'P5. OIL & G;:F.ASF--:,EE: FOOT NUT? F/, PG 2.
<br />EPA Form 3320-1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT aE USED.) 0 0 0 b 0 / it U G 4 0 5- I S 0 i PAGE 2 OF
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