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ERMITfEE NAME/ADDRESS (Include Facl!lry Nmnv/T,ecanon iJDif/ermq
<br />NAME
<br />ADDRESS BO+I I E Nn. " I ~' F
<br />P.U. pUR '7H{
<br />FACILITY VAOF'IA CL) fl142R
<br />LOCATION80W I is
<br />CO H142H
<br />NATIONAL POLLUTANT DISCHARGE ELMINATION SYSTEM (NPOES) FORTI ApprOVed. I
<br />DISCHARGE MONITORING REPORT (DMR~ OMB NO. 2040-DODO .
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<br />Approval e>~ires 05-3)-9!!
<br />PERMIT NUMBER DISCHARGE NUMBER yy~'
<br />MONITORING PERIOD '1 ~"." T° 3 T I f; ; Pll ;, Q Q 2 A
<br />YEAR MO DAY YEAR MO DAY _
<br />FROM 71 07 D TO 7 n0 ll` p,~~C-~IpaCc. (x~. .~ ~~~
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<br /> (3 Corti Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER 46-53 54-87 3845 46-53) 54-91 EX OF TYPE
<br />~~~ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNffS '~-eggs 6&70
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<br />NAME/TITIP PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY E%AMINED AND TELEPHONE DATE
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE,
<br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ME SIGNIFlCANT : ~ / . ~ ~ ~ ' _ ~ ~
<br />~ PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE
<br />. 7~ j/ ~ ~~ i ~ ~r~ ~ ~- J/i POSSIBILfIY OF FINE AND IMPRISONMENT. SEE 1B U.S.C. 41001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE / ~ / ' i•%J~ / ~
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<br />COMMENTS AND IXPLANATION OF ANY VIOLATIONS (Re/erence ell attachments here)
<br />SE6 PART I. A.4 FOP OETtiILS OF TEST PAOC'eOUE°. 't F,POFT L07°.~^' nIi.UTTO4 ("' FFF{,17=n'!') si4I!'R IS I, F'"4AL TO j~••
<br />Ci Tf:ST JF:SANIS"S (LC57) AND ATTACK ACtiTE TO%TCTTY TEiT- 3F4'OnT FOP"I Tn ps?.
<br />EPA Form 3320.1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) PAGE OF
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