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PERMITTEE NAME/ADDRESS pnclude Faciliry NameJlacarion ifDgerenrl <br />NAME SeNE.CA CGAL CCCFlN1 <br />ADDRESSGAA4 EA U <br />A,1xDEN cc e1639 <br />FACILITY <br />LOCATIOI~AYITEN CU k1L30 <br />A'i'TN: G. PUD kUNN, G:Nt.IiAL NANAGEk <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.~e xjwF~ T <br />DISC(HAR GE MONITORING REPORT (OMR; OMB ND. 2040-0004 <br />I17- sJ C I N U k Aoproval expires 05-31-98 ~ <br />„ ISU°k Ai•) <br />PERMIT NUMBER DISCHARGE NUMBER Ft F I !) L P v u "I T <br />MONITORING PERIOD DI SCi1A nEf 1C '[FIE/F1~F CFff I! <br />Y MO DAY YEAR MO DAY <br />FROM TO U U~ 4~'+~ NG C; ~ChAi+CE +__~ ~0: <br />(~ 2-nJ (za-zs) (z6~z7J (za-zeJ (30 01J NOTE: Reatl Instructions beforn completing this form. <br /> (3 Cerd Only) QUANTITY OR LOAD (4Cerd Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (5161) 't' (38.45) (46-53) (54-61) E% OF TYPE <br />' (32-37) <br />AVERAGE <br />MAXIMUM <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br /> <br />(sz~sal ANALYSIS <br /> <br />(6468) <br /> <br />69-70 <br />bCLIDS, TUTAL <br />LI;iSULV ED SAMPLE <br />MEASUREMENT "''`~`" ' '` # 10 <br />6a <br />3(~ E (~ ( `) <br />~ <br />I~3C~ <br />(~."b <br />7UlyS 1 CI U P~RMIj ~` A>r>71n 93r IfOXT {~'v ~- ° C~ L <br />~ AB,i(6 TbLll ~FP.F <br />t.F'iL'JC17T G80SS YALUt REQUIREMENT [.xt~ ~ ',jjg - ~@~It~ L'1 !.G/ [ <br /> SAMPLE <br /> MEASUREMENT - <br /> PEBMIT "`~ <br />~. <br />' <br /> <br />! <br /> °~EOUIREMENT ' 1 <br /> SAMPLE <br /> MEASUREMENT <br /> PEpMI~' w,- <br /> {~GIUIREAAEN7 4 <br /> SAMPLE <br /> MEASUREMENT <br /> E d <br /> ii~C;tU1REMENT. ~~~ <;. . <br /> SAMPLE <br /> MEASUREMENT <br /> RERMIT <br /> REF]UTA~MPNT ~ - , <br /> SAMPLE <br /> MEASUREMENT <br /> ~: PERMIT..: ... <br />- ~ , <br /> .)iEQUIREMENL -. ~ - - - ;?' <br /> SAMPLE <br /> MEASUREMENT <br /> PERpt1T <br />~ <br /> RE©l11REMENT <br />% _,,,y,~^". <br />:". <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER <br />PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY EXAMINED AND <br />ATION SUBMITTED HEREIN <br />AND a45E0 ON MV TELEPHONE DATE <br /> : <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. <br /> ACCURATE AND COMPLE-TE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR <br />MITTING FALSE <br />NFORMATION <br />NG THE <br />INCL <br />D .~~ <br />L J <br /> I <br />. <br />I <br />SUB <br />U <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 16 U S C. § 1001 AND 33 U S C. <br />SIGNATURE OF PRINCIPAL/EXECUTIVE ~ ~ O f O <br />I <br /> <br />TYPED OR PRINTED g t319 IPenenies urpar these sretules may mcwde tines up ro ff0.(xq entl or <br />maximum lm <br />risonmeM Ot baMre¢n6months entl 5 <br />eers <br />) OFFICER OR AUTHORf[ED AGENT AEA <br />NUMBER <br />VEAR <br />MO <br />DAY <br /> p <br />. <br />y E <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />I:S LI^'IT N[LL r3E IiAIYEC ANU SESSLEAULF. SULKS 17l7T APPLIED FUA C=lO1A,2~1AA PAFCIF EYEN7; RS° b <br />5e'fTLEAbLh SULIUS llflli'iiAIYED FUA )lU1k,~4AA Pkf.CIF EYEYT SU6JECT TU BURGER OF FkCGF I1 l.~.i. CIL 6 <br />r'~F'e cL'_cii T L t P ~(1< r/`M TTl10t Yr~e:J IP r_O_t L•_ <br />EPA Farm 3320.1 (OS-95) Previous editions may not be used. (REPLACES EPA FORM T•40 WHICH MAY NOT BE USED.) [I O UEI 0 / 99 0 E t 7 ~ I6 ~ : PAGE I OF <br />