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PERMI77EE NAME/ADDRESS p+d.e. FrlbyNwJrucmrm r/Dlponq <br />NAME c.YF'I{~y LI'iF+IRf: CUI{PGKAiIL,t. <br />ADDRESS {' ,] CJ <J X G C1 <br />Chalo <br />CO d1bZL <br />FACam CYF~t~S Er;rIFL i;unriiliATICN <br />LocAno"GRAIL; CU &laZS <br />ATTh M1ChAEl n. LUDLUM. GLNLr AL MC+i2 <br />:~-•-,._ <br />NATIONAL POLLUTANT DISCHARGE DJMINATON SYSTEM NPOESI Fonn Approved. <br />DISCHARGE MONITORING REPORT !D/!Rl OMB No 2040-0004 <br />(?461 ! rsl ~nn~.; t\~t arc i i~ ST!•.~ ~i w~ <br />i 00034 4 r~. ~ x Approval expires 05-31-98 <br />~UUK ~iK 1+:J47 <br />PERMIT NUMBER DISCNMGE NUMBER F: - ~ I NAL <br />~:.';r.. MONITORING PERIOD MINUR - <br />aYNA`Ru MO DAY YEAR MO DAY <br />FROM ~.. I ill TO ~l~ 00 jl #5v# NQ III$S iR6E ~ +{•,< <br />(2x2;1,1 ai7o.T1 n425r ns-2n n8-291 r3a3n NOTE: Raed Imtructiom belore completing thb form. <br /> <br />PARAMETER !3 Grd OnlY1 QUANTITY OR LOADIPT l4 Gid Onl 1 QUANTITY OR CONCENTRATION <br />Y <br />NO. FREQUENCY <br />SAMPLE <br /> <br />l32-371 /4653/ (546!1 /38J51 I46-531 !546/1 . <br />EX OF <br />TYPE <br /> AVERAGE MAXIMUM UNI ~ INIMUM AVERAGE MAXIMUM UNITS . <br />rs;-sal µ~Yyys <br />!64681 169-]OI <br />>:t:FFtCi STATi{E 7DAY SAMPLE 4t•/AN{..} {. .;~i;..};• :.vMV•}<i •:ti••::~.:i. ~1 <br />LhK I,EkIuJAaHNIA MEASUREMENT <br />TCI'9n J 0 0 'PERMIT;.. #:4~#k~~:!- :: .;;'21?P~!!!R>!!.~:SA 4{<•F II.9 `i+f{etksire x•~ra+:,~,y.l tr.- i i"rEY:.: :17!!IG~+:5 <br />]EL' CIJMMLNTS 9ELUW REQUIREMENT.! .: i. „'; '~~~;: `%; <br />:y,.:,>z:~b <br />. <br />~ <br /># <br /># <br />eta YAL:3~< <br />-_~~T <br />xtFr`tCT STATR[ TORY SAMPLE ,}4{,444 44##+l1+~ ~ <br />+ <br />..~ <br />, <br />1'J Y`fc v4;•••,:.. {..,. ;:.. i. {. ~ j <br />ChK F'1MLPMALES MEASUREMENT "~ <br />TCF'bC J C U PERMIT:. ~N#is+i!d . #+p;pR~A. ,y ;, ,F{. f t <br />~.J {.'{<{'~~<7 L<M',Y9~FIG i '[~- :TR~.f: .1~lS:FL1: <br />SLt CUMM~raTS IfELUr. REQULREMENT •:....: . {. ;. ;<4 . <br />ti'. VAL IL ;...: L:CNT . <br />........:..:.. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~. ~ ~ ~~ ~~ <br />~ <br /> :REQUIREMENT .. ..~.. ~... <br />.... .. ... .... ... <br />.::.... ~ ~. ... <br />~~. ... <br /> SAMPLE <br /> MEASUREMENT <br /> <br />.. <br />.. PERMIT. ~ ~ ~ ~ <br />.. <br />. <br />.. <br /> REQUIREMENT <br />~~~ <br />~ <br />~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> ~.. ~.~ PERMIT ~ ~ .~ ~ ... <br />~ <br />~ ~ <br /> .REQUIREMENT: ~ ~ ~ .. . <br />.. ....~ .. <br /> SAMPLE <br /> MEASUREMENT <br /> ~: PERMIT:~ <br /> :REQUIREMENT <br />.. .~.. <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> :.;:.~. PERMIT ~...~:~ ~~ .. . <br /> REQUIREMENT: ~~~~. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW TNAT I HAVE PERSONALLY EXAMINED AND <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN <br />AND B <br />E TELEPHONE DATE <br /> ; <br />AR <br />D ON <br />MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />1 ': <br />Richard Rlills OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~ %~ <br /> TRUE. ACCUMTE AND COMRETE. I AN/ AWARE THAT THERE ME ' i/;.. <br /><~' <br />' ~ ~ <br />; ~'~ <br /> <br />E <br />i <br />t <br />l Wl <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INOLUDING A <br />~ <br />~ <br />t <br />nv <br />ronmen <br />a <br />ananer <br />J , <br />THE POSSIBILITY OF qNE AND IMPRISONMENT. SEE to U.S.C. f 1001 AND 33 SIGN ~~ ~~- 4 A 4Q <br /> u.s.e. f t at e. rAwlNti.+ wv.• en..+ mltm+ nur +ICAN+ 6n.+ w ro S IO,000 ATURE OF MtINCIPAL EXECUTNE <br /> <br />TYPED OR PRINTED <br />+Mwmui.wnwnpimrrrNWMewrnsmmN+rW6y.r+.1 <br />OFFlCER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />a nnv urLnnn I wrv ur Alv T vwLA I wlvs IrTererence e6 sttecnmenrs oars/ <br />Ott 1.D.> FUk :1~TAIL$+ n[F'C1kT LtThALITY i)EiiIYATIUNi A~ -aFrt~T F VtipwTN/K~F'kUDUCi20N A$ TOXICITY r.l-f <br />LLWt$T a LFFLUCt~T AT hHILM STAT SII;NIF O1FF dETAILc:~ TE$i L IUtNIMGL WA, ;79SEkYEi; USINb icST CCGc ., . 1~[~ <br />~CTw.! T~~T rt•t, p . 1 tv erT+ru fun.w Tr rGC Tor rv.~u Tn u i rITnV +.. Ts~cf p AT tftu T!1 GDA <br />EPA oirn 3320.1 108=85jPrevious editions may be used. ~ - ~ - 1REPLACES EPA FORM T-40 WHICN~MAY NOT B USED.1 -~ ~ - - - ~ ' - - PAGE OF <br />000~.7/9b11uIi-19t1 i <br />,.~., <br />