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PERMITTEE NAME/ADDRESS (lacLuleFacillry Namdlaca(loa IfD~arary ~ NATgrLIL POLLUTANT pSCHARGE ELIMINATION SV5rEM (NPDES) Form Approved. <br />NAME T P. A F P E R t1 I N I tl G, I :a C• DISCNARGE MONITORING REPORT (DMR) `I I N O R OMB No. 2040-0004 <br />ADDRESST{APP~K AI Ma ~ ` (SUAR Nti) <br />P. 0. R d I l d 7 PERMIT NUMBER DISCHARGE NUMBER F• _ P I ±~ A I. M O F' A T <br />FACILITY CP.AiG CO tl1b2b - MONITORING PERIOD -UI~CHAF.GE TO FLUMc GULCH <br />LOCATION ' YEAR MO DAY YEAR MO DAY _ <br /> fROM 4 TO <br />0 `J 3C a#a~ MO DISCHAF.,;E r.rsa <br />e <br />A T i X: ':. G ~ R D O N P E T E g 5, PEE 5/- L' t: M G y _ plating this form. <br />NOTE: Read Instructions befor <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FReoueNC SAMPLE <br /> PARAMETER EX DF TYPE ~ <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~~r9 <br />OIL ANU G&EjSE SAMPLE `~ <br />i. V I S U A L MEASUREMENT <br />yuD6b I ,0 u <br />r,;;,CfPLUERT CNOSS I/~LU <br />~" SAMPLE <br />~!~ ~ dAFASI IRFMENT <br />u ,,.',r'., , ` . <br />ry <br />_+~xi <br /> <br />I I SAMPLE <br />4U) #Qtlr qr.^-,t r.:;: rl !i4:r # ~•.t :CU <br />5=1 ~ .u~ <br /> <br /> <br />.~ <br />NAMElfIT1F PRINGPAL EXECUTNE OFFICER ICeMyunder penalty of law that thin tlocument antl all attachmems ware <br />tl <br />ith <br />sl <br />d <br />i <br />i <br />ri <br />I <br />tl <br />/ TELEPHONE DATE <br />i <br />n eccor <br />anca w <br />a ry <br />em <br />es <br />gna <br />prepared under my direct <br />on or super <br />sion ' <br />l0 assure Nm quel~fled personnel propary gather end evaluate lha Inbrmeeon <br />W. Gordon Peters ~, aubmittetl. BesedmmylnquiryolthepeBOnorpersonswhomanegetheeyslem, ~~~ - ~ ~ / <br />/~~'~ <br />- <br />]O-S24-4401 <br />0 <br />10 <br />°4 <br />thefnbrtnetion <br />~~o~~nadi.xllyresponslbletargaNaringNelMOrmatlon <br />4 <br />, <br />' <br />President/General Mena QI~ ' <br />nd mrr <br />lela <br />g ' <br />l <br />c <br />rare <br />w <br />tl L <br />h <br />b <br />l <br />k <br />l <br />d <br />d b <br />li <br />c t <br />p <br />, <br />ore. ec <br />u <br />, a <br />nme <br />V,tot <br />e <br />ssY O <br />my <br />now <br />e <br />ge en <br />a <br />e <br />eu <br />l <br />i <br />l <br />Mb SIGNATURE OF PRINCIPAL EXECUTIV E <br />on, <br />e <br />se <br />miet <br />1 em aware that rhea ere significarn penalties for eubmittlng <br />TYPED OR PRINTED Includln the sibil or fine and im rtsonment for knowi violarions. OFFICER OR AUTNOR2ED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />AHD EXPLANATION OF A VIOLATIONS (Reference all attachments here) <br />I <br />GS <br />"rep 1ROIJ LIiSIT$ GILL GE .AIY.°.~, AIIU Sc*TLcAGL'e °_JL ~i~'.il AF'!`hfF;, ". <=1CY9,?u4P PRECIP EVktii- <br />1 <br />. <br />Eti;,OF YRODP HEQUIP.E"1iNTS 114D2R. ';Ay~3;- PY.F'.RIT?'cp; MVJT i~K;; AL:. ~~? ":•i4';- ii .*tA.":J •~:, T~) i1ED.U('E ?H <br />~~ <br />I I I~Px'P,rll hll~I)~~ i~ 179 ; Ad if,ons~niay be u ;r : . - . ,. ~ ~ •- . ~ ~ ~ ~ ' ~ • ~ ' " ~' ~ - ' ~ ~ <br />_ .THIS IS A 4-PART FORM PAGE <br />OF <br />D ~ <br /> 4 <br />