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PERMIT'TEE NAME/ADDRESS (include Facifiry NmwJLocaion i/DlBerenr)
<br />NAME
<br />ADDRESSyCw I p, >;,,. • • r
<br />FACILITY PAl)aIA CO gl`I J I
<br />LOCATIO
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (DMR~ OMB No. 2040-0004
<br />a-rel rI'- al ~t T ~ ^ N Approval expires OS-31-98
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<br />P RMIT NUMBER DISCHARGE NUMBER (G U P P V C
<br />MONITORING PERIOD ~' I{r, r r h r 7 D Q c p T B A I 1. ^ TC 8
<br />YEAR MO DAY YEAR MO DAY __
<br />FROM 7 TO ~ D 4', 9' S C H (! 4 '- E§ '~'% ~`
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<br />QUANTITY OR LOADING
<br />(3 Card On (4 Cerd Ony) QUANTITY OR CONCENTRATION NO. FREOOENC SAMPLE
<br />PARAMETER S
<br />3
<br />(54-81 3845 4&53 54-61) EX OF TYPE
<br />f32J>7 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANaLYS/s
<br />6!7
<br />70
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<br /> MEASUREMENT
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<br />JISSOLYEO MEASUREMENT
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<br /> AEGU2i[Eh~ENT _ ~ " r
<br />NAAIE/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FAM FY U R PENALTY OF
<br />IU ITN THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMnTEO HERE NALLY E%AMINED AND
<br />IN; AND BASED ON MY ~ TELEPHONE DATE
<br /> INQUIRY O OSE INDIVIDUAL
<br />THE INFORMATION, I BELIEV S IMMEDIATELY RESPON
<br />E THE SUBMITTED IN SIBLE FOR OBTAINING
<br />FORMATION IS TRUE, ~
<br />~ /
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<br /> ACCURATE AND COMPLETE.
<br />PENALTIES: FOR SUBMTTRN I AM AWARE THAT TH
<br />G FALSE INFORMATIO ERE ARE SIGNIFICANT
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<br />INCLUDING THE ~
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<br />~ I ~ I ~~ ( ~~ ~. (~ ( POSSIBILffY~OF FINE AND IMPRI
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<br />SONMEM. SEE 18 U.S.C. $ 1001 AND 33 U.S.C.
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<br />COMMENTS AND EXPLANATION OF ANY vIOLAI IONS (Neterence en ettecnments Here)
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<br />A rAl o-t 0)lA~ Prevbhs editioNs~ma of bevSedt • '' • EP CES#~ T AY ~ B .) _ - - • • . ~ PAGE OF
<br />OnTi7/9'1(1i1rJ-177'
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