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PERMRTEE NAME/ADDRESS (In['lude Faclliry Name/Location ifDi$ermQ
<br />NAME
<br />ADDRESS R O U I[ '!'~ . ,•, r Y Ti
<br />P.J. 4r)Y a~l j
<br />FACILITY PAC `~ i !. (; v $ j 4 j.~
<br />LOCATION
<br />yOwIt CO Hlu~~{
<br />GT^r:_ LI;. LT !'e e_ vac r: ~rr~e rr
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATON SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR~
<br />(S t8/ (i)- 9)
<br />rr~
<br />P RMIT NUM ER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM TO n t
<br />(2621) (1323) (24-25) !26-21) (2&2P) (30JI)
<br />Form Approved.
<br />~ 7 !10 P Appr Nel ezpi es0531-96
<br />(SiIPP VC)
<br />Its ~F SP/r'INE DFiYC TO DFP.a TRL
<br />NOTE:tReadlrisfrucLOns bp6torBee~rt TleUng fYiis }ortn.
<br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUEN SAMPLE
<br />PARAMETER (x653) 54-67 38-45 46-53) 54-61 EX OF TYPE
<br />(~~3>! AVERAGE MAXIMUM UNffS MINIMUM AVERAGE MAXIMUM UNITS
<br />f62A) a4aLYS15
<br />fi4-6B
<br />6370
<br />;r tl SAMPLE tr t:~ef?d aaRek r,:t ~O*•.•,••• ( 12)
<br /> MEASUREMENT
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<br />.)•p y_ ;; U i MEASUREMENT
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<br /> MEASUREMENT // lam
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<br />(AS PS) MEASUREMENT
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<br />'~I1. AND GRE11'5f SAMPLE "3:#ON^,. G+,.340:} ik:t:};;^-:: .^.("•.^.'r: ( 7q)
<br /> MEASUREMENT
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<br />~J TkBAT '•1T PLA?7 MEASUREMENT
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<br />LIISSOLYfD MEASUREMENT
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<br />REdUIREMENT ,~ ~ . , ,
<br />NAME/fTTLE PRINCIPAL EXECUTIVE OFFICEA I CERTIFY UN R PENALTY OF
<br />AM FAMIUM RH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMffTED HERE NALLY EXAMINED AND
<br />IN; AND BASED ON MY TELEPHONE DATE
<br /> INQUIRY OF. OSE INDNIDUAL S IMMEDIATELY RESPON SIBLE FOR OBTNNING
<br /> THE INFO TION. I BELIEV E THE SUBMfITED IN FORMARON IS TRUE,
<br /> ACCURAT D COMPLETE.
<br />ENALTI
<br />TTIN
<br />-' I AM AWAKE THAT TH
<br />SE INF
<br />G FA ERE ARE SIGNIFlCANf
<br />IN
<br />WDIN
<br />THE ,~ , ~ ~ / , , I
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<br />°!F '~'- ({,/~ ~ P
<br />ES
<br />OR SUBMI
<br />POSSIBILITY, FINE AND IMPR L
<br />ORMATION,
<br />C
<br />G
<br />ISONMENT. SEE 10 U.S.C. 4 1001 AND 33 U.S.C.
<br />I SIGNATURE OE PRINCIPAL EXECUTIVE t ~.L ~ !r - '' _ 7 I_ 4 /'
<br />TYPED OR PRINTED rgne>imurrim antler Ihese s
<br />plsonmerrt oleeMee bhrtav mey
<br />nclude Nnm u0 b Sf0,000 eM or
<br />n Bmam/u end syee,.T.) OFFICER AUTHORIZED AGENT
<br />~
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell eTTecnments nereJ
<br />J~TTLEAs:.E S^i.T:>(i Lt°?:' '.'!I^.' l•'iLY IF C=:)oP~'gH+ PQEC7P FY°!!+. [5 CLAIM' I° !'LAIC aPp?OVF9 EP v,~CO,
<br />~J`SS T IB:k L[°.I'-'S '[( 'I'II PI IT•;J '"7 ~`?'li-: T,ZD `!~ASUAF'"~NTS-3P:£ T.R.2, Fr; P04 RNFD£~ ^F PP.40F
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<br />000`:7/99 D 71 7-7 77 ~
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