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PERMITTEE NAME/ADDRESS pnrGrde FucJln NumriLocnlion i/Oderenq <br />NAME CYkhUS EFfFIFE CCFFLirATICN <br />ADDRESSEAGlk: RI1lE CCCF1fT <br />e.o. nox de <br />FACILITY C F; A I ~ ~ ,~ , ~C e l 6 ~6 <br />LOCATION - ' ~" <br />~TCa: ACi~.Gn:. - '7~ 4. P. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION <br />OISCHAf1GE MONITORING REPORT <br />(s 16J <br />nr~~ <br />-"""~°"" ` PERMIT NUMBER I E <br />MONITORING PERIOD <br />FROM <br />(26 2]) <br />...;z="~ <br />(NPDESJ Form Approved. <br />I' I n C F. OMR ND. 2040-0004 <br />Approval expires 05.31-98 <br />ISUEE N4) <br />auMeER F - fINAI !•CFJT <br />CNFCNI( GF7 7E_TIlC A7 CC3 <br />DAY Y , __ <br />1 hC CI`_CFARCE ~__I '+~~ <br />po-3N NOTE: Read Instructions before completing this form. <br /> (~ onry) QUANTITY OR LOADIN ': (4 Card Onry) OUANTIIY OR CONCENTRATION NO. FFEOUENC SAMPLE <br />PARAMETER (4s-58) (54-61J ~ (38-45) (4653) (54-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM U ITS MINIMUM `:'.~ AVERAGE MAXIMUM UNITS <br />lsz~col ANAL1515 <br />(6466) <br />69-70 <br />:EFFECT STATY,E, /i;4! SAMPLE .Ya3+~; <br />~ ~x,M#~ <br />~ #~~%~~; ~=iz~% 1 ~=) <br />O 1 <br />~1I~R <br />L' H ti C E E: I O C A P n\ I A MEASUREMENT }, OO, ~~ C <br />7CI•.~c. S 0 u PERMIT +7 ^. ty##~!!-" _ L#:7 11.'J ..~~1~~'`4~.•-, lJ(<741~~~~' ~' EF- -` "];'1,`~: 1 C"~~~.5 <br />UEE COi ":RTS BELCi~ REQUIREMENT ~ " f`t'~ ~>oilry [N YALL'P <br />- - <br />. ~ ~ CE FT <br />~FFF'iC" _7ATRP 7CAY SAMPLE •~...... ~iC#4# <br />- er <br />^ <br />'~ K4>;t;t rY{K::~ I i=) ~ ~~' <br />~~ <br />C r ii ~ I ~ f F"HALES MEASUREMENT 71 <br />t <br />/ <br />W <br />TCFgC S 0 0 FEFIMIT C>:z •::'ri 9O~{t~l ' , Olt <br />~- ~ ':w~ 3kLA1~#>616 ..s "'~;a. !rP } F _ ibT G!l~C9 <br />.°,t.t CCt;hcti'fS EELCN "REQUIREMENT ,`~r-„ ~ OC ,; ~LCt ~ ~ , Cf h'I - - ~ " <br /> SAMPLE <br /> MEASUREMENT ~~ <br /> <br />PER)v14 ~' <br />T sl <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />" PEiildtT <br />~ <br /> flEQUIREMEN7 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> flEOUIREMENT " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMlT ~ - <br /> REQUIREMENT ! '^;, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT- :. <br />.~ . ~ i <br />- 1~ ~ r~ , <br />C <br />' ~. <br />~ . <br /> REQUIREMENT , - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO <br />T NALLY EXAMINED AND <br />D <br />D ON M TELEPHONE DATE <br /> <br /> <br /> <br />ichard Mills AM FAMILIAR WITH THE INFORMATION SUBMI <br />TED HEREIN; AN <br />BASE <br />Y <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIA1tiLY RESPONSIBLE FOH ODTAINING <br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. <br /> <br />^ <br /> <br />rj]Q $]Q-'~]~Z <br />r ACCURATE AND COMPLETE. I AM AWARE THAT THENE ARE SIGNIFICANT // <br />Environmental Maria er PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE <br />PUSBIBILITV OF FINE AND IMPRISONMEM SEE 18 U.S.C 4 1001 AND 33 U.S.C. <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ y ~, <br /> <br />TYPED OR PRINTED 4 13t B. (Penellies untler (hose slarules may include fines up rp Ef0,U70 and a <br />mm~mum impnsonment olbenveen6montns ends years.) OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />"NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANA I IUN OF ANY VIULA I IUNS (HererenCe au aR6CnmenTS nerB) <br />Ito i.N.! F'Oh i,iT~IL_e. ht'pChT LEI11dLIT_Y %EhIYATIChS AS R~Et!•FC:"r Gi:CfITN./nEfRGCCC7ICN A. "1CbIC]TY" Fil <br />Lulrt:Si .. i•r'FLLr.t~1 AT YF:ICB STni SIC;AIF I:IFF EET~EEN TfS1 f CCBThCI YA_ CESERYEC C°ING 7EE1 CCCf ": `, ICs`_ <br />t II ~'. II ~ L /' - l 1 j; .' __ I T T ~L l~l raj T /' R C C T ~ f. T ! i ~I ! C b C C /'!' f V 1 1 • Y\ C/ Y. R 1 f T <br />EPA Form 3320?{1 (OSA5) ~FTreviolis editigps may nqt be used. ~~ ~ > ~. •~(REPLACES ESA FORM sf~0 WHIC}I MAY NOT BE USED.) . ~ ~ r - ~ • ~ - ~ ~~ • ~ PAGE OF <br />. -_ C0197/~CGCi71-lEit 1 <br />