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r~ <br />PERMITTEE NAME/ADDRESS (Include Fncililv.4'nme/Lurariun fPi$rrenq <br />NAME CYi'nL5r,tFIFF CCFPCkATICti <br />ADDRESStAGLE nIfr CCCFIFY <br />P. C. EOY b8 <br />FACILITY"RIB CO E1t26 <br />LOCATION <br />G'CTA: ];;FGkf, 't Vw.if f_ V.C. <br /> <br />NATIONAL POLLUTAM DISCHARGE ELIM (ION SYSTEM (NPDES) Form Approved. <br />- DISCHARGE MONITORING, • aRT (DMR; OMB No. 2040-0004 <br />y.~, R~+sl ;, ~ .. m- 9r t I NC h Approval expires 05-37-98 <br />";';o' rrn u u "' (SUER li) <br />~'" PERMIT NUMBER DISCHARGE NUMBER F _ fIYlll~ ~ CCFAT <br />MONITORING PERIOD CMAF NIC Si_1:T 'IE_T 16C F7 C:i <br />YE "" MO DA• YEAR MO DAY -- <br />FROM TO (~`•. ,•= ='~¢~ aCBAFCF '~~'~ <br />(2, z-z3} j (zs~z7) (ze zel r3o~sD WO~i~[_~F3,ead Instructions before completing this form. <br /> (3 Card Ony) QUANTITY OR LOA ~ ' ~(4 Cerd OntyJ QUANTITY OR CONCE ON NO. FREOUENC SAMPLE <br />PARAMETER (4fi-53) (54~6iJ '-~ r;, (39451 (4fi-53) -6+) CX OF TYPE. <br />(3237) AVERAGE MAXIMUM MINIMUM AVERAGE MAXIMUM UNITS r <br />(6g 63} ANALYSIS <br />(64-fie) <br />69-70 <br />~r:Fk'E'C; :iA1'kE 7LAY SAMPLE :+-:::D~ #:0::^~ ` qq// <br />QQ Ci`4#r10 ~:t•Y,i ( i?) <br />~ <br />~ f /~ <br />~ <br />'ii CEB ICLAPNYjA MEASUREMENT /O <br />/~ 9 <br />:tP.iC = U U I~iF o~i0#ca ~ <br />~ ~_: ]#•5 ~.`; ,r 4 1 941 aq _ '~ ~~~ :GBFC45 <br />J ~ E it O^I F t c T S E E L C ~ Fly'",4J1 fifv1EN7 '"~~: <br />~Ir` i >r ## j}~. . <br />~. ~;`"_: _ F F '. <br />~~ <br />;.EF'E'~C1 ~7ATse %Cll <br />Fi N Y I ('. L FIf A L E _- SAMPLE <br />MCASUREMENT +'vA9i! -_ . <br />``'~',a aqyr <br />/'~Q~/r0 . ..~::,+: 4>V'~j~ <br />~~~-~~ ( ~=~ <br />Q ~j <br />'/ r~ <br /> <br />~ <br />TCYoC .. L i#4x7K+;: 0dx.d#i? Iv X;::~ <br />'~=' A>p4gt~l-`' <br />'iE'. ~P# F <br />I EF- Y'IT, ~Cl~CS <br /> <br />SEi CG„~ r~ EL'-~"k <br />N~' <br />ra:+. <br />FF VAltlB <br />>ti,:,=•" ?~ <br />CF1~7 a. <br />.~~ . <br /> SAMpI:~ <br /> MEASUREMENT <br /> AEF'IMIT-~ " <br />~ - °,4.':, - x ~"^+~+ ro ~~:~ <br />` <br />'~' ~ ~.3 <br />~ <br />" <br />` .. ti.. <br /> ~flEOUIREMENT - - `e{~',a <br />. <br />:':-- ' <br />;~ <br />" <br /> SAMPLE <br /> MEASUREMENT <br /> ERM67 <br />~ <br />;~ I>~;, )i <br />s, <br />~~ . <br /> "ACQtJIfIEIv1CNT ~x <br />~ . <br /> SAMPLE ~?~'~ <br /> MEASUREMENT <br /> <br /> <br />R M.s <br /> <br />H ~~ <br />~f <br />rss <br /> EMCNT <br />AEQU jLL ~ <br /> SAMPLE <br /> MEASUREMENT <br />.. PERMIT , - :..~~s+. <br />` .~~ ._' <br />'" <br /> REOUIREMENT - <br />`:7~ „ <br />.~= - ' <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> F1E~UIFiEIvJENT ~"~I _ " <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CER7IFV UNDER PENALTY OF LAW THAT I HAVE PERSONALLY ExAA11NE0 AND q TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORM ATION SUBMITTED HEREIN; AND BASED ON MY // <br /> <br /> <br />d Mill <br />Ri <br />h INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION. I DELIEV S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION IS TRUE. <br /> <br />' <br />97O 878-2712 <br />s <br />c <br />ar ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICAHI ~ <br />Environmental tvlana er <br />9 PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING THE <br />POSSIBILRW OF FlNE AND IMPRISONMEM. SEE to U.S.C. 5 1001 AND 39 U.S C. <br />SIGNATURE OF PRINCIPAL EXECUTIVE /y <br />III' ~ <br />fff ~ l <br /> § 131 R. (PCrrehies under Inese s(ahnes niay inclutle hoes up ro St0,000 end or OFFICER OR AUTHORIZED AGENT CR <br />E NUMBER YEAR MO DAY <br />TYPED OR PRINTED maximum rmpnsonmont olbehveen6monrhs antl5yeers.) D <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attacnments nereJ <br />- S.is.3 ECh CcTAII`_. TE?CkT LFIF:ALIIC GE6IPARICkS !~ ":+IikeC1"~ (, EC>TN/HtI•iIGCLCIICN AF "1 C;;lCITY"• FF1 <br />C.n~.,.: ~ tF'FLLiNT dR 4HICH ST-T SIGNIP DIfF 6t'SkEfP TEii1 6 CCti1hC1 ~A~ CEStiiYE>: CSIF6 1F_`7 CCCF "`", ICES <br />CC381A000]]1-16iC PAGE ] OF <br />