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PERMITTEE MAMEIADDRESS/Include <br />funGry name/Larvrion it dJ/erenrl <br />NAME_NLi (..d Lli 71'LL ~(rT-. l.ll r, jL L.A S~.Y_. Sib ~:.,~-_ <br />ADyESS t;~chL.b."1LSTi•:.LL1L'b$.:),1iiGlttiiClr.UlJlil_ - <br />_ - _ tlU L e_fl ST ~LI1.4911iS ~:. S 1'1L n.E_T_ - _ _ _ <br />FACILITY _ <br />LOCATION-_-_-_-_--__------ _-_- --_ <br />~t'lu: OAaIU J. HACDOOGALL iSC. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES/ <br />DISCHARGE MONITORING REPORT /OMHI <br />11-161 /1719/ <br />PERMIT NUMBER OISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM y TO ~ <br />(141p (71-1J) 7N•15/ 17b-17/ 178-191 1343/) <br />r -FINAL <br />F11 tl2 CSC:IhG TO GRASSY CLrEK <br />(iINOA (BURN NM) AOUTT <br />NOTE: Head Instructions before completing this form. <br /> (7 Card Only) QUANTITY OR LOADING l4 Card Only) pUALITY OR CONCENTRATION <br /> <br />PARAMETER <br />I~6J3/ (SI-6// <br />138<S/ ()6531 l34-6/l NO <br />E% FREQUENCY <br />OF SAMPLE <br />TYPE <br />/31-37/ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS ANALYSIS <br /> l61-63 l61~691 (6970/ <br />L'~t SAMPLE ##Y#Y# Y'f Y'Y#~ %FY#YY;f <br /> MEASUREMENT <br />L CUCV 1 (] (~ PERMIT ###### ###%~~# v#'Y 6.5 ###### 9.4 ~ NCE/ RAB <br /> REQUIREMENT , <br />YYYY <br /> <br />::~LIJ:i, SE1'TLeAcLt <br />SAMPLE <br />LYY~iFYY <br />Y#•lYY~ ` <br />YYY~{r'fY <br />YY#'fYY <br /> MEASUREMENT <br />L1.~47 I. U li PERMIT ;i>'V##'~# Y`ii.#Z}# %iX.~ r##v## r'.1##%~# Q~~ NCE/. RAB <br />C REQUIREMENT <br /> <br />VjL AhL Ll (IEA Sh <br />SAMPLE <br />YYYYYY ` <br />YY•SYY'f ` <br />Y#YYYY 4 <br />#Y#YYY <br /> MEASUREMENT <br />rutu <br />[+ EXTh-GhAY 15ET1 <br /> <br />LL <br />V1/~J6 1 ff V <br />PERMIT <br />Y####Y ~y y <br />Y#Y### <br />~#~' y <br />##~#Y# A Jy ~y <br />YTY##Y <br />10 <br />ONTIN <br />RAB <br />~ REQUIREMENT <br /> <br />I n%h <br />SAMPLE <br />YYYYYY ,` <br />YYYYYY • <br />!'fYYYY <br />YYYY## <br /> <br />'1 :.'1xL tIiCCV tihAULE MEASUREMENT <br /> <br />Ul;~;'; i O V PERMIT ###### ###### ~:## ######~ ,###### OPTIONAL ONTIN 'RAB <br /> REQUIREMENT <br /> <br />t LJN, IN CONDUIT GA SAMPLE Y~fYYYY ##1`~fYY #YYY#Y YY#Y#Y <br />1HtIU Yh BA'lhENT t'LAN' MEASUREMENT <br /> <br /> <br />~VV~V 1 V U <br />PERMIT guy <br />YyY### <br />REPORT <br />###h#;s Jy <br />#TY### ~{~y ,/. <br />TY###'! <br />#YY <br />NCE/ C <br />NST AN <br />- REQUIREMENT <br />'„:i <br />~CLIL'S, 7C7:LL SAMPLE #,~#~1## ;~#Y#;r -.,r:;r,ar #;~#r#;. <br />L I .`.:J U <br />L Y E L MEASUREMENT <br /> <br />4 <br />I.J(JJ 1 V 0 <br />PERMIT y <br />rfy##YY <br />#YYY# , <br />Y1xY y <br />YYY#YY .ry ~y <br />##YYYY <br />AEFCAT <br />TALY <br />AAB <br /> REQUIREMENT <br /> <br />LaIL dNU GhEASE SAMPLE ~i~#y#,! YYY#Y# Y#YYY# YYYY VY <br /> MEASUREMENT <br />Y i S U A L <br /> <br />•:4tit:ti 1 C U PERMIT #L#### 0 eS=L ####..# # #### #_#### '### NCE/ ISUeL <br />- REQUIREMENT NO DISCHARGE <br />NAMElTITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE P <br />AND AM FAMILIAR WITH THE INFORMATION SUBMITT ERSONALLY EXAMINED <br />ED HEREIN; AND BASED / TELEPHONE DATE <br /> <br />ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR / <br />~ / <br />_ <br />~ / <br /> <br /> <br />Karla Rabuck <br />OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION <br />IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG _ <br />/ ' <br />LL/Z t,F(_ LZ. L[_ i c% <br />L <br />AA <br />Tlt <br />V <br />P NIFILANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING <br />THE POSS <br />BI <br />IT <br />MPRISONME <br />OF F <br />T <br />S <br />608 754 <br />22 !111 <br />T C(? <br />reS T Ue I <br />L <br />Y <br />INE AND I <br />N <br />. <br />EE 1B U S.C. 1 1001 AND <br />33 U <br />S <br />C <br />6 1319 <br />A <br />t <br />P <br />l <br />i <br />d <br />i <br />l <br />d <br />Jla <br />au9 IGNATURE OF PRINCIPAL E%ECUTIVE - <br />91 91 D3 3I <br /> . <br />. <br />. <br />er r <br />ru sta <br />/ <br />ena <br />r <br />rs <br />ures maY <br />nc <br />u <br />e fines up ro <br />, OFFICER OR AUTHORIZED AGENT AR <br />A <br />TYPED OR PRINTED and or marrmum imprisonmem pJbrrweenbmonrhsand Jyears.l D NUMBER YEAR MO DAY <br />COMMENT AND E%PLANATION OF ANY VIOLATIONS /Reference a!I attachments here) <br />ULL L' GNtASE: SEE FOOTNOTE F/, kAGd 3 OP TUE PetiBIT. fGAAENLY GISCNAAG60 UNDER CO-O035653. <br />EPA FO/m 99ZO-1(RBV. D~RB)PTeViO1/5 Cd111O/IS rnBy t)E!/SEd. (REPLACES EPA FORM T~dO WHICII MAY NOT 9E USED.1 Paf.E OF <br />