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PERMITTEE NAME/ADDRESS//nrlude <br />/ ennrv A'umr/L«auen JeJ/rrenp <br />NAME -112) l.Il Ld 111.2'. y L'y 1.H [~ 1.1:1+2115 ~ lzll ~- - - <br />nD ]CRESS I, It ~: n rl A N1 S'L' ti L1 i1.A aI Ltt G1 C4LU.4LlLL - - <br />- - - l: L t_ G A S.T ~1I_I. II.A U.h E~ ~'LIz E~T_ - _ - - <br />---~121Y,~~LLL~------~~ 5351{7 - <br />FACILITY _------_--------- <br />LOCATION _ _ _ _ _ _ _ <br />A'L ti:: UdV1D J. :SAC DL)0G'wLL ESL. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPDE'S) <br />DISCHARGE MONITORING REPORT(UMR/ <br />(1-16/ //7~1fl/ <br />i-; e .. <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ~ <br />R63U (1Z-1)I /34-131 /1d-I7l I1R-291 /30.7/1 <br />F - e1hAL <br />F!T i15 C~CNhG 1U GRASSY CfiEEK <br />t,ING6 (SUtln b4) ROUTT' <br />NOTE: Read Instructlona belore eomoletinD this lorm <br /> (J Card Only/ pUANTITY OR LOADING /I Card Only) QUALITY OR CONCENTRATION <br /> <br />PARAMETER <br />(l6-33/ (3161) <br />/3RIJ) //633) /St-611 NO <br />EX FREQUENCY <br />DF SAMPLE <br /> <br />/J1-3J/ <br />AVERAGE <br />MA%IMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MA%IMUM <br />UNITS <br />ANALYSIS TYPE <br /> (67~Q3 (61~6d1 /6970/ <br />I' f{ SAMPLE Y•'iK ei='~ i'iY i~'•.'~#%i .`.4 <br />YY Titvi= <br /> MEASUREMENT <br />(/~4 UC] 2 n U PERMIT #~r#•r %A ii .4##ve:# ee t).S ##v#~# 9,U lyCE/ RAH <br /> REQUIREMENT <br /> <br />.1 L•LI. I15, SL'PTLtAEI.t SAMPLE Y•f YY•f h` ~V Y~~•f}`A y~1t#YY Y•YYV YY <br /> MEASUREMENT <br />U li ~~{5 L G L~ PERMIT #L`yi#%,`•~ '`~#'~#~~ Y~ iF*. i?#i?;F '•,l i}#### C,5 NCE/ RAR <br /> REQUIREMENT <br />YY•f it <br /> <br />L.LL AeV is 11k AS E. <br />SAMPLE <br />TrfYY%I <br />'fY•f Y•~'e <br />•fY1fMYY ,y <br />#YYYY'Y <br />G h A V (`I 1:"L' <br />E i{ CLr N E Y Y li <br />- MEASUREMENT <br /> <br />' <br />1 <br />O V»D I V U <br />PERMIT JJ <br />#Y Y'!TY ~y ~y <br />Y#YY#Y <br />Y#Y y <br />YYY}## ,A .y y <br />i`%'1:Y##Y <br />IU <br />ORTIR <br />RAb <br />_ e, e, REQUIREMENT <br />YYYY <br /> <br />211 \/.l <br />SAMPLE <br />~YYYYY '` .y <br />YYYYYY r, ,y <br />YY4`NYY '` ` <br />YY#TI ~fY <br />~L la'L i.L 1liCCV);hAr Lk. MEASUREMENT <br /> <br />,, ,;y ;; ! U () PERMIT '.sLf}'r'`IX`v# ####;:# ' r;;;: ###### ###### <br />' OPTIOdAL OBTIN $AEl <br /> REQUIREMENT Y#YY <br />r ,l <br />E LLd, !11 1. {J (ICUII VN SAMPLE 1YY•f •f't YV 4Y•IY YY#YYY YYYY'f# <br />ln6U Tftia'2 <br />r:G~1' FLAN' <br />M MEASUREMENT <br />( <br />' <br />~ V G5~ ! V 1.3 <br />PERMIT .4 yµ~y <br />Y#YY•!Y <br />fiEFORT .a /, <br />~#YYYY A .yy~y <br />~.rY TYY y .y <br />~#•?Y#~ -y.y <br />'HY•; <br />~ <br />RCE/ <br />RSTAN <br />, REQUIREMENT <br />r ,y <br />YY#Y <br />rI <br />~UC2t/J, 1C1 AL SAMPLE ~Y•Y ~Y•I 4 <br />YY'FYY'f •IY YY•JY .IAA <br />YYYYYY <br />C L O G l: <br />{. 1:.. <br />7 MEASUREMENT <br /> <br />( <br />1 <br />V ~ J ~ 1 G () <br />PERMIT <br />y#y#yy ..//,~ ,,yy <br />#YY~/V# <br />YYY <br /># fY##Y A y A <br />Y#YYYY <br />REPG6T T <br />TRLY <br />)RAH <br />~ C REQUIREMENT <br />Y Y'J <br />1.21 AND li F1iA5E. SAMPLE iiv#=A4%i .if vir"*:~%i i}+'i #'r i}i~ Y%."r v`'~~i# <br />V 2 ~ U A L MEASUREMENT <br /> <br />{ <br />yYCyQ L V ~ <br />PERMIT } y <br />11YY#YY <br />O (, <br />yS.L • J, <br />#YT##Y A <br />~Y#Y#~# ~a .y M <br />YYY#Y# <br />'IFV~ y/~ <br />pyE/ r' <br />ISUAL <br />~ ` REQUIREMENT <br />N D <br />NANI ElTITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE P ERSONALLY E %AMINED TELEPHONE DATE <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITT ED HEREIN; A ND BASED ~ <br /> <br />RLA RABUCK ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION ~' __ / <br />~ / { v r '/ ~ , <br />~ <br />~ <br />[ <br /> <br />UICE PRESIDENT IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT (HERE ARE SIG <br />HIFIGAN, PEN <br />LTIES FOR S <br />MITTING F <br />INF (.~~ L (: <br />( <br />` ~- {~,~ , C <br /> ALSE <br />A <br />UB <br />ORMATION, INCLUDING <br />THE POSSIBI <br />ITY OF FINE <br />IMP <br />M <br />SO <br />S o <br />DB 754 2291 (l <br />9 L <br />D3 1 <br />31 <br /> RI <br />L <br />ANO <br />N <br />ENT. <br />EE IS U.S C. 6 1001 AND <br />3] U <br />S C <br />1]19 <br />P <br />hi <br />A GNATURE OF PR NCPAL EXECUTIVE <br /> . <br />. ( <br />ena <br />rs undrr ! <br />. 4 <br />rse smm,a mur mdude Ines up so !10.000 <br /> <br />TYPED OR PRINTED <br />cntlor marimum lmpruonmrnr oJArrweenbmonrhrand J)rars./ <br />OFFICER OR AUTHORIZED AGENT PEA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> O <br />wmmem nnu urLnnn nun ur RNT vIVLwIIUNJ IReJerenre all dr(denmen/s here) <br />GIL E GNEASE: SEE FOU1'NCTE F/, FAGd 3 TN THE FdRHIT. FUlit1EHLY UISCN9RGEL UKCEft CU-0035653. <br />EPA Form 33201 (RBV. 9-Rt3) PraV1011S B(3IIIODS mdY bB (/SE(/. (REPLACES EPA FORM T I0 WHICH MAY NOT BE USED I PAGE OF <br />