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PERMIITEE NAME/ADDRESSp rL FrWryNw/Lacena l/D~.n•q <br />NAME XERk C'lAL :D"IPANY <br />ADDRESS "1Akk !'IxE <br />P. O. BaX 773u;7 <br />STcAIihJAT 3i'kIN ~i ~O i1JU17 <br />FACILITY <br />LocnrloNyALllr:N CO yL'aJJ <br />r <br />NATIONAL POLLUTANT 7MSCNMOE ELIMINATION SYSTEM (NP~f$l <br />DISCHARGE MONITORING REPORT (OMRI <br />11-I5) 17-191 <br />CJ~95003J <br />PERMIT NUMBER DISCNMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM J U 1 TO U J JY J <br />116111 111-131 114151 /1617/ l1B-191 130-311 <br />POND A/TRIG <br />(SUNk NY) <br />F - FI"IAL <br />[!INOF. <br />form Appr2oved. <br />TO Cp~ppBo~eyl ~7 p41r~e OBr431-98 ~~' <br />tt.7~i <br />~'~~ NG DISCHAR;E ~ X_~ ~:° <br />NOTE: Rnd {rntNCtloru beTara compNtinp tflu corm. <br />PARAMETER 13 Grd On/yl QUANTITY OR LOADING !~ Grd Onlyl QUANTITY OR CONCENTRATION NO. FREOUENCr SAMPLE <br /> 106531 154611 l38-051 /x653 (54151/ DF <br />l31-371 EX <br />MALrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS' let-eJ! l50-68) (69-)OI <br />1 .. SAMPLE rr..~. ...`•>r7 :~'I# ( 17) <br /> MEASUREMENT <br />:J1~iU L U PERMIT 0L-~R 71~4fi ~ YRRB:-;f #--^.:= [..§ ##fi~ # 4.U ~ '~~$1cLX .xi ETt3 <br />c'i'Lu 6:.i ..?.i"-; YAL7^ REQUIREMENT ~ 3~3 '!Lilt t3~U lf~ .. ~ ltAXIHUf0. SU <br />,..Lu:iF ~~; T. L?a3L!^. SAMPLE hF'?O:;k ri48 :,"- 3RGY V+: 4: ik# ',lr# ( '1 rj) - <br /> MEASUREMENT <br />~~~:/:~ 1 J 1 ~.:.PERNIIT~~: RC#.#:IIr.a~~. 9r~4C:-Y:L #M+'F C0L?A~O~ ##0~"?~ # LT~~ ~ ~ bi ~^ <br />$~ - S -: t`:: <br />-['t LUdtiT i; :'J6S !0.LJE :REQUIRENIEN7 .;:-:# ~ ~ .D.AI~Li~ wX tiL/L - . <br />nJx7tt ~~ <br />ILL ANJ ., it~'A~i': SAMPLE r3#p:a .-. ~.': :: x~: Y+Y;~ ... #>< ( 19) <br /> MEASUREMENT <br />./35:11 1 U 11 'PERMIT :»"IVx?R: 4.~F.CCsC* " ••^.'k` ?tr;Y:#iY r~~A# /k j-!J ~ ( ONTIN :$Ae <br />cFF'LUENT .+HO55 vaLJ•! REQUIREMENT #X ;: D+1I LY kE 4(,/L vw xT <br />' LJrlr IN MDUI7 -1t SAMPLE ( ^v3) :r ~XFfi"+`+- +-# 4G fi;:;:+`. ::=# <br />rt i{ U T k 2 A T r1 F. '1 T '. 1 J C MEASUREMENT <br />~tl')SJ 1 0 J PERMIT )PSLJ9AL f{EPORT ~.r:+$ YY~~ ~ -~ra#a:= ~ saa <br />t <br />x~_1~/ <br />:xsrA:~ <br />:F'FL'JENT .:NJ55 i;IL.Ir; .REQUIRENIENT )UpA Ap:~ ~AFLf. '!% RGD ~ ~ ;''~t:^ <br />M:OVFH <br />I L ANU ::dEA:~t SAMPLE v.Y rir ;: ( qj) Qt :=r fi:: ., G;< ;+?~.:•~-'.`- <br />[ ~ U A L MEASUREMENT <br />:~+~6b 1 J J PERMIT x::aa:x NEPORT T EJ=1 ~p'~4G6 #?Y'x. # :.~--r;R## y 0;~4 t NCE/ ISUAL <br />~Fr,UEMT JR7ci.i VaLIE. REQUIREMENT INST 7$X' N0=0 #fi## 1 <br />RONP.1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERTIFr uXDER PENUTr of uw TNAT I NAVE PERSONALLr ExAMINED MD <br />AM FAMILIM VATN THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br /> Mr INQUIRY OF TNOSE INDINDUALS IMMEDIATELY RESPON9BLE FOfl <br />Richard p• [7](15011 OBTNMING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE, ACCUMTE MD COMRETE. 1 AM AWME TNAT TNERE ME <br />SIONIRCMT PENALTIES FOR SUBMITTIND FALSE INFORMATION <br />INCLUDING <br />Vice President , <br />THE POSSIBI <br />ITY OF R <br />PRISONMENT <br />SEE 1 <br />1 <br />1 MD S <br />E <br />0 <br />99 ~ ~ n <br />2 4 <br />21 <br />2DD[ <br />L[) <br />i <br /> . <br />L <br />M <br />AND IM <br />8 U.S.C. f <br />00 <br />l <br />I <br />BIONATURE OF PAINGPAL EXECUTIVE / 1 t <br /> U.S.C. S <br />J1B. I/UIWIMI MIOII UI•~ NNb1 nlry YKh.W FMI (p b S IO,OfW AREA <br />TYPED OR PRINTED r4lw/n•ll'rl1•n AIIP/IAmIMlII OIeIMIM e1.N„duW er..:l OFFICER OR AUTNORI2ED AOENT <br />CODE NUMBER YEAR MO DAV <br />CVMMCNT$AND EXYLANAIIVN VY ANr VIVLA1wIVa lrte/eFlnCe el/elreCOmenrs neFe/ <br />~S:TTLEAIiL:: SOLIDS LI"III' :aIVt:D FJR 1)-TaA 2u-HH PUECIP EVC:ti :;./uJL.;1' IJ JURDF.iJ OF °RODF kF.'~UIRR.~G!;TS IN <br />t1A[tT I•H•1•Dr P. r+. ,TO3`1MATEH i9AN4iEM.'YT PLA'i DUE 1-1-J3. ` <br />EPA Form 3320-1 108.95) Previous edmon• mey be used. (REPLACES EPA FORM T-40 WNICH MAV NOT BE USED.1 ~ 2 3 3 /,~ ~ ~ ~ 1 ~ - i ~ 5 9 PAGE 1 OF <br />