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PERMITTEE NAME/ADDRESS (debt F.csnyNw/L«.n« JDIpn«p
<br />NAME POYUERHG4N CARL C~.',JdI~Y
<br />ADDRESS ROADSI De r.IaE, to } j j••,)dfAl-,~
<br />P, A. uUA IltlO
<br />PALISADE' Cu di:i2o
<br />FACILITY
<br />LOCATION
<br />ArTN: Jonh a. `;cNAb, PHt.iLD;NT
<br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM IIVFDE$1
<br />DISCHARGE MONITORING REPORT (DMRI
<br />lI-I5l I77-I91
<br />G00 7 4
<br />PERMIT NUMBER DISCNMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM TO tl
<br />!70.7(1 122-731 /71-I51 /76771 17H-191 130-371
<br />.Form Approved.
<br />cAMto P.INC sll/a z°~'~L'L°'24'Ap~ooo II(E
<br />(SUER NO) ApProvaLe?P~r4'f0~=9B
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<br />NOTE: Road Inetruetlorle belwe compbtinq thh fwm.~°
<br />PARAMETER !3 Gre Onlyl QUANTRY OR LOADING I4 Grd Onhl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !46531 150-611 138-451 !4653 15F5/1 E °F
<br />137-371
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS X
<br />
<br />!s7-s]1
<br />MALrBIs
<br />/54-681 TYPE
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<br />!5&701
<br />I'1i SAMPLE
<br />MEASURE
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<br />:• .': 41:~ik~04 : "9.0
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<br />EPPLUENT GBOSS VALU 'REQ;U,
<br />IREMENT:
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<br />tPPLULNT GROSS VALU REQUIREMENT ,
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<br />I MEASUREMENT ~ )/ t~ r2
<br />1045 1 ,'.~'
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<br />tF'FLUEII'! ~~ttti55 VALU REnu1REMENT
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<br />JLL AND GFISA4E SAMPLE .-x;r;r#b Y.~?b b+} Y7ibb#:
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<br /> MEASUREMENT /v /,~ N~~ ~ r/ G~
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<br />3Sb2 1 0 U PERMIT fi=':•bYb :xribbbb a#a Cr;!b#bAt pgp~I11~.:. :ONTIN iRAB
<br />EPP.LUENT 6ROS5 VALUE REQUIREMENT `t
<br />X406 3Qp•A"~~~ .;`j;k1.5:1 NAX RG/L GY)tiT
<br />k'LOY, III CONDUIT O6 sAMPLE ~i 13 ~ p3j bbbbbb 4Cb404 riCbbbri
<br />IriHU TBEATM£RT PLANT MEASUREMENT /~ I ~ ~ O ~ N
<br />0050 I 0 0 PERMIT iit L~DRT ~ RL'P418;T ~" ~~a-.~rtl>dlx~a .1~i~>,t~>4~V ": ~: ~.~.1~.I~X?'~ISAIO" I ~F Asa ~£I±KLY ~$TAN
<br />k:FPLUENT G605s VALU REQUIREMENT 30UA AyG DAILY' :1tX . MGD
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<br />I$SULV6U MEASUREMENT 1 / v ~
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<br />J VN A SAMPLE ~ b':r r•=b ( 9q) ri#abbb Qtb4bb bib?rib
<br />Y I SU AL MEASUREMENT
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<br />iPFLUE>rT GROSS YALU :REQUIREMENT" :: "
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENUTY OF LAW TNAT I HAVE PERSONALLY EIrAMINED MD
<br />MILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED OM ~ TELEPHONE DATE
<br />I^ ,,~ G ,~ •~ ~ (~~J ~ ~
<br />s'
<br />/ MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPON4BLE FOR
<br />OBTNNING THE INFORMATON
<br />I BELIEVE THE SUBMITTED INFORMATION IB
<br />V ,
<br />TRUE. ACCURATE MD COMRETE. I AM AWARE THAT THERE ME
<br /> SIGNIFICMT PENN
<br />TIE9 FOR SUBMITTING FN
<br />SE INFORMATION
<br />INCLUDING - ~yj / ~
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<br />.
<br />,
<br />THE POSSIBILITY OF NNE MD IMPRISONMENT
<br />SEE to U
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<br />1 1001 MD ]]
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<br />BIONATURE OF PRINCIPAL EXEC
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<br />E U.S.C. 1 1 ]te. lP,rWtlr, uW N,« ,rovn, In,Y McAW lxw, W ro J 10,000
<br />TYPED OR PRINT
<br />D .nsrmuimun inM,Fevrwnr ofaw«n ammrA,wey.ral OFFlCER OR AUTHORI7ED AO NT CODE NUMBER YEAR MO DAY
<br />COMMtn I s nlvv cnrLnnn I Ialn alt nn r vlvLn t was rrterorena ai arrecnmsnn note/
<br />TNIS OUTFACE IS NOT BLIGLdLE POH EXf:MPTI0N5 FROM TOTAL SUSPPNDEC SCLI[5 (T55), 10TAL IRCN AND/OR
<br />S~'fTLEA6L6 SOLIDS LIMITATIONS - SEE I.A.2.
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<br />EPA Fwm 3320.1 108-951 Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.( 0 0 3u R / 9 8 C 2 2 3-125 6 PAGE 1 OF
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