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PERMITTEE NAME/ADDRESS (Include Facility Namr/GOCanon if Di~((eranq <br />NAME <br />ADDRES TRAFF'Eh I~ININGe INC. <br />P.L. bU:.' ~•'7 <br />FACILITYC:iAIG CG ElE~G <br />LOCATION <br />F TT•. ~_ ~nPr~fN G4TF6c DP F4/C: F'% hfN <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMH~ <br />(246) (17- 9) <br /> <br /> G <br /> PERMIT NUMBER DISCHARGE NUMBER <br /> MONITO RING PERIOD <br /> YEAR MO DAY YEAR MO DAY <br />PROM CC C6 GI ro QC CE 3C <br />(20-P1) (I2.23) (24-25) (]6-~]J (28-29) (30-31) <br />Form Approved. <br />OMB No. 2040-0004 <br />!: I N C i.Y Approval expires OS-31-98 <br />1-ueE Ar) <br />ACUTE GE1 'IP:716C tC} lu~A <br />Y'+z NC Il cruA FCf ~__~ CG% <br />NOTE: Read Instructions before completing this form. <br /> (3 Card Onry) QUANTITY OR LOADING 14 Card Only) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (48-53) (5d-61) (38-45) 46-53) (54-fi 7) F>( OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(fix-631 ANALYSIS <br />(64-68) <br />69-70) <br />CSU Sl:~ie}; yE}t it 3Cl SAMPLE ~~+t;^4 +I:C+fit tot C,+0 .: t=:4=: ( ~:) / <br />elRccr+F.L E., MEASUREMENT o <br />~/qD p O ~GS <br />ANbC 1 U U ~"PC?HhUT. O14V>RIRq ., !RD4-AArN' 4S%~ 1SQ ~ "~+QttCAsOA >aO+It~A F ; F- A~OAY 6A6 <br />EFFLGtS1 i,HUSS YALCE HEQjlJRBM~NT ~ .A04 Y CF i <br /> <br /> SAMRLE <br /> MEASUREMENT <br /> rd~,;~~np~ .. ~ t rY : • . <br /> ~, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMtT <br />' <br /> RHQUIq <br />~MEN7 - <br /> SAMPLE <br /> MEASUREMENT <br /> BERMkr . <br /> REpUIflEMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT ' <br /> <br /> flE~k~IAE,MENT~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> P~RAQIi' ~ - ~ _ x , <br /> REC~6IREMENT - <br />NAME(TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM IAW THAT I HOVE PERSONALLY E%AMINED AND <br />ATION SUBMITTED HEREIN; AND BASED ON MY TELEPHONE DATE . <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS TRUE, ~ ~ ~`^ <br />_ 1 <br /> <br />P <br />W <br />G <br />d ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICAM /~+' <br />OT <br />OCl <br />01:B1:S <br />. PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE 970-824-4401 OV 04 27 <br />r n r / n POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 4 1001 AND 33 U.S.C. <br />l <br />li <br />E10 <br />P <br />i <br />h <br />i <br />f100 <br />tl SIGNATURE OF PRINCIPAL E%ECUTIVE <br /> <br />TYPED OR PRINTED tres up ro <br />or <br />§ 1319. ( <br />enalt <br />es untler I <br />ese statutes may <br />nc <br />ude <br />, <br />en <br />marimum ~mpnsonmam of between6months ends years <br />) OFFICER OR AUTHORIZED AGENT AR <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . OOE <br />COMMENTS AND F>(HLANAI IUN Uh ANY VIULAI IVNS (Mererence err artacnmen[5 nereJ <br />i.S.: <br />Str ?P %-`J, FCh Lf'TAILS CF 2F .i7 PhCCFUUFf. nEF^FT LCSC - STA'Il ti'lI~~~L fC1A^:`~i]i•rit a}1Ch IS <br />r <br />, <br />L.clarl I 503 CF 7E_7 CFOAhISi'_, AND ATTACK ACUTE 7GXICITF TEST heFC}7 FCr' IL tt:. iIFIF~ l ALi <br />EP' Form 9 20-~I'( •9 j r vio s ifio sr' ay of be P 'EP M W Y 8E .) "• i ~ " L~ -' ' ' r `' ~ ~ - GE O " <br />' <br /> CGC~~,/~~~CI <br />.i-1t,1. 1 <br />