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<br />PERMITTEE NAME/ADDRESS (include Facility Name/Lacanon ifOfferentJ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ FOrln ApprOVed. i <br />NAME DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004 <br /> <br />ADDRESS <br />' <br />yURfH TNO"1PSON CHEr <br />,K %INES r ~ 5 cr ~ (SUER aC) ' <br />ZlbU ,:ONPASS DRIY.P.~. SUITF; lUl PERM17NUMBER DISCHARG R .,. _ BIy~'. pL'fl(N <br />FACILITY'dIND JUNCTION CO'81SUb~, _;:'iJ`1T.' - i 'C8S'CING FOR 007p <br />LOCATION,Akd04DALE C^ 81623 FROM ~ ~ ;iISCR A_AG~: ~ #~~ <br />SAMPLE <br />MEASUREMENT <br />nI1lG J• L. )1'JY L.:. ~. V:.]dL 11AV GNb• '~- <br />' UANTITY OR UOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER •~ EX OF TYPE <br /> AVERAGE MAXIMUM, .UNITS MINIMUM AVERAGE MAXIMUM UNITS 'INa-PSIS <br />•~;Fr~cr sTArP,e IDAY SAMPLE . •^. .`;:aC4"O '• •: •r:=,`• ~~'f°k':4°: ( .~ 1) <br />~fiR PI1EPIlALEi MEASUREMENT ~ ' <br />1'~Pb;: S J 1 `;a~. :~:=: <br /> <br />~ ~##. =#?_M#Rira ~ .•,. <br />_ <br />;^,: <br />- & <br />v`~'RCta "#+tl~fill0c#4_jl' °R- H*~'= <br /> <br />" _ <br />iSE CUN1:,Nf5 b};LOr' Eq )it: t`}Y"" ~- 'X'f ENT " - <br /> SAMPLE <br />_._ __. _ ~"" <br />~ i <br />~ <br />' <br />`~ <br />SAMPLE <br />SAMPLE <br />MEASUREMENT <br />~_ ~ ~ .: w< <br />~~~ ~~~ ~_ I f I • . . <br />SAMPLE <br /> <br />SAMPLE <br />NAME(TITLE PRINCIPAL <br />~ . E . S-Io ~rlU- <br />TYPED OR PRINTED <br />un vvoi enlennarr <br />RM179'a ~' r ,-~,k ar' <br />#th`~~ R~lul NT, r - ~~ "s , <br />OFFICER I Certiy untler penalty of law that IhiS doi <br />preparetl under my direction or superyisi <br />to assure that qualified peinnnel'popar <br />submmatl. Basetl on myinquiry of thep <br />or those persons directly responsl0le br <br />submitted le , b the bast of my Imowled( <br />I em aware Nat Nere are SignRCaM pens <br /> M RINC.P RIO[Y--"r~ <br />YEAR MO v ,EAR MO DAY <br />0 0 i .'. 0 0 <br />.r <br />nent end ell attachments were <br />In accordance with a sysem designed <br />lather and eraluata the information <br />on or persons who manage the system, <br />Ihering the information, the inormaion <br />rn0 ballet, true, accurate, entl complete. <br />Including the possibili~Tine antl impnsanmi <br />NS /Rr./ernnra all aHarhmanls hOrel <br /> <br />,~~ <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />YEAR MO <br />^E 5.x.7 FDP. TEST PRO=EDURc. HPT t1ESULTS OF LF,THALITY Cir:i?IYATIOYS A5 "':LFEEC?", i„c;WTN 6 I~EPRODUCTIO;! <br />..:kLYATTUI'!i5 AS "TOXICITY". RPT COYEST FFFL AT GNICN STATISTICALLY SIGhIF ?TIFF ~F.TREEN TES E COtlTROL <br />PA'Foim y ( EV 3 ~ revious a irons rt'iay 'e us d. ~ ' `- ~ u ~ ~ . i ~ ~ r.., r >_ ~ - . ~... t t ~ TF~IS~I~' -P ' R GE 'i0 <br />.;_,..... _. CJ1u9 /00 0 71 7-1233' 1 <br />