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ur. n/.n,.J ,.ren. ,- J <br />NAME_~ L_CSiALSiLCflUSLa'~~INE1__- <br />ADDRESS DOD _ <br />L~___'~ Tn~e __ _ <br />FACILITY ---_------------- <br />LOCATION-_-_-'----~ ---- _-_- --_ <br />A TTJ'~ f1nNl:T ,TPV C•IC(lY ORPC rRJ NT <br />....~ww vu~n I ISCHnuGE CUMINAIIOn $Y$IEM bti'/'/1L.S) <br />~DISCHA JONITORING REPORT /D.SfNI <br />coooooz aoz a <br />PEPMri HUMBER UISOHARGE rJUln OER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />D0.])/ O]~)L OJJ 11 Q6-)]I n.4JaJ R6 ill <br />F - FINAi. • <br />sTnanwtlr^ at;r t~,^ :° <br />NOTE: Read instructions b?fore completing This lorm. <br /> l?Card Onl/~J OUANTIiY OR LOADING NCard Onl,v/ QUALITY OR CONCENTRA TION <br />1JD - <br />'i ~Ul ~'~'~ <br />SAMPLF <br />PPRAMETER /16571 (JI-b lI /J8~d5) lJb-37/ OJ yIJ EX ~° TYPE <br />Q7_o]/ AVERAGE MA%IMUId UNITS MINIMUM AVERAGE NA%IJAUTA UtaJg <br />N: 41 r ~°L <br />rM Ark <br />rr y p.r <br />IL A:\D .SF.9S.^. SPMPLE •v•~••- =T :: .~.. .~..-v. L'.~.:. <br />Q I j (t ^ (• h1EA5UREMENI <br />9/iCGG 1 0 'J PEPM:T ##i-##: p P.S=1 er=-+ ~ ~~~~~~ -###~:_'.: -= VOE/ ISUAL <br />~FF a-N r,tio,s •rtiLa~ REOUIREIAENT rrt z ~, = 71'76T9 <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIPEMEHT <br /> $4MPLE <br /> MEASUREMENT <br /> PE Rh11T <br /> REOUIREME NT <br /> SALIPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAIAPLE <br /> MEASUREMENT <br /> PERM17 <br /> REOU:REMENi <br /> $aMPLE <br /> MEASUREMENT <br /> PERbUT <br /> PEDUIREMENT <br /> SAJAPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREME Ni I <br />1 <br />NAME/TITLE PRINCIPAL EX ECUTIVE OFFICER 1 CEfti1FY UNDER PENALSY DF LAVJ THAT I HavE PER$ON4LLY Exn MINED <br />IN <br />AM FAM <br />IAR <br />TH iNE I <br />ORM <br />T <br />i I <br />R <br />N <br />SED <br />S TEL EPMONE DA J E 1 <br /> WI <br />NF <br />A <br />ION <br />DBM I <br />ED HE <br />; A <br />D BA <br />AND <br />IL <br />E <br />OrJ MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> <br />Dunf ee <br />t~1anager <br />Brian P OBi AIIJING THE INFORMATION I BELIEVE THE $UBrdIREp INF ORMAiION <br />r <br />, <br />. I$ TRUE. ACCURATE AND COh1PLEiE I AM 45VARE THAI THERE ARE SIG „!~[ ~/ <br />Environmental Studies NIFICANi PENALTIES FOP SUBIARiING FALSE WFOREIANON. INCLUDING , <br /> THE POSSIBILITY OF FINE AND IIIPRI$ONIAEfJT. SEE t8 U5.0 p IDDI AND <br />n <br />YNI <br />U <br />S <br />1JJ9 <br />V <br />l <br />J <br />h <br />d <br />Jr <br />7 <br />C $IGNATUREOF PRINCIPAL E% UTIVE 602 774-5253 90 ~ 7 25 ~ <br /> <br />TYPED OH PRIlJiEO nrs un <br />. <br />. <br />rna <br />r. r <br />r,r .mnnrs mar m <br />u <br />r Ina un ro <br />U. L <br />] <br />. 1 <br />I <br />awe o.maumam,mP•uonmrnro/err.rr~emumnr mns~~ra.~ <br />/ <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />Mo <br />Dar <br /> . cooE , <br /> <br />W <br />W <br />CONIM ENT AND EXPLANATION OF ANY VIOLATIONS lFelrrenre oll auachmenrs here/ <br />1F RO DISCJI~RCE OCCORS REPORT°y0 DISCIfARGc"". OIL A;1D GR°ASE: SF.E FOOTNOTE F/. <br />EPA FOTm 99201 (RBV. 9-R8) P/BVIDJ/S edlllOnS ITIBy DB uSed. IREPLACE$ EPA FOPIA T~dO WHICH MAY NOT BE USED.I PAGE OF <br />~)^1n111?'75:;'1-17Un ~ <br />