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PERMITTEE NAME/ADDRESS (lm•lude <br />Fncilily Nnme/Locnlion if differenll <br />NAME _COLLl~LKO -L~AAI.. s (1:~~ A:L ~ - - - - - - - - <br />ADDRE6"~7'nu~,Jr ~!iNF_____________ <br />---5"7.37~iTATE-~iI-CH-41i-~~~------- <br />FAGILRY____________`_______ <br />LOCATION <br />lTTrl• J1!`Y II Drr C Amv+Ufrr\: <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (Nlrl)LJ ) <br />DISCHARGE MONITORING REPORT ! OM11Rl <br />r n l•^ c) r•• ~ I n ~: I For A roved. <br />PERMIT NUMBER OncwgweE Nuueew F S I N F i ti A L OMB No 2040-0004 <br />uEST PIT SF~ror/~exnl~e~Og37L9~p C~i! <br />MONITORING PERIOD 1, Y <br />YEAR MO DAY YEAR MO DAY _ <br />FROM 7u O1 (•I To ?'+ ,j3 ?1 y..... qr/ ~I~r!(AP/;~ ~ _~ ,Y,..t <br />rmnr. ,n_nr _+<r N(1TF•RA>d inefrueflnn>ho}nT n nldlnn rhie form <br /> (J Card Only) QUANTITY OR LOADING (0 Card Only) QUALITY OR CONCENTRATION <br />PARAMETER l•Ib-SJ) (-SO-6!) (J8~J5/ (Jb-5.1) <br />(146/) NO, FRE ~ENCr SAMPLE <br />(J7-37) EX ANALY 515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA %IMUM UNITB <br /> 161{)1 (61!81 lhYAlll <br />IL AND GREASE SAMPLE ~~Lr/'-d~'.. ( 9u) ooat::,rr -, r.:,>};,+, x.,yy~;,u <br />ISUAL MEASUREMENT <br />4066 1 0 O 09°'~~'~ Y S=1 nl'aaX'Ik'~' ~I~~kf14 4Yr4aria n,aa $EHLY ISUAL <br /> REQUIREMENT <br /> = d0'Jb <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />• PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF Lpw rMAT I HAVE aERSONALLr ExAMmeO TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMAi~ON SUBMITTEO HEREIN ANO BASED <br /> <br />R.G. ATKINSON ON MY INQUIRY OF THOSE INDIVIIXIALS IMMEDIATELY RESPON519LE FOR <br />06TpINIhG THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATIpJ 5 / I <br />~, <br /> <br />VP LAND/ENVIRONMENTAL TRUE. 4000RATE ANp COMPLETE ~ qM AWARE THAT THERE ARE <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />T <br />'• <br /> . <br />THE POSSIBILITY OF FINE AND IMPRIyJNMENT SEE IB USC 1 IDOI 4NO <br />3 USC S <br />/4 ~ <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~Q~ ES~4-4t(51 94 OL II'~ <br /> <br />TYPED OR PRINTED 3 <br />1319 ( <br />nuhirs unJer These summ. mo) i cluJe floes up m <br />SIOpIXI unJ nr mavmum minn'sonmem o! bOxeen b mumps dnJ 1 )mrsl <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />TEAR <br />MO <br />DAY <br />SHTTLEAflLF. SOLIG~ LIr'J: •1.6PL7!" ^t,LY TF' != If:-!9, :_'L!-!+'• F'Rr:':IF %''f';'~T 1~ f:Ll.;tIP'. IF CLr[~+ APPR~Y'U ', <br />WJl~D. TS~.F`IAnv LI".I'ES Yi.LL 'mr ePTI-~c;; ~n ;•f•r~i:yF,l. 1...~;111:L,.I;;•r:'.--`'~.. r,'I,]ar pr. a c•11) I."Yr''~' I <br />EPA FDrT 3320• ',.9-88) P/BVi01/$ ed/1/0/15 mey bC USed. (REPLACES EPA <br />NOT BE USED.1 <br />~,~(.•.I/?31Ino_'_ jai <br />OF <br />