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'ERMITTEE NAME/ADORESS~nrluut <br />'~rlll(y N~mtJ orulon l!Ierrnll <br />I~Me Y'`81dU COdL CUp_LENECA 111____ <br />~OORESe~~ ~ rJL_Y.d (I.Y_ . - _ - _ . - <br />---FLAGSTAFF_---__--.JIZ~l5J1Sll__ <br />'ACILDY _ _ _ -/~ _ <br />DCATK7N a OtJ WL• ~~C-------- <br />ATTN: ^rL~a+.I^ i "'~~r• ::, PRESIDENT <br />DISCHARGE MONITORING REPORT (IIh1R) <br />(1-Ib) (I7-19) <br />COJJUu~l vU4 a <br />PERMIT NUMBER ola<RAwYa wuN.aw <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ) 70 <br />(Za1U p1-17) (Za1s) rte-n) (18-191 (jo-n) <br />P1111 U H • <br />(~ U B R N J) Fagg dllplpved. <br />F- F i N A L OMB No. 2040.0004 <br />lliSCtlAHGF. '~R-roLait41~I~t1g~IT'~RBhK <br />#'s~ AO DISCAAAGE ~_ ~ ### <br />NOTE: Read Instructions before completing this lorm. <br /> (1 Clyd Ollly) QUANTITY OR LOADING (~ C1rd Only) QUALITY OR CONCENTRATION <br />PARAMETER (16-571 (11fi1) (78.151 (16-SJ) (5161) NO. FREOUENCT SAMPLE <br /> EX A <br />yS TYPE <br />(JZ-17j ~T <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 6111 e Te <br /> 1 <br />1 (eleal ( <br />l <br />FLOH, 1N COtl DUIT OR 9AMPLE <br />EASUREMENT ^l <br />Q <br />~~ <br />b •3a~ ( u3) ####Y: #C#### ###### <br />~ <br />I~ <br />itlBU TREATtlENT PLAN . v` ~ . <br />50050 1 0 0 -renilir;• HSPOHT'- :OP.TIONAL' #.~!#?~# #~~#~+~ ~-~OSi4e, '##+* Y$$RL NSTAiw <br />EPFLUEAT GROSS YALU 1R°~"K!!~'"*' >..30D1 :~AYG :.::GAILY t!Y MGD , 4#~R# <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ PERMIT ~.. ' . y ., <br />~ .. <br />" <br />' <br /> REQUIRWENT - ~ - ~ <br />. . <br /> BAMPLE <br /> MEASUREMENT <br /> '~PlRMIT ~.. <br />~ " <br />~ <br />~ ~ ~ ... <br />.~ .. , .. <br /> REQUIREMENT. ~ '~ :~ ' <br />,. <br />.. <br /> BAMPLE <br /> MEASUREMENT <br /> PERMIT "- .:, ., . ,:.. ~: -.;. <br />,_.... <br /> <br /> <br />. .,,- ~:.., <br /> <br />...:. .. <br /> <br />_ <br />~ ~~,. <br /> <br /> <br />... ..: <br />. - <br /> REQUIREMENT. . <br />. . ` <br />. .. . ~ ~ ~ .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~.. .: ..: <br />.. ~ <br /> <br />., .. - ~ ~ <br /> <br />~ .... ' <br /> REQUIREMENT' '~: .. <br /> BAMPLE <br />' MEASUREMENT <br /> .. ~ .. <br />'. PERMIT .'~.: .. <br />, : Y-:..:.' <br />~ <br />,_ '. - . ... <br />' <br />' <br />~. ' ~. ~ <br />.. <br /> <br />' <br /> REQUIREMENT. p.... .. ,: ..., <br />..~ .. <br />. <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT , :.:,.. <br />. ~: :~ .. '~(.g <br />_ .~ <br />.: <br />. <br /> <br />: ~:....' ':. ~' <br /> .REQUIREMENT . • <br />:... .. <br />, .. . . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY IAAER PENALT' OF LAw TIUT I HAVE P£RSONALIr ExAMINED <br />I TELEPNONE D A T E <br /> <br />~~ <br />5 ~ ~ <br />~ AND AM FAMLIAR WITH TI# nFCRA1ATICN SUBMTIEO HEREN. AND BASEO <br />IXi MY INOIARY OF TIgSE NDVWAts MMEWTELY RESPONS'HLE FOR <br />V <br />~ <br />~ <br />Q. ORTAINNO THE NFORMATx]N I BELEVE THE SUBAYl TEO NFORMATION IS <br />TRUE ACCURATE AND COaWLETE I AM AWARE THAT THERE ARE ~( <br />1 <br />'1 / <br />L <br />~F~ <br /> $GMFICANT PENALTIES FOR ~LlxVTTNG FALSE ViORMATxX1 INCLUD¢Y <br />T <br />TY <br />9 <br />1 q7 ~ 70.1 b ` <br /> e ~, H¢ POSSIBILI <br />aF FNE AND MPPoSONMENT SEE 1 <br />Us.c. <br />IoOI AND <br />33 u5C 1 IJI9 (Rntlrie uMer Ihe~e vmlu ma <br />include Rnn u <br />la SIGNATURE OF PRI (PAL EXECUTIVE 0 <br /> Y <br />V <br />fle <br />h <br />R <br />M <br />E AREA <br />TYPE OR PRINTED AM Ant or mFximum imprnanmenrW der«ten 6 mwrr <br />F And 3 ynnl OFFICE <br />OR AU <br />ORRED AG <br />NT NUMBER TEAR MO DAY <br />COMMENT AND E%PLANATION OF ANY VIOLATIONS (Reference tll allarhmenta here) <br />OIL S GREASE--SEE FOOTNOTE F/, PAGL' 3. <br />t~RTHLY .iAMPLiNU IN~THUC'IIUNS--FOU'TNUTE D/. <br />EPA FOfm 9920-1 fRBV. 9•BB) R'EYRIIJS edilionS Tay 6G' USCd. (REPLACES EPA FORM T•10 WHICH MAT NOT 6E USED.1 , .,,T r , ., - T !~ ~ ~ PAGE IOF <br />