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PERMITTEE NAME/ADDRESS (Include FacilhyName/LocationifDierent) <br />NAME _ <br />tI?' ; DFN (*-IJ CH FIRI"'.1NAL, INC. <br />ADDRESS HAYI)EN GULCH LOADOUT <br />P. .3. S T EWIPOA ! Saf-?R IIN G-b t.iJ <br />FACILITY HAYDF-61 <br />[rtdl?Cl~I 1_'_?. Ot#T <br />LOCATION HAYDEN rO <br />AT"' N: J19 "NI W'= TI'1Ml- N, 1'11^ FRA'1"13IR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />QCt <br />PERMIT NUMBER DISCHARGE NUMBER <br />f MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />t3 b,61-317 FROM lui ?= . TO t.t `t . .s <br />Form Approved: - <br />OMB No. 2040-0004 <br />M???? <br />FINAL RD?,?T <br />J!}12 ` atW/4 tt UKY LzCP"+,YrA1.11'11 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />OIL. AND 'a"R- F SE SAMPLE # ? ## 3? ? ? t 94) d ## rd ? # # >i K ### 3t####?t (? 1 <br />U ? } <br />? <br />V I SUAL. MEASUREMENT ( V( <br />j <br />.) PERMIT ?a•?k###?# h'+:-i'?:.:?`f 'C ES+?I #•??-irti?••x••ir i????:s#•?. •sr•3r?z•!r-?3 t••i#•?:iF W1F..?/ "a.?i_ir•=HL <br />EFFLUENT GROSS VALUE REQUIREMENT s NS T MAX P40=01 MONTH <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 />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a system designed <br /> to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Based on my inquiry of the person or persons who manage the system, <br /> or those persons directly responsible for gathering the information, the information <br /> <br />submitted is <br />to the best of my knowledge and belief <br />true <br />accurate <br />and com <br />lete <br />L) ' l <br />1 <br /> , <br />, <br />, <br />, <br />p <br />. <br />1 <br />th <br />t th <br />i <br />ifi <br />t <br />lti <br />f <br />b <br />i <br />i <br />f <br />l <br />i <br />f <br />i SIGNA URE OF PRINCIPAL EXECUTIVE V j <br /> <br />TYPED OR PRINTED am aware <br />a <br />ere are s <br />gn <br />can <br />pena <br />es <br />or su <br />m <br />ng <br />a <br />se <br />n <br />tt <br />ormat <br />on, <br />including the possibility of fine and imprisonment for knowing violations OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . CODE <br />NI <br />r,~ <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />5ETT#...EABL.E SCsLI'Ca LIMITS WAILED FOR 10--YR, 124 HR PRECIP EVENT SUBJECT TO BURDEN OF PROOF REQUIREMENTS IN <br />PART" 1. B. 6. ANY ADDITIONAL_ Lr'•>tT"A SHAL.1. BE SUPPLIED T£3 THE DIVISION WITHIN 48 HOURS. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 0,( )21 H f oftFja&4 par4. Drm. PAGE 2 of