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I c nM II It ItNAM tI n o UHESS llnctude - NATIONAL POLLUT ISCHARGE ELIMINATION SYSTEM(NPDES) Approvod. <br /> ,."'Iffy Name/ ' n11 DISCH QONITORING REPORT(DMR) No 204000U <br /> NAME' ' �� C_AO A_L_CO_ (N UCL A 11I N (2- (17-19) F — FINAL Approval expires eao-tat <br /> nooREssCO, I ROD AA _ C000002.,L3 002 A STOBI'WA?ER DISCBARGP <br /> N UCL A- —— CO 814 24 PERMIT NUMBER DISCHARGE NUMBER <br /> acrtlTY V — MONITORING PERIOD <br /> F <br /> --CI —--— ---— —-— -- — �... Y M D YE 14 O D Y <br /> LOCATION __ ` �^ FROM - TO MINOR (SUER AC) !!l1TRS <br /> A2?�i: DENflIS 'STEVENSON, PRESIDENT (20-21) (22-23) (24-25) • (26-27) (28-29) (30-31) NOTE:Read instructions before completing this form. <br /> ( Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> PARAMETER (46.53)1 (54-61) (38.45) (46-53) (54-61) EX OF TYPE <br /> (31-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> /62-63 /64-68/ (69-70) <br /> PH 6 <br /> SAMPLE Y �i• ##Y # # <br /> MEASUREMENT <br /> 0400 1 0 0 PERMIT ,e # # ## # # 9.0 OXCE/ . RIB <br /> EFFLUENT GROSS VALUENNINUMREQUIREMENT # MAXIMUM SU NONT8 <br /> OL,I DS, SETTLEABLE SAMPLE <br /> MEASUREMENT 4 w• <br /> rJ 1 0 0 PERMIT ## ### # # 0.5 INCE/• GRAB <br /> EFFLUENT GROSS VALUE REQUIREMENT , ## �+• DAILY RX IKL/L NONTH <br /> IL AND GH,EASE SAMPLEM~'+k## <br /> REON EYTR—GRAY METH MEASUREMENT' <br /> 0556 1 0 0 PERMIT ## #' ## ## # # # # # ### # ZO ON?Z1f RAB <br /> EFFLUENT GROSS YALUE REQUIREMENT #### Z15T )sZ !fG/L GENT <br /> FLOW, IN CONDUIT OR SAMPLE <br /> 88U ' TEEATHENT PLANT MEASUREMENT <br /> 0050 1 0 0 PERMIT REPORT R RT ###### ####$ ###### ### EEHLI NST <br /> EFFLUENT GROSS VALUE REQUIREMENT , 30 DA AT DAILY 8Z MGD <br /> OLIDS, TOTAL SAMPLE <br /> DISSOLVED MEASUREMENT <br /> 0295 1 0 0 PERMIT ## # ###### ### ###### ###### REPORT ?RLY RAB <br /> EFFLUENT GROSS VALUE REQUIREMENT #### DAILY NX dG L <br /> IL AND GREASE SAMPLE ###### ###### ###### ###### <br /> Y UAL MEASUREMENT <br /> �6 1 0 0 PERMIT ### 0 1 ES=1 QNCE/ . VISUAL <br /> EFFLUENT GROSS VALUE REQUIREMENT INST M1 NO=O ###$ NORTH <br /> SAMPLE <br /> MEASUREMENT '- - <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE DATE <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN;AND BASED <br /> -BY,r Ct h �e jl U I, Q� ON MY INOUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> {/ OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION <br /> IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG- <br /> I��gr., a NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING t�S THE POSSIBILITY OF FINE AND IMPRISONMENT.SEE 18 U.S.C, f 1001 AND SIGNATUREOF PRINCIPAL EXE UTIVE �/q <br /> ���`� d <br /> 33 U,S.C. } 1319.(Penalties under there statutes may include finer up to $10,000 AREA <br /> TYPED ORPRINTEO and or maximum imprisonment ojbetween6 months and tyears.) OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS(Reference all attachments here) <br /> IF NO DISCHARGE OCCURS REPORT"NO DISCHARGE". OIL AND GREASE; SEE FOOTNOTE F/. <br /> EPA,Form 3320.1(Rev.9-88)Previous editions maybe used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 00 05 3/900910-14 0 2 PAGE 1 OF ' <br />