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PEF'IITTEE -TAME/ADDRESS (1111111d, NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (,VPDE.5) form Approved <br /> facdit) nante/Lotanon if d0jerent) DISCHARGE MONITORING REPORT (I)MR) OMB No.2040-0004 <br /> NAME_ I ' _ __ ----------_ U-/61 (17-19) Approve/expires 9-30-85 <br /> ADDRESS` 11 ..i I <br /> PERMIT NUMBER DISCHARGE NUMBER <br /> ------------------------ <br /> -—— ——————————————— MONITORING PERIOD <br /> FACILITY '�('_I C I_(CIF --------------_ YEAR MO DAY YEAR MO DAY <br /> LOCATION FROM - ,-jL I TO <br /> ------------------------ (20-21) (21-23) (14-15) (2627) (_8-_9) (30-31) completing this form. <br /> > NOTE: Read instructions before com le g <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (54-61) (3845) (46-53) (54-61) NO FREQOUFNCY SAMPLE <br /> (32-37) EX ANALYSIS TYPE <br /> >< AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63) (64-68) (69-70) <br /> FL OW SAMPLE No Liscnzi e <br /> r� C[�'' MEASUREMENT f, 7 <br /> :)OOUV 1 0 PERMIT �' 01�L! 1h, <br /> REQUIREMENT <br /> SAMPLE * ,* <br /> MEASUREMENT <br /> PERMIT <br /> 5 0 1 0 REQUIREMENT * * * 01/30 GR <br /> SAMPLE <br /> IRON MEASUREMENT <br /> PERMIT ,� * * 01/30 GR <br /> 1945 1 O REQUIREMENT <br /> OD <br /> SAMPLE <br /> SETT. SOL MEASUREMENT * * N <br /> I <br /> PERMIT <br /> ' U <br /> 545 1 0 REQUIREMENT * * * OPT140h 01/30 GR <br /> TDS SAMPLE <br /> /� MEASUREMENT <br /> PERMIT <br /> 702y5 1 0 REQUIREMENT <br /> 01/90 GR <br /> SAMPLE ,* <br /> I MEASUREMENT <br /> PERMIT <br /> 400 1 O REQUIREMENT <br /> * 0.5 * 5.0 01/07 GR <br /> SAMPLE * * X <br /> O &EG MEASUREMENT <br /> PERMIT <br /> 556 1 0 REQUIREMENT <br /> OP7ht0h! 10 01107 GR <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> RESNSIBLE FOR <br /> James S. Lunan OBTAINING INQUIRY THENFORMMY OFOATIONN IVIDUALS BELIEVE IATHEDI SUBMITTED ATELY INFORMATION <br /> IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG J <br /> Manager - Permits NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE IB USC 4 1001 AND SIGNATURE OF PRINCIPAL EXECUTIVE 602 774-5253 87 07 27 <br /> 33 US 41319 tP—.1m, uadrr th.— stalutr. a,., mrlud, luu•. up h, 811,teu, <br /> TYPED OR PRINTED andnr maximum tmprlwnnu•nt o/hew—a 6 month,and iera-, OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> CODE <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> EPA Form 332 f 0-79)PREVIOUS EDITION TO BE USED (REPLACES EPA FOR WHICH MAY NOT BE USED.) OF <br /> UNTIL SUPPLY IS EXHAUSTED <br />