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PERMITTEE NAME/AD SS (lwim&Facility NamWl ocaHm (fl)( emnr) <br />NAME pAKR EffERGY I`1 <br />ADDRESS CARBD N JUNCTi DR IINi: <br />27a SAWYER Di2IVI: <br />DURANGD , Co 613)1 <br />FACILITY 0 A .` H I D d E N„ h <br />"�"Y INC. <br />LOCATION (/� <br />I T111110 -U r%g DI IT," C- vv L) 7, =Trfi ai n <br />NATIONAL POLLUTANT ARGE ELIMINATION SYSTEM (NPDES) Form AD - ed. <br />DISCHARGI ITORING REPORT (DMR) OMB N<-0004 <br />2-16i 17-191 QWJ N �; F; D I V D 2 T 0 C A�b��val---pirTs o6-�3`i �s <br />PERMIT NUMBER DISC ( S I, r, R $ 10 <br />F - Fr SAL <br />MONITORING PERIOD 11 1110 Y, <br />YEAR MO DAY YEAR MO DAY <br />FROM , r ( TOco u * ft f., + ( P (• .. r� <br />120.21) 122-231 124-251 12&271 128-291 130.311 NOTE:NRr, eed 1j11atru`tifiu orlst� be'torj eam1Iettnp,t,: this form. <br />PARAMETER <br />(32-37) <br />13 Card Only/ QUANTITY OR LOADING <br />(46-53 (54-61 <br />(4 Card Only/ QUANTITY OR CONCENTRATION <br />!38-45 (46-53 154-611 <br />NO. <br />EX <br />162-631 <br />FREQUENCY <br />QF <br />ANALYST <br />(64- <br />S PLE <br />TYPE <br />169-70) <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />OIL AND GREASE <br />SAMPLE <br />MEASUREMENT <br />:p?.�Xr�X <br />/ 9a' <br />y <br />it.YGsr Y <br />u{:Ic :tf: <br />n#nth## <br />84066 1 U .0 <br />'u� )` L' <br />_� x # <br />PERMIT • <br />REQUIREMENT' <br />Frrx <br />8 i <br />r: <br />7r w Fli•L't3 <br />rr... <br />.�w .yrs �t <br />, <br />x' -,•a: Ik <br />#:t. T <br />r j �13it E <br />SAMPLE <br />r <br />MEASUREMENT <br />PERMIT' <br />e• <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />' <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />"- <br />�I <br />j <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />f <br />PERMIT <br />REQUIREMENT <br />�- <br />SAMPLE <br />MEASUREMENT <br />1 <br />-. <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT _ <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE FFICER <br />I CERTI UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON <br />OB INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING <br />THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. IT 1001 AND 33 <br />U.S.C. s 1319. /A►n lWa under these statutes may lnelude rMes up to $10,000 <br />end ormaxh/wn @npriaoiwllent orbtween 6monthsand 6 years./ <br />t <br />J i <br />TELEPHONE <br />DATE <br />) <br />�Cr r� 4 ��l J - <br />!1 <br />CODE NUMBER <br />YE <br />MO <br />DAY <br />SIGNATURE OF PRINCIPAL,FXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />TYPED OR PRINTED <br />%.VMMCry 10 ArvV CAI"LP 111N I IVIV VP AIV T V IVLA I MVA IrTerererice 9// errecnmenus nerel <br />SMLEABLS `§AIDS LI"'II APPLIES ONLY IF C= 10 -YRS 24 -PR PRt�:Ii' L,YENT I5 C%i,?MF;Ue IF CLAT" APPROVE!) DY <br />NQCU, TSS 5 IRDIN LIMITS {JILL ND 39 APPLIED TO REPfJiiTFD "F.A.;UiCrNj:,NTS--S T' T.IA, PG 5 A`;-'1 I.P,1r), P(; 5. <br />hh 08195 e�iio s i�ditio tr y b u13ed. - (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />