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PERMITTEE NAME/AD S(b'a1/deFxdtyNmdLocndonlfDlQG.ent)
<br />NAME OAn•,;I F:NEP.i'� I1Z.
<br />ADDRESS CA; tiI.)N JIINCTLD`, lLwF:
<br />270 SAWYE"; DHIV•;
<br />DURANGD D 6L3D1
<br />FACILITY
<br />UAKRIDZ7. ENERGY INC.
<br />LOCATION
<br />NATIONAL POLLUTANT ARGE ELIMINATION SYSTEM WDES)
<br />DISCHARGE ITORING REPORT (DMR)
<br />2-1661 17-19
<br />R
<br />PERMIT NUMBER DISCHARtlE NUMBER
<br />MONITORING PERIOD
<br />YEAR I MO I DAY I I YEAR I MO I DAY
<br />FROM y TO
<br />'12n-211 122-231 124-251 126-27) 128-29) (30-31) '
<br />Form App ed.
<br />004
<br />S `i E D I P D N D I ^ 7 Zipr va %' 65-
<br />p rove- __�-r x105-31-98
<br />(31!;i!% i,) 12,3+t i
<br />F — F'I1;AL
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<br />NOTE: initru�letinp•.rt ie form.
<br />a i. • • a,Id a U A,(3
<br />Cord Only) QUANTITY OR LOADING
<br />14 Cord Only) QUANTITY OR CONCENTRATION
<br />NO•
<br />FREQUENCY
<br />SAMPLE
<br />(46-53 (54-61
<br />136-45 46-53 (54-61)
<br />EX
<br />OF
<br />TYPE
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />(32-37)
<br />(62-63)
<br />ANALYSIS
<br />(64-681
<br />(69-70)
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<br />( 1 3)
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<br />PERMIT
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<br />i ti R U TR T MO N T P L A ti T
<br />MEASUREMENT
<br />PERMIT
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<br />t79 LY
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<br />50050 1 OT 10
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<br />EFFLUENT " R V A O F
<br />REQUIREMENT
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<br />SAMPLE
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<br />E F F i U E !f 'r K' .'S V A LII
<br />REQUIREMENT
<br />NAME)TITLE PRINCIPAL EXECUTIVE OFFICER
<br />I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN, AND BASED ON
<br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
<br />)
<br />TELEPHONE
<br />DATE
<br />r t<iF
<br />ice+ t f;v
<br />TRUE, ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ARE
<br />,nM
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
<br />THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 AND 33
<br />U.S.C. 1 1318. (Prns/dss undor dwss stnwftt msy Mckdo rows up to $10,000
<br />SIGNATURE OF PRN AL EXECUTIVE
<br />AREA
<br />TYPED OR PRINTED
<br />sod or nwknun lmpdsonnwnt ofbotwoon 6 months and 6 ywn.)
<br />OFFICER OR AUT RIZEO AGENT
<br />CODE NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLA I IONS (KOrOrOnCe all 8n8cnmenrs n6r6)
<br />SET'fLEA:JLR 'SOLIDS LI'4IT APPLIES ONLY IF C- 10—YR, 24—HR P Q;i�JV LVLNT IS' C'LAIMUD, IF C1_,AI`, AF' "DVF.D BY
<br />WQC1,, TSS & IP014 umiP:i W1LL NDT "IF APPLIED TO REPORT".) '!F'1njURL.iLNr3--5 E I. i .I A, PC, 5 AHD I. I.1D, P: 6.
<br />!x - `108- WeVidu3 ditio ay b ed. — — 13 - (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
<br />034'11/0708114-15„ 1
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