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C, Mmtfa~ amount of principal pi~ct produced or raw material consumed,t~orted
<br />in item 7, above, is measured in (Check one):
<br />A:o pounds B.d tons C:o barrels D.o bushels-^'r"~E.O sgnare feet
<br />F,agallans ~ 6,optetts or units N, t7 other, specify
<br />9, (a) Check here 1f 4lscharge occurs all year p , or
<br />(D) Check the month(s) discharge occurs; ~,.f Ar.
<br />i,OJanuary 2. t7 February 3.pXarc~4,CfApril S.pMay 6.t7June
<br />7,t7July B,OAugust 9,C]September 10.00ctober 11,OHOVember 12.t70ecember
<br />(c) Check hw many days per week: 1,01 2.012-3 3XX4-5 ' 4.0 6-7
<br />70, Types of waste water discharged to surface waters only (check as applicable) ,
<br /> Flow, Ilarq
<br />ga per operating day voltme treated before
<br />discharging (percent)
<br />Dtsdlaige per
<br />operating day 0.1-999 1000-4999 SD00-9999 10:,000-
<br />~ 50,000- None 0,1-. 30- 65- 95-
<br /> ,999 or tmre 29.9 64,9 94,9 100
<br /> (1) (2) (3) (4) (5) (fi) (7) (8) (9) (10)
<br />A. Sanitary, daily
<br />arerage
<br />B• Ca~Mk~jCXtXitiid(X~COC Delayed ischarge of surpl s XX XX
<br />9r~Axx+k~zsi9~c
<br />0. Process water,
<br />daily average
<br />1. Maxinum per opera[-
<br />1ng day for total XX
<br />dischar a (all pas)
<br />71, If any of the three types of waste identified in item 10,eithertreated ortmtreated. _
<br />arc discharged to places other than surface waters, check below as applicable,
<br />Average flow. gallons per operating day
<br />Paste water is
<br />discharged to:
<br />0.1-999
<br />(1) ~
<br />1000-4999
<br />(2)
<br />5000-9999
<br />(3)
<br />10,000-49.994
<br />(4)
<br />50,000 or more
<br />(5)
<br />A, Y~ntcipal sewer system ~ I
<br />B. t!nderground well
<br />C. 5=ptic tank
<br />0. Evaporation lagoon or pond
<br />E. Other, specify
<br />12, Number of separate discharge Doints: A,p 1 B.t72-3 C,G 4-5 ~ 0.[76 or uarc
<br />13. Natae of receiving water or waters South Platte River
<br />14, Does your discharge contain or 1s it possible for your discharge to contain
<br />one or none of the following substances da dad as a result of your operations,
<br />activltles, or processes: ammonia, cyanide, aluminum, beryllium, cadmium, .
<br />chromium, copper, lead, mertur ,nickel, selenium, zinc, phenols, oil and
<br />grease, and chlorine (resldual~,~ A,C(yes E,ono Oil and grease only
<br />i~cartify that i am familiar with the information curtained in the application ,nd
<br />that to the best of my knowledge and belief such information is true, complete, and
<br />accurate.
<br />use Warren f.rsigiwca
<br />Pr~A name of Per/ / ~d
<br />Oate A icati Signed
<br />Mona er Real st t
<br />n tt e~~/fiL.'1 ~1.GGl.~-2~
<br />Signature of Applicant
<br />id U.S.C. Secden i00i pio ri des thel:
<br />Whosrer, in any matter u~i dun the /urledfedon of any daperen ant or egetey e( Na thtited Stetee
<br />Iu+a ~(nglr and w(1 (ally (d siQea mncada ar m.ara up ay any lock, schema or deriC• •
<br />meterid (eel. or makes any fafaa ficdcou0. or lraudilmt ustem en4 or repreaan taGOn; ar
<br />mekaa or uses anY (else wri deg or doamanr knowing same to contain any (also fiedtioua or
<br />(reudilrnt stetamant or aftry, shall 6e fined not mere th en il0.000 or impsaonednot moo
<br />then f Year; er aotA.
<br />
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