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PERMITTEE NAME/ADDRESS p,vi,b Frd~ryN.wJl«.un UDlpwwd <br />NAME •raA~.: -_~ , ... <br />ADDRESS T k' Y 1 f'~ " i <br />P.i). 2.~J 1'.7 <br />CdA~_ <br />:l.hc6 <br />FACILITY <br />LocAnoN <br />ATr!!: w. JUhU;ra Yi'TEP::, : ftES/cl.d N;,d <br />NATId1AL PoLLUTMT dSCHMOE ELIMINATION SYSTEM /NPOf$l <br />DISCHARGE MONITORMIG REPORT IOMRI <br />11-161 17.191 <br />000732115 C ~ A <br />PERMIT NUMBER dSCMMGE NUMBEA <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAY <br />FROM TO -- .. _ <br />!70.711 177-73I 11I-15I 11617/ !~B-291 13P311 <br />Form Approved. <br />a. ~I c T c w e s T ? Y E' ADM ry4',RL°p4roooa <br />Approval ezp~rpPS05-31.98 <br />(TUFF. !r) 1~ +- <br />F - FIRP.L <br />!'IlICF <br />~~.rr: BC CZSCyAar` Hwy( ;;:. <br />NOTE: Rssd Instructlane bsfors c' ompMLlnO.lftis form. <br />PARAMETER !3 Qrd only QUANTITY OR LOADING !d Grd OnlYl QUANTITY OR CONCENTRATION Np, mEDDENCr SAMPLE <br /> (16-53 (54611 f3B-d51 Id6-53 15481) <br />Ex OF <br />TYPE <br />137-971 AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ls7-sal MALYBIB <br />!54691 !6370/ <br />~ hG Vfl Aii' SAMPLE ~3+=k~k;: ( 94) Gtr OOt 3{t?Ot,~ '.'tfiL: h.} <br />~~ 1:iU h L MEASUREMENT <br />~~4Ub0 1 0 G ~ :. :PEflM1T::'r~;' :~; Ct~ ?0.a RLt~Pf7$~T ES=I d:g0i:tyq BtCq~~?~ ~ At!SfirLIG q#;: c ~ £EY,L YISOAI <br />r:FFLUE:IT GROSS YALU .1)EQFS.II9EME.N7;i :. , <br />.3NS~ lfl.)w< <br />Nc=O <br />OfAlF4 <br />:: <br /> SAMPLE <br /> MEASUREMENT <br /> :...::.. <br />.. ..:. . <br /> <br />..: <br /> REQUIREMENT .. .. ~ .. . ~ ~ .. - ... . <br /> SAMPLE _ <br /> MEASUREMENT \ <br /> / J <br /> PERMIT ~ ~ .. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~. <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASVREMEN7 <br /> PERMIT ~ ~ ~ ' <br /> REQUIREMENT ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. <br />~ <br /> ~REQ.UIRENIERIT - .. <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I ccerlFY UNDER PENALTY of <br />AM FAMILIM WITH THE INFO uw THAT I NAVE PERSONALLY ExAMINED MD <br />RMARON SUBMITTED HEREIN: MD eASED OM TELEPHONE DATE <br />' MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE fOR / <br /> <br />Gordon P~tar• <br />W <br />OBTIINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />T <br />T <br />RE ~~~~ <br />~ <br />~/>F- <br />• <br />n HA <br />TRUE, ACCUMTE AND COMRETE. I AM AWME <br />THE <br />ME <br />90NIFCANT PENILLTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING 970-824-4401 98 10 23 <br />~ <br />President Q Ganer8l M6IL8 Cr <br />Y , <br /> THE POSSIeIUTY OF FINE AND IMPRISONMENT, SEE 18 U.S.C. F 1001 MD 3] jIONATUIIE Of P1IMECNAL EXECUTIVE <br /> U.S.C~ ! 131 B. /AFnFNY. nIM dMM .f1N1ra /nFY ircArd rvlr. 10 M ! IB,000 <br />TYPED OR~PRMITED A+s.r msre+wn ww/d.nnrwaewwn s.nnlnr.,dswr..l OFflCER OR AIrtNORIIE0 A0ENT CODE NUMBER YEAR MO DAy <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRs/srsncs eN sttschmsnts hers) <br />Z:iS E TOTAL Iknt. LI"'IT~ w'ILL NE I:AI7i:D, A4v ~ETTLEASLE SJI.ILS L1R17 A6FLIE~ FCB <=lOYR,?4:~{k Pk Y.~;lU _YER~1'- <br />:;Ei: dUnDEH OF pkUOF kE,lUI!tf:MENTS UfiUER I.A..1. TUS MONIT~fiIEG - r.~.3. C7L~E GfEASc"". - :,E= i. F. L.(U). <br />iQ 111Y AYEEAh r. IC HTf.Rfi ST KuNTH LY iVF'4s :F' DOR7Nr, DFR T!1^ ~i'Df RTF f. <br />EPA Form 3320-1 108-951 Previous editions may bs used. (REPLACES EPA FORM T30 WHICH MAY NOT BE U6ED.) U ~.~ ` I~ / 9'] 1211-164 r," PAGE 20F 2 <br />