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r£NMITTEE NAME/ADDRESS q,.rA,a.Fxn.p n..+.~i.~..,,o„uu,P...,.,. - <br />NAME Tf!APPFR "-IN[N1;, I§tC. <br />ADDRESS T 1S A P P E R ti i !I F. <br />P.O. HOC 1"7 <br />CRAIG ^J !'IG26 <br />FACILITY - <br />LOCATION <br />ATTH1 Y. GDRD7N FF.TFR;, PRES/G£R AGP, <br />NATIONAL POLLUTANT D19LNARGE EDMINATION SY9TEM INPOESI <br />DISCHARGE MONITORING REPORT IOMR! <br />l1-16'1 17-191 <br />ti <br />PERMIT NUMBER DISCN,wGE NUMeEfl <br />MONITORING PERIOD <br />Y AR MO DAY YEAR MO DAY <br />FROM TO , <br />12411/ 117-231 111-151 !1617/ 116-191 /.70.311 <br />Fonn Approved. <br />M T ~, 7 tj OMB No. 2040-0004 <br />{ S t) P R 7 V) Approve! expires OS-31-98 <br />p - ot'!fAL -'l~ f ' <br />PnW~ ~'i ~n nrpt)LR PTf?4Ti rrrLC'! <br />Paa +'!7 OT SCf10.P, r'.E .(~) O¢/k <br />NOTE: Reed instructlorr before eompletiny this form. <br />PARAMETER 13 Grd Only! QUANTITY OR LOADING ~ ll Ord OnlYl OUANTITY OR CONCENTRATION }ID. FREOUENCV SAMPLE <br /> 146-531 !5461 /3A-151 116'-531 (54611 <br />EX OF <br />131-371 - ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS as-sai l646'el /69-701 <br />OIL AND GP, P. 115E SAMPLE a4000rR ( 90) QtrAfi00 fi+%firrg4 ana~t.~ <br />V I S O A L MEASUREMENT <br />84066 7. 0 0 PERMIT QAtOCOP R!PO[T f;S=I ~~O.M14~IIrQ::~~~ :~. QI'~fit3:mtfL' ~ hClO'tk..tl~4(~. 4d01 ;~:~ , <br />~~-Lt .7[$QA <br />F:PFLUL'dT GRO55 9ALt7 REQUIREMENT _ >y . <br /> SAMPLE ~ - ' <br /> MEASUREMENT <br />~ <br /> PERMIT ' <br /> REOUK3EMEN1 ~ . <br /> SAMPLE <br /> MEASUREMEtT ~ ~~! t <br /> PERMIT <br /> REpI,tIREMENT <br /> SAMPLE <br /> MEA!UREMENT <br /> FERMfT - - <br /> REQUIREMENT ~ ~ - ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT-.. - ~ ~ • ~ ~ ~ - - - <br /> REQUIREMENT. <br />~ r.,>, <br />/ SAMPLF,. <br /> MEASUREMENT <br /> PERMIT:' -- ~ ~ - ~ <br /> <br />REQUIREMEryi . <br /> SAMPLE, <br /> MEASUREMENT <br /> PERMIT. ~ ~. .. ....: ~.:~ ... _..,.. ~ ... ~: <br /> REQUIREM~,NT ~ - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ~ LF,RTIFY UNDER PENKTY OF LAW THAT 1 HAVE PERSONALLY E%AMINED'AND. <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND eASFD ON TELEPHONE DATE <br /> <br />' <br />-MY INQUIRY OF TN09E INDIMDUAlS IMMEDIATELY -RESPONSIBLE F011 / y <br />!~ C <br /> <br />f• <br />'#• GGutdOn POtetB - <br />OBTNNING THE INFORMATON, 1 BFDEVE THE 511BM4STED INFORMATON 15 <br />TRUE. ACCUIUiE AND COMRETE. I AM AWARE THAT THERE 'ARE <br />SIGNIIFICANT PENALTIES FDR SUBMITTING FALSE INFORMATION <br />INOLIAING <br />J /~L+-~ " <br />/ <br /> <br />970-824-4401 <br /> <br />9 <br /> <br />O4 <br /> <br />0 <br />FtraeidentfGanetal ?fans AI , <br />/ 100} µpaa <br />TMFOOSSlBlLITY OF HNE AND IMFAISONMENT <br />SEE fe U <br />S <br />C <br /> . <br />. <br />. <br />. <br />f 1]te <br />A <br />Wd <br />N <br />/ <br />d <br />N <br />rol <br />U <br />S <br />C <br />0 ti1EiNA1TlIIE OF MIINR7PAl EXECUTIVE <br />TYPED OR PRINTED . l <br />IA tINNI <br />IKA. <br />MA Iy <br />. <br />. <br />. <br />M <br />.~mnlnA ^MT <br />A <br />10,00 <br />wA.nrA.tAwr irRMSAVrlntwan..A, enlarlAs And6 yerA/ - OFRCER Op AUTHORIZED AOENT C <br />E NUMBER YEAR MO DAY <br /> OD <br />COMMENTS AND txrLANA l ION of Rnr vwLA noes lne/eronce sn errscnmsnm nsrsl <br />TSS~, TOTAL iRDti LTtrITS i~ILL &P, YAItfiDe Ai1D SETTL£APLF SOLT75 LTKIT APPL;F!> F•r1I~ <=70TP.,?n!tR PRP.CIP FYF}J"- <br />SEE BURDEN OP pR00F Rl~UIRf.!iCNTS UNDER I~A:'Y.~~:TDS BONII'DRING - LRe3. f1TL f. ^,TEg} gg _ qPF T.P.I. (A) <br />EPA Form 3320-i IOB•95 Previous sdNion] mey a use - 1 USED.) PAGE OF <br />._. a...~.~.,5.1..-.~...~.~..I - - - - ~ ~. <br />