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PERMITTEE NAME/ADORESSII.v..+.Fwenyn.,...~1.,~ .goyp. u, <br />NAME TkAPPF.R +itiiNr:, itF~~. . <br />ADDRESS THApp F.R `!LWf - <br />P.O. BOS t'i <br />C?AIC :'O Rt62o <br />FACILITY <br />LOCATION <br />ATfN: A. GDRD~M PfT6P.5E PRES/GE!A 1!64 <br />NATIONAL POLLUTANT DISCHARGE El1MINATIOM SYSTEM INPOESI <br />DISCHARGE MONITOEIINO REPORT /OMRI <br />17-161 //7-79/ <br />r <br />PERMIT NUMBER DISCHMGE NUMBER <br />MON170RING PERIO~ <br />YEAR MO DAY YEAR MO DAV <br />FROM - (~ TO J1 <br />126111 l11-131 174751 116771 l18-791 13631) <br />Form Approved. <br />r r q n ~ OMB No. 2040.0004 ' <br />(51!';i 9 F, Y~ Approve{ expirea OS-31-96 <br />p _ rr frAL •nPA••. <br />nn eE Tf' ''! R C@LC.H <br />s.,. .,°, l;rseBtKr,~ ~ ~( >Sss <br />NOTE: Reed inetructlorle before LFb}h~MTinp this form. , <br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING !4 GTd Only) QUANTITY OR CONCENTRATION Np, FREOUENC SAMPLE <br /> - !46531 154811 l38-/51 l~6531 /54811 ~ OF <br />137-371 EX <br />ANALYSIS TYPE <br /> AVERAGE ~ MAXIMUM UNITS MINIMUM ~ AVERAGE MAXIMUM UNITS rea-eal I8A-591 159-701 <br />UIL AMIT ~.idF.AS P. SAMPLE Q#RptrQ ( 9Qt d«ffs fYi Tk##C 3' w:`. 4';. ~l.k <br />YISUlL MEASUREMENT <br />84UG6 1 V V PERMIT P+PROOft P,CPOR7 ES=1 110'616¢;:' atllklspti~b 4..?~~+f5"y::. air,. ~'j.j <br />FPFLO°!;T GRDSS 9ALV REQUIREMENT dST O= ?~#fi'< <br /> SAMPLE <br /> MEAESUREMENT <br />-::- . <br /> PERMIT - <br />~ <br /> -REQUIREMENT ~ ~ ~ ~ ~ <br /> SAMPLE <br />MEASUREMENT <br />~ <br />. , <br />~ <br /> PERMIT <br /> REQIJIREMEIJT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~:.: ;~,;•~.~ _~. <br /> REQUIREMENT - ~ ~ "' :y <br /> SAMPLE <br />' MEASUREMENT <br />- <br /> PERMIT ~ ~ ~ ~ ~ ~ <br /> REQUIREMENT- ~ .. ~ - <br /> SAMPLE <br /> MEASUREMENT - <br /> <br /> REQUIREMENT <br /> SAMPLE <br />' MEASUREMENT ~~ <br />I <br /> PERMIT- ~ :. ,.. .... .. ~ . _; ~ . .. . <br /> .REQUIREMENT <br />NAME(FITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY E1IAMINED AND T <br />~ <br /> <br />AM fAM1UM YAM THE INFORMATION SUBMITTED HEREIN; AND BASED ON <br />e i/ ELEPFIONE DATE <br /> <br />' - <br />MY INDIAN OF THOSE INDIVIDUALS IMMEaATELY RESPONSIBLE FOR ~ , <br />~~ <br />~`- <br />/ <br /> <br />W. Gordon PaCars OBTNNING THE INFORMATION, I BEDEVE THE SUBMITTED INFORMATON IS <br />TRUE, ACCIIMTE AND COMPLETE. I AM AWARE THAT THEAE ARE <br />SIGNIFICANT PENALTIES fOR SUBMITTING FALSE INFORMATION <br />INCLUdNO 7 <br />970-824-44Q1 <br />.99 <br />04 <br />30 <br />Prasidant/Craasral Mena ar , <br />THE POSSIBILITY OF FlNE AND IMPRISONMENT <br />SEE to U <br />G. 1 1001 AND 77 <br />S <br /> . <br />. <br />. <br />U <br />s <br />C <br />s 1 J 1 P <br />fPwrti. uWr tlwAr mein <br />blch <br />ti <br />N 8 <br />.. a <br />m i 10 <br />000 BIONATUIIE OF rRIMCMAL EXECUTIVE <br />ED OR PRINTED ~ . <br />. <br />. <br />. <br />. I <br />. <br />P <br />11 <br />, <br />Y <br />d <br />d O <br />TYP e <br />wma <br />lnun inpLNlTwrr a/bnvrl tmmms an06 yaanl OFFICER <br />R AUTHORIZED AGENT CODE NUMBER YEAR MO DAV <br />VVMM[rvlJ Nnu~ ~nnn,rvn ~r nnr vwLn nvn~Inr,vor6V en euecnmmmn./e/ - <br />TSS a ToTAi iROM LL!'II1i JILL 8F. YAIYED. AMD SSTTLE11RLf. SOLIDS LIMIT APPLIPD ?~r± <rt0YPF2Cmo T`RP.C.TP PfFNT- <br />5££ Bi1gDEN DP PROOF RF.7'SIBEl16lTS U*EDEH i.Ae~• TDS lIpAIlOFI'~C - IePla3• OLL :sR^Agr - "F.F i.P.1.(1)i. <br />-.._r -- ___~. .. .. ~..-ter _.--. _..... --..~ -.-~~.-.-......-. <br />OODfi7/44021-10?A <br />' .'` <br />