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PERMITTEE NAME/ADDRESS pMi6ssWry Nw/laanm UD(~E.e,r/ NAME TI:EhIY"fIf CCAL C`7 ADDRESS ~y515 NGUTT COUNTY FOAD Y27 CA& CF2EK CC 80467 NATIONAL POLLUTANT DI]CHAROE ELIMINATION 4YSTEM INPDESI Form Approved. DISCHARGE MONITORING REPORT IDMRI p~ l7-161 ll7-I91 C4 R0 %JIv M°T `•`T1 NtB l~p~~~~040~OfI04 r r•~ F17 ~ ° (SI)9R VR} Approt/e iej{"pjre1B505=~1-98 PERMIT NUMBER ~ IBVHAROE NUMBER r _ F I Y A L !! ~, FAaurv MONITO RIOD " L ~: C R TLf1,'IYN,ILE CCAL CO R MO DAY EAR MO DAY __ LOCA710N FROM O ? ,'.-I a ~^:; >;: ~ 10 1 99 12 I No DISCH4kC, ~ A __ NOTE: Reed IneDUCUont before campletlnp th6 form. 1 "i ~ ! ,d7-?31 111-751 176 1 l23-291 /36311 PARAMETER !3 Grd Onlyl QUANTITY OR L (4 Qrd On/yl WA'JJTRY OR CONCENTRATION Np- FREQUENCY SAMPLE l37-371 06531 /50-61 l3B-451 (4G53 (50-61 EX OF TYPE AVERAGE MAXIMUM S MINIMUM AVERAGE MAXIMUM UNITS /67-s]i ANUrms l61-561 /e37o1 w EFF EC'I ~'I ATFt 7C74Y ~ ~ ~~ ~ ~~ ~ ~ ~ ~ AC#':#S~ ~ ~ ~ ~ ~'.< { ,3} 1 CHh CEFECLAFH~16 MEASUREMENT ~~ ~ C-.t[ARj TCF3t ~ C ~ PERMIT .. ~~ . .... :kKtL~#', . ..... ~: ....~:: :•;;.0 ;=:=t ... ~, - LlYtraKl.is?Ls`.: . .'. .~x'Ir~~:XS'..: F.?- .. . 1'.tt~.Y- GP.:.1:A. _ - - ,.. .. :REQUIREMEN7~ ~.. . :..: ... o ; , ,:.;:: ,. °. E f F f C T S T A T R E 7 D A Y ~ ~ 5 C+d~O~ - D ~__;-'_ ~_ ~ "" ' _ ( 2 3 } ~ . CHr FIMtFHAL~FS MEASUREMENT q ~ ~( C~~ag IC-oC S 0 c :.:.:. PERMIT~i.:: ~ ,~.: ..::.. ~: ~~s~04?rk ~~~. ~.. .. :, tl.~#~A.. ~~ #0 ~:~~3 ~.tS~.( ~ ?~>;~ > :7~: _.~: ~>p.#Kt@i7u~. :~':`~.... .: .....: ~ffitir.;~ rXs'i'4r °['._ }!.:~ ~~~.#.q `~~. ,. ~ ~ n c a ' C :REQUIREMENT ..:.,.. . ~. ... ... ... :.. ... ~, $ f ;. . . , .. . .~ ej ~ .. .. . ......:.............. V N T . . SAMPLE MEASUREMENT M~ ~.: ~"~ PE.RM17~'::: ,... ~ ~.. ~ ~ ~:: ~~: ~ .: .. .. : .:~, .......~ .. .. . ',zi. ' ~ ~ ~ '.REQUIREMENT. .:.: ~:: ..: .. . : .::, ..: r r : ~~ id ~ ~~~~ ~~- ~ :. ~ ~~~ ~ ~~ SAMPLE ~ MEASUREMENT ..: ~.: ~('.ERMIT..:. . :.:: . . ~ . REQUIREMENT: ,,... :. :. :: :.. :. ,, ;:.:::.. .: .: _~... SAMPLE ,. MEASUREMENT :. ~:..PERMI.T:~~~;: ~' ,. ::: ~:..~..: .. ..: .. .:: .. .. . •REQUIREMENT.: :~ .:.. :.. .....: ..:.. ~ ... ~~~ :... ... ~. ~ .: .. .. .. ,.,~::r :::~.: :... SAMPLE ME UREMENT :.~... .. ~~REQUIREMENT SAMPLE MEASUREMENT ... .. .. r ;REQUIREMENT.: ::..•:.~:: ~r~.:'~.:.':: ~:"^.~' :::::~= .,.:::: ~~ .. ~ ~~~ ~ ~ NAME/TfFLE PRINCIPAL EXECUTIVE OFFlCER 1 CERTI AM FA FY UNDER PENUTy o>; MILIAR WITH THE FO w TNAT t NAVE PERSD TION SVBMITTED H NALLr ExAMIN N AND BA ERE ED AND SE N TELEPHONE DATE MY INQUIRY OF 1X05 IN ; I INOVALB IMMEDIATELY RESPONSIB D O LE FOR n ~ , "~ I - I i` ~ ~' 11 OBTNNING THE INFONMAEI I BELIEVE THE SUBMITTED INFORMA TION IS / / / / IC 1 ' 5 I C 1 - i l TRUE. ACCUMTE ANO CO SIGNIRCANT PENALTIES FO ::$$ ~PIETE. 1 AM AWARE TNAT THE UeMITRNG FALSE INFORMATION INC RE AAE LUDING .7/ ~ ~ D%~-~/O-Z 71Z tilde $ @I rv ronmer ta ~' 9 ~ THE PoSSIBIVTY OF fl ( , 1 1 PW d ~~ ~ r NE /A SONMENT. SEE 8 V.S.C. ! 100 AND ]] SIGNATURE OF PRI PA EC o ~ U.S.C. 1 13tP. IPVrhy. dwr memo nrr Axpd. IMr. ~ ro J%000 NCI L E% UTNE TYPED OR PRINTED .ae a~mvirenr inpd Mlrrn f marar. W B yrnal OFFlCER OI1 AVTHORRED AOEM CODE NUMBER YEAR MO DAY l.vmm[rvlJ wlrv [Ar'LAPIAt1VN Ur ANT VIULAIIVNalRB/elenOB a//ef7BC/Ilne/IL4 Oele/ SEE I.P.2 b 5 FCF L'FTAILC~ CF TE54 PAOCSDUFF. F.3F0;2 LCiI,~T :. F.FFi.Lic!1'" AT MHICl+ `i'!ATTS?ICALLY SIrNIF LIFF FET4EFN TEST E CCAThGL HAS C85EA1ED G`ING TP.ST CODE ^S°. INC=21w. ATTACH CYRO"!TC TOYICITY " r E arm 20- 961 ~ Pretnow edifiona mey be used. P A M TAO WHICH MAY NOT BE UbED.) ~ rt , L 1 ~ ~ 7 ~ 6 0 l -12 ~ I PAGE ,OF ~_ .- _._