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PERMfrTEE NAME/ADDRESS (Include faciliry Nomr/Locarion 7/Dlffermq <br />NAME BQ~IE RE'_:-ruUct:~ LI'Ir'rr:D <br />ADDRESS8OIJIE MO. ~' "TSH <br />P.O. d:77f 't I J <br />FACILITY PAOYIA CO dlli?3 <br />LOCATIONUOL If. CO 3141 <br />.'re.: iYIL'LI+" 9. =r5 ~y;, >17hr^^. 9f:R <br />NATIONAL POLLUTANTbISCHARGE ELIMINATION SYSTEM (NPDES) FOrm Approved. <br />DISCHARGE MONITORING REPORT (DMR; OMB No. 2040-0004 <br />R-'o) ('~- e) n T ~O R Approval expires 05-31-98 <br />^ PERMIT NUMBER DISCHARGE NUMBER (S I I fl R V C) <br />~ - °TNAf. D~'.L?a <br />MONITORING PERIOD '15"HC CF `R Tr? DFFH ^'ayl1. '- "''H <br />YEAR MO DAY YEAR MO DAY <br />FROM 79 0/ U1 TO 00 U9 37 .~ N.I D• ~CH~Prp ( x ( ;., <br />(2a2r) (22-zsl (24-25) tzs2r) (lass) (soar) '- ANOTE: Read Instructions before plating this }orm. <br /> (3 Cartl Ony) QUANTITY OR LOADING (a Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (a6-53) 5a-6r) (3845 (<s-53 (5a-67) P~( OF TYPE <br />(3z-317 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(sz671 ANALYSIS <br />(6668) <br />69-70 <br />-It SAMPLE '=*aRR'~ .RG~~:~ ,.m##3x ( 12) <br /> MEASUREMENT <br />~UUGO 1 0 D PERM11': ' #10##tF# G##' :k:'YX: tl(~1" ~` #yti(p>Onp,r : ~'s]1 <br />+ tr <br />~t~~L <br />'N~`. <br />:.F°LU(;NT I:RO.;S Y4L'7' REQUIHEM~N'r ~,#sG - . l <br />r.IDS, TOTAI. SAMPLE :=F:tL`0+ G~ia#r 4##+kt# ( 19) <br />~~3PENDEJ MEASUREMENT <br />uUS30 1 0 (+ ---.~`P }T -' a #~ - ~~ it~~ ' ° #14TIN~ ~`` ~ ~ <br />4 <br />;;FFLUENT GROSS YAf,U, AEQ MEIVI' ~`,,~" r, .~ {rM1"- esaa/ , <br />~ 'Ik~~.' ~ <br />, k~'w <br />:;OLIDS, $ETTLR.,I{L:' SAMPLE -~'~~Y` oa=g~~` #a#v <br />/ ( 25) <br /> MEASUREMENT ~" _ ~ ~ <br />0US4S 1 D 0 ~~- PERMIT <br />• .~~##4'~ °w .~ ## #^ <br />~ ~ '~",..,. ";- ~~:8~° <br />' <br />r FFLUENT GROSS YALU REQUIREMENT ,;.~• ~ ,r T ~ ~ <br />° <br />I ~tON, TOTAL SAMPLE • ~: :'37 +~~`'`~~ # y"-'~t~-"` ( ] q) <br />{AS FP) MEASUREMENT <br />J1U45 1 0 U PERMIT ~Y° .,, +OrrftAc#¢+#I oar. #01#iF43 ~~Q 6si1 /CLl ~ ~~ <br />i•:FFLUEA'T GR755 Y F i U REQUIREMENT ;"` ~ ' fir;; r#~~ ~ ~ ~ =t" ' F '~~ <br />.;IL AML) GkL'A~R SAMPLE ~+=f:r•'•= Rr~fitzt •.:~.•;;`~ ~:r,.qR~'- ( ]9) <br /> MEASUREMENT <br />UJSU2 1 0 0 ""PERMIT ~" .`: BtF~Or~* ~~*~ # <br />~ , ~•~~ ## <br />lflk ~. - <br />~~ <br /> <br />'~ <br />Q'M'C~ <br />$~~ <br />&FFLUEf+T L,FtUS`_. V~.LII AEQUIREMENT` '~ a ') -„+~'-: >r#r~ °~'~ ~ ~, ~•~ ` as: <br />E`OG, ! C: v.': _^`lI~ nu SAMPLE ( 03) lt'+t#3:'# 301,`.X"k'.`• ##O~',}i` <br />•; U T F. .. 1'C "'"~ r ' 1. ~ 'i MEASUREMENT <br />`rU~7U !; .1 PERMIT ' .RB p(~'~-' $E¢OQi' ,,. ..,+~#'#'### ##., jAlpir '' ''' IR## '~~' '~# ` ~: $~~~ ., ...:: <br />iFFLUENT Git'ti': 'IRLU REQUIREMENT 00*. Y lIGD -;.y <br />:,LIDS, f~:'AL. SAMPLE x.:a~a a=~=-'= '~=~'~Y'.' ( 1q) <br />:.LSSOLYL'D MEASUREMENT <br />I!11-IS 1 t' Ll PERMfF ~'-.a4~al##4r ;#tf+01$Ik '. .3: -plp~lrt##" mt~1-URt ~ D,?7tt16X~, ~. ~ ' Tt11L7~ ~ "~ <br />..'fLfJENT ~+i%~!~`~ Yd.LU REQUIREMENT F- ~ . yYra ~ ~ ~-. - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN; AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDNIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING f <br /> THE INFORMATION. 1 BELIEV E THE SUBMITTED INFORMA710N IS TRUE, <br />/~ <br />~ <br />' <br />~ r <br />1 ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />F <br />RMAT <br />N <br />I ))~ <br />' <br /> <br />r n ~ ~~ i Ah r l--~ i J~'/w~ ~L PENALTIES FOR SUBMITRN <br />POSSIBILITY OF FINE AND IMPR IO <br />, <br />NCLUDING THE <br />G FALSE IN <br />O <br />ISONMENT. SEE 1B U.S.C. 41001 AND 33 U.S.G <br />SIGNATURE OF PRINCIPAL EXECUTIVE /p~~y` <br />'/ /V n <br />7d ~ ~.~ > ~ <br />/J _ q <br />~ S <br /> <br />TYPED OR PRINTED 4 131 B. (Perel(ies antler mesa smnxas may Inclutle lures up ro Sf0.000 erM or <br />menmum Mprlsonmenr of 6eAVeen6manrhs entl5 years.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (HetBrenCe all9aaCDmentS neR3J <br />~ETTLEAULE <br />Ty E IROM SOLIDS LII•TT 9PPLIFS ONLY <br />LLCITS 7LLI. NOT ii P. APPLIu.U IF GIDYR,2fiHR CRECIP F.Y''VT I5 <br />TO RP.PORT6D '1F.A5UR~MC~TS-SFE CLAT."YD <br />T. 1. 2, . T~ CL AZ' :+.PP?CYP.U '.Y 'a^C^, <br />P!7 5 F05 d17NDPR OF PRO^F <br />pq rm 0-i 0 Previous a itions may no be u~B .' • `• (l7E CES FO 7 I /IY O 13 E .) <br />0~0 PAGE OF <br />~5/99Ci12-122? 1 <br />