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PERMITTEE NAME/ADDRESS (/nc(ude Feciliry NmnelLocmian ifDifferenq <br />NAM, soar ar::.);,,..,,, ((•~I?-,, <br />ADORESSyUNIC Kq• ;r "["'; <br />P.O. `10C '~'1 <br />FACILRY PAOMIA ~'9 61C2H <br />LOCATIONiO~ I r: CO 51 411 <br />PTTN: NILLIP". i. ^'Af. T?_ ~TUh nra <br />NATONAL POLLUTANT DISCHARGE EUMINATON SYSTEM (NPDES) FORn AppfOVed. <br />DISCHARGE MONITORING REPORT (DMR~ OMB No. 2040.0004 <br />!z-,e) (Ir-9) 77NOR Approval expires OS31-8.p. <br />^ PERMIT NUMBER DISCHARGE NUMBER (5 U •i ~ Y C) ' <br />F - ~rr)A[. Deii4A <br />MONITORING PERIOD _~ C 4 G O F S R r0 n g E R ° a 4 I L ~~ TC H ' <br />YEAR MO DAY YEAR MO DAY ~T <br />FROM 7i 07 0 TO DQ .)O ~10 "'z VO D: SCNi?GP re~~ ~+`'' , <br />ftazl) !zz-z3) !z~-zs) !ze-zT) rze-zs) (3431) ; NOTE: Read Instructions beto COm lBting this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER l4s-53) !s•r-sl (39x5) 46-53/ (50-67) Fx aF TYPE <br />~2-3n AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNRS <br />1c1-631 A/JALY3IS <br />64-68 <br />69-70 <br />JIL AND ~RE.4SE SAMPLE $;:*~xa ~~~~~+ <br />VISUAL MEASUREMENT <br />!i4U66 ]. U 0 rip MI'L`-" . ~~n11M41s+K. , - <br />'~ <br />;-`. E5=1 ~ ~- '- ~~. +~1d16101'O# #4C - <br /> <br />~.F!'LUEkT GSOS~ YALU. <br />I, ~ <br />~~,~` , <br />; <br />;,, <br />NO-0 <br />",': ,..< <br />u~ - .~, <br />,:- <br />-r.C# <br />~ <br />(;',,,.-~; <br />., :~ <br /> SAMPLE <br /> MEASUR <br />EMENT <br /> ~~ii <br />~Ml l~1 <br />'k '~'Ic <br />~ <br />+ yp~~ <br />µg~ 1 ~i <br />} <br />'9 ~' i YJY' <br />~ ` <br />~t .i ~fi Yf' <br />w,, <br />;, <br />~ <br />J[~. <br />i <br />~~,.j' <br />' <br /> RM~NT- <br />) w ' <br />~ ~~ <br />} )~ <br />" ~~ xe~ `~ <br />; <br />ry A•(i :0 <br /> , I .' I i. <br />We <br /> SAMPLE <br /> MEASUREMENT <br /> R MIT <br />- a z <br />~ ~ <br />s <br />° - ~ , t!i :.fTS <br /> AEQUIREMENT - • - _ „~ a i <br />v1 <br /> SAMPLE <br />I <br /> MEASUREMENT l ~ / S <br />C ~!/~1? <br /> PERMIT ~. - " ~. ~ ..- ..-. . ,,,. <br /> REQUIREMENT '" ' <br /> SAMPLE <br /> MEASUREMENT <br /> <br />-~ ;r ~ :. <br />~ - <br />,> <br />~ <br />~ <br />-' <br />a~ i <br /> AEQU REMEN7 , , r <br />, <br />3 , <br />;. _ lYw <br /> SAMPLE <br />• MEASUREMENT <br /> PERMIT. - ` ~„_' <br /> REQUIREMENT _ - ~ rs~;i <br /> SAMPLE <br /> MEASUREMENT <br /> "PERMIT ~; z r <br />_ Ts k"M <br />• <br /> ~REpU1REMENT ~ <br />' <br />NAME/TITLE PRINCIPAL IXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMIUAA WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HER NALLY EXAMINED AND <br />EIN <br />AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDNIDUAL <br />THE INFORMATON, I BELIEV S IMMEDIATELY RESPON <br />E THE SUBMITTED IN ; <br />SIBLE FOR OBTAINING <br />FORMATION IS TRUE, <br /> ACCURATE AND COMPLETE I AM AWARE THAT TH ERE ARE SIGNIFICANT 1~~ / ' <br /> . <br />A <br />FO <br />BM <br />T E INFORMATI <br />FAL INCLUDING THE <br />ON <br />/ <br />~ ~ ( (~ ~~ ~ I /~ f')( PEN <br />LTIES <br />R SU <br />I <br />S <br />, <br />DNG <br />POSSIBILITY OF FINE AND IMPRISONMEM. SEE 18 U.S.C. 4 1(x11 AND 33 U.S.C' <br />SIGNATURE OF PRINCIPAL E%ECUTIVE <br />~7~ nn `` <br />_/d ~ ~d ~) <br />~~~ <br />i~j <br />of S <br /> <br />TYPED OR PRINTED § 1319. (PomMas under these statutes may Include fines up ro 510,009 end or <br />maximum rmprisonmerrt ol6eMeenBmwtru entl Syeers.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />r <br />.~i~9~ <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Hererence flil attachments nerB) <br />i1:TTLEABLk: SDLIDS LI!!IT .4PPL75i 09LY IF <1DYR,74HR PRECIP P.VF.Y? Ii CL3IHFD. 7P CLA[f+ APPRCVEA aY 4QCD, <br />:'SS E ZkUN L[t"•ITS HILL tIOT 8F. APPL[?D T~ REP/)RT°.D "!£ASUREf'F`7T5-Sq$ I. !1. 2, or, `_~ FOq ?URDEN CF P400F <br />E>?'q Sr 20.1 0 = S) Prev use Itio s y t be u4B I (REP CE5 R ~ Y N .) ' -' • ' • ` • ` ' PAGE OF <br />0000619?0312-1222 <br />