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PERMITTEE NAME/ADDRESS (/nclude Facility NamdLocafion ifDifferenq <br />NAME (, Y F ;;, l-);; i Iq <br />ADDRESS~INEi 1: 2$.3 SCUTH, 7,: ECKf1A(J F'V, <br />=1G0 EAST MINERAL CIRCLE <br />FACILITY `NGL EtJ 017D CO 60195 <br />LOCATION <br />r-~?TN. ML7NR IS W NEGLEY, ;.ENERAL AT NY <br />D <br />PARAMETER <br />i AVERAGE <br />SAMPLE <br />MEASUREMENT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form ApprOVed. <br />DISCHARGE MONITORING REPORT (DMA) OMB No. 2040-0004 <br />• PERMIT NUMBER DISCHARGE NUMBER F . ~ - F 7: ~ :iAL F: ^ ~.' T T <br />MONITORING PERIOD "II:v3_ =, F..7!JL` E Tq Ft'iDEI_ Ch^F~T~:1~ <br />Y ~ DAY YEAR MO DAY <br />FROM TO ~ 'r#: .;L+ .._. -:qp. cs- ~ ~ :; c. <br />,~,. ~ NOTE: Read Instructions before completing this form. <br />Y OR LOADING J.!' ' ~ QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />EX of TYPE <br />:MAXIMUM UNITS MINIMUM AVERAGE rM~AXIMUM UNITS ANA~vsIS <br />7 O V' l ` r r~; <br /> ~ , <br />:.FFLUENT :'RI7SS VAL{.iE ### ~~,..ro M - <br />` q•?,` <br />;_~LIDS, '!ItTA:- _ <br />SAMPLE ####JFts ##~-•a## #####* •. . , <br />+"5°E-IJD~P MEASUREMENT ~ ~ - NA NA L,A h.1'I ~..)`1 <br /> <br />~, ~, <br />'~:. t0 L ~. <br />_ <br />~ ~ - <br />.. A <br />~P~F Ct7Mt•IEN fS DELCW iti - s; ~ ,~ ~ <br />~~ ~r. r: r ` °,~r,P;~_ ,'f( ~~ <br />m iC~.,'L TN ;iF <br />. <br />:'ILID:_,. T~CTAJ_ SAMPLE ~###itc ####e~i~ :;u-iFce ~ :: <br />' ~ -, ~ <br />iUSPP"dD'~f._` MEASUREMENT ~5 r <br />°^p (~ (~ ~I <br />~. <br />~-y',' i <br /> ~' ~ , <br />~ •Y ~V - ~e. `. " <br />h F!_ V; fJT GRCSS VALUE O '~~ ; <br />; t t: := w <br />- <br />~-' , L :;<r <br />; <br /> . <br />~ l ... . ~,. ~ . <br />~C;LID3, SETTLEABLE SAMPLE trc#r,#i:-- e-+r~x#~w~~a ~-i-ar.--. # ,, .:, .. <br />d L Q ~ I ' <br />` <br /> MEASUREMEN T ~ <br />! ( , ~ ( ! ~ j i J <br />r <br />:_~ <br /> <br /> ~. "; <br />SEE C17MMENT9 DELGW ~ -•~ R F <br />• ~i3 ,. <br />1.. <br />~ ~t,: a .,~ ~•, l~ .:~'.~ 7~ 1L rt ~)-l i' ~, ~ <br />~OLID:i, SETTLEABLE SAMPLE ~''~#~`"p'~ f`~'~Fiit- <br />~' a~~saxt: <br />~ <br />~ _ <br /> MEASUREMENT ~ ~ <br />, NA I~ JJA /.~ <br /> •,_., ~„ <br />"~ <br />~~~FLUEN? GRC55 VALUE s' a~+~r. ~~is~ ~4;~ L'L .. ~'~# "[; <br /> .." . ; <br />- • . <br />:>IL es GREASE SAMPLE a'n#~-## ###ak~K. i~ ar: s:a## ~ it#cttart- 1-' <br /> MEASUREMENT .l ~ ~+ (JP ~ ~fl r'o1 /- ~^( <br />,'.Sv ~ 0 fJ #r~ <br />4:a <br />!Sc <br />: i <br />.r. <br />FF!_.U':NT GRCSS VALUE " ~ #x~~ ~e'?~' .., <br />a <br />;~'_` {; !I '' <br />-.. ~: ~~ ' <br />i FtGN, 'i C,Ir,L :iAMPLE ####¢# ~ iE####~ k+,x :=~.: r. ... ~t <br />i A=; FE MEASUREMENT .. ~ NH N~ ~~P r ~1 <br />,0.,i..~ I; O •, <br /> <br />'~ <br />~ rr <br /> <br />- <br />h ,. <br />EE GCMMEI':TS BF~LC4J $ ~ #fi~. .' ~ `Nf G,L <br />NAME/TITLE PRINCIPAL EXECUTIVE OF FICER I Certdy <br />re <br />are under penalty of law roar <br />d under m <br />dlreclion <br />r <br />U Nisdoclment and ell attac <br />idn I <br />Ni <br />d hments were <br />ish <br />d <br />i <br />d ~ TELEPHON E DA TE <br />tic h a r d i ! I s p <br />p <br />y <br />o <br />s <br />pe <br />s <br />n accor <br />ance w <br />a system <br />es <br />gne <br />to assure roar qualifietl personnel propedy.gamar and evaluate Neinlormation <br />M J. <br />•. 97 0 ~' 0 _' 71 <br /> aubm <br />lad. Gazed on my ingulry of b,a person or persons who menage the rystem, ,~ <br />~ % ~ , <br />Fll! ~ I r' O I7rIPfT i d ~ "B (18 Tl@ r' or those persons tliredty reaponslble for gathering the IMOnnetlon <br />the inbrmatlon ~ <br /> , <br />subm,tted is , to Ne bost d my knowledge entl belief tme, atturate, and complete. <br />I am aware that w <br />r <br />i <br />ifi <br />nt <br />lll <br />b <br />b <br />mi <br />l <br />l <br />l <br />l <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ % <br />L'. ~ ~ . / v' <br />TYPED OR PRINTED ere a <br />e s <br />gn <br />ca <br />pene <br />es <br />r su <br />m <br />ng <br />a <br />ae <br />n <br />ormabon, <br />includin Ne sibill or he and im risonmem br knowin violations. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS (Aelerence a//attachments here) - <br />~'.?ERNATE i_IMITS FCR Y:~I:~, IRnN gc SETTLEABLE SOL..IDS iLrJ'~ 'U ' l APPLY CiNLV I- .= li. '/N 24-HR PRE.CIP EVt.P :f <br />~S ~Lr~I('iED. 3 <br />E <br />E <br />I <br />A. "~ <br />', <br />P <br />G <br />1H. FOR <br />BUR <br />DEN OF PROCF REG•.iIR};M;'NT5. OiL E, I;RFASi=~~- ~~E I=gUTN©TE F~', PG ~_'. <br />( <br />1 <br />p <br />p <br />tl O'TO~~J CA1~t~l !~I! C~I~Ij ( <br />' <br />T <br />~, <br />/~ <br />(~ <br />y~ <br />I~-LI"1 r'1TI~IIITL T <br />'!~T''~ <br />"~fsT°S' <br />T ~ <br />" . <br />EPA Form 3320.1 (REV 3/99) Previous ! <br />O <br />~Ir <br />editions may be used. LL L 000? 1 ! 001 12 JHI~ ~S~•PART FORM PAGE 1 OF <br /> _.1.....~..~:}~.:..: ..... . <br />