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PERMITTEE NAME/ADDRESS pnciude Faciliry Name/Locarion ifO fferenQ <br />NAME BOOZE RESOURCES LIBITED <br />ADDRESSBONIE NO. 2 ttiNP. <br />P.O. BOY 493 <br />FAGUTY PAONIA CO 81428 <br />LOCATIONBOYIE CO 81428 <br />A2SN: MILLI ~~! A. BEAR ~R._ MTNP. McR <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES) FOrm Approved. ~~. may: <br />DISCHAS GE MONITORING REPORT (DMF;B) OMB ND. 2040-OW4, a <br />RINOR Approval expires 05 <br />PERMIT NUMBER DISCHMGE NUMBER (SOBR NC) , i <br />P - PINRL <br />MONITORING PERIOD DS OP SR/RIME DRNG 20 DEER <br />YEAR MO DAY YEAR MO DAY <br />FROM 00 O4 0 TO ''Yr EO DISCA~IRCbE 1 #+# <br />lzav) !zz-zs) rz.-zs) (zo-z>') pe-n) l3as+) T NOT .Read Instru Ions for Gleting this form. <br /> (3 Card Onty) QUANTITY OR LOADING (4 Card Onty) QUANTITY OR CONCENTRATION NO. FREGUENC SAMPLE <br />PARAMETER (46-53) (5461 (3B<5) (96-53 !5.1-61) IX OF TYPE <br />(32Jn ~ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS B1S <br />~ 6370 <br /> ~) 89,.6 <br />OIL AND GREASE SAFdPLE #~'$#t# ( 94) #r##r# Y####~ ###;,#:: <br />Y I SU A L MEASUREMENT <br />84066 1 0 0 ~''' '~ <br />~#* <br />t 4 E5=1 " ~ ### <br />EFFLDEN? GROSS ~II,B 1 ENT ~ <br />-_ <br />a~- ~ ~c~ <br />~' ~ ; NO=O . <br />I-'=f a ~ <br />:~y'r ' ~~<, <br />##t+C . <br /> SAMPLE <br /> MEASUREMENT p ~1 <br /> <br /> PERMIT s „~ , r i , , ~. ~ri <br />., Q~-,; .`N'r')~ ~, <br /> REQUIREMENT :.:a -r~~t ..,~": -.v; , <br />- _ .s-. `°yy t, n. ~-:-,: .f <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 't~~.- ', iX: :^,t°' 6 ~ ;H " <br />~;`;' ~.`F~+€ . <br /> REQUIREMENT , •'±. yy~' <br />1 ~ <br />N~ A, <br />4 " r ". <br /> . y rn r4 ~ <br />Y- ~ <br /> SAMPLE <br /> MEASUREMENT <br /> r a ; ` y S <br /> REQUIREMENT # <br />~r ,; ~ -,~, ~-y. <br />~~a -r <br />,n F'", ~ <br /> SAMPLE <br /> MEASUREMENT <br /> `~~ ~ t r aS !4 r:.•:. ~ '+d r <br /> REQUIREMENT ,r <br />A"~' t s ~, <br />~x ;: r . <br />f- t <br />. <br /> <br /> SAMPLE <br />MEASUREMENT <br /> ~~{p~~n~ <br />3-IS Y~.~I"'IT _ <br />s Rt F t I," <br />r`~+x',-,5 t T i.~ <br />Y r '~ 1-F <br />y "'~x}~ <br />~LY <br />: <br />iVi h <br /> .R )FJEMENT - y r • a <br />, .. Sry? ` :. ~, - <br />+ q, ,. ~ ~' <br /> . <br />a <br />w. , <br />;a ; a <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br />` ° ", <br />' w <br />. ~ ~ t <br /> iEQUIREMENT <br />1 .: <br />~~ ,~ -: <br />•., ` <br />~a <br />~ `„ <br />x <br />t` ~ <br />y t ~ , <br />e v <br />~. <br />r ~± <br />~:; <br /> r <br />- <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY EXAMINED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORM ATION SUBMITTED HERE IN; AND BASED ON MY <br /> INQUIRY OF THOSE INDNIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTNNING <br /> THE INFORMATION, I BELIEV E THE SUBMNTED INFORMATION IS TRUE, <br /> ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMrI'TIN I AM AWME THAT THERE ARE SIGNIFICAM <br />G FALSE INFORMATION <br />INCLUDING 7HE <br /> , <br />POSSIBILITY OF FINE AND IMPRI <br />NMEM <br />SE <br />C <br />7 <br />S p <br /> . <br />E 18 U.S. <br />. § <br />.C. <br />SO <br />001 AND 39 U. <br />4 13 <br />P <br />fa <br />N <br />I <br />6 $IONATURE OF PRINCIPAL IXECUTIVE / ~S~ <br /> <br />TYPED OR PRINTED 19. ( <br />ere <br />es wder <br />ase stahxa5 mey <br />nclutla <br />nas up m 510,000 entl or <br />maximum lmpnsonrnenr al beMSen6monlhs entl3years.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> <br />t ~ ~pp <br />r ~'~il <br />`i <br />„I <br />,, <br />k`,I <br />COMMENTS AND EXPLANAI ION OF ANY VIOLATIONS (RBtBTanOe ell attachments here) <br />SETTLEABLE SOLIDS LIeIi APPLIES ONLI IF <=lOLF,20RY PRECIP EreNT IS CLAI!lED. IF CLAIe lPPRO~ED BI NQCD• <br />255 6 IRON LIRITS HILL NOT BE APPLIED TO REPORTED 1lEASORBRENTS-SEE i.A.2• P6 5 POR BORDEN OP PROOF <br />orm ~ Prewous a (lions may o be uYe .• • ( CES T' .) - • PAGE OF <br />0005~/990~T9-T2~~ ~ <br />