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PERMITTEE NAME/ADDRESS (fnc(udr Facilirv Name/Comrion i(D(Berent) <br />NAME SE:NcCA CGAL CCCFAFY <br />ADDRESSDkAtrEk D <br />kAYCEM <br />CO 61639 <br />FACILITY <br />LOCATIOt~A YG$N CO 61630 <br />ATTDI: G. HUD dROwlS. GEkEi2AL 17AtiAvlR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT (OMR~ <br />(1-I6) (1]- 91 <br />GOOGOL" ..;,~. GGb A:. <br />PERMIT NUMBER DISCHARGE nuMeER <br />MON170QING PERIOD <br />Y ~ ~ ~~I ° M -~ ' AY YEAR MO DAY <br />FROM TO ~ ~ ~ <br />(gP ~ 3' (1a-151 (16-1]) (1819) (3P31J <br />Form Approved. <br />n I ~ & OMB No. 2040-0004 R <br />Q A?proval expires 05-31.9t1 <br />(SU6k Ni) <br />f - FI~1Z PIEUTT <br />CIS tl tf{f 7C TFIE/Lt1 :i:Ftt+ <br />1p0 4~~1.!CdAECE ~__ ~ Co^' <br />< ead Instructions beforn completing this form. <br /> (3 Cab Onty) QUANTITY OR LOADI (c Card Ony) QUANTITY OR CO TRATION NO. FREOUENC SAMPLE <br />TYPE <br />PARAMETER (46-53) (54-6/) (38-45J ,(46-53) (54-61 E_X of <br />/3237) AVERAGE MAXIMUM UNITS ".MINIMUM AVERAGE MAXIMUM UNITS <br />(fi263) aNaLrsrs <br />(64-6B) <br />69-70 <br /> <br />OL1 ~ C l <br />SUSPEKDhU <br />SAMPLE <br />MEASUREMENT <br />"~' <br />''~~`~` I <br />9 oA <br />~, <br /> <br />~ p~ <br /> <br />I ~ <br />1 <br /> <br />/ V <br /> <br />v <br /> ; <br />; ~ <br />•~ <br />UUS3U I D G ;, PEAMIT ~~ ~ 99fi; YOXr <br />~ <br />~ ~, r>jr X <br />" <br />tFFLUtkT %~kL`SS Y1LU t1117EMENT XLL? ~'+-., ' ~ h~~ <br />P , <br />1 rG/L ~C 'r <br />~CLIDS. .`i TSLEA SAMPLE '`~~~"~R ~ ( ` l ( ~' <br />/ <br /> MEASUREMENT ~ ~ ~ ` r O O y <br />vo5u5 I o o - :r ~ o yea xs~ ; ~{REEC ~ ~. <br />cFYLUEriT GkOSS YALUk "9,E~IA'~ENT XX>rY: , <br />. ~_'~3UC1 ~ _ ~~f? bI ML/I r ~~111 <br />N • SAMPLE `z~ `~` ~' ~ ~ ~ 6 <br />O D6 <br />~ + 5 I v ` <br />(AS FE) MEASUREMENT . ~/ • ~/ ^• <br />UlU4S 1 0 0 ~ a ;z: <br />A <br />LE'FLUEkT GBOSS YALUE UgUIRt:MEyT '•~~~° _:~ 4G AIE~- EG/L ~ 11~~58 <br />OIL AN G { A SAMPLE ': t:qn. •,r ;:C :r,t=9 Z O a t~ '~ ~ „ <br /> MEASUREMENT (J <br />U37H1 1 U 0 '"PE9M1#~ ~ ~ Via" ~ „vr`,~ :. .;E:. -i16 <br />cFFLULt:T GHO65 YALU gU~~fvi.~~lT' "'~: ~ '•~~°'~ _ ,,~?.:r.~ ;"r~ CG/I r~P"4 <br /> SAMPLE <br /> MEASUREMENT <br /> PERM I <br /> ,RjQ1JlR8M Nt' <br /> SAMPLE <br /> MEASUREMENT <br /> :~?ERMLfi "':- - <br /> <br />~ <br />' <br />0. <br /> ~E~UI~1G N; a <br />. , z~tc= <br /> SAMPLE <br /> MEASUREMENT <br /> e8 MIT <br />~ 'i :. <br />fi ,~ 4 <br />X ,~ ~ . ". <br /> E~~fi <br />ETCQW .: r ri+* <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERS ONALLY EXAMINED AND TELEPHONE DATE <br />AM FAMILIAq WITH THE INFORM ATION SUBMITTED HER EIN: AND BASED ON MY r <br />INQUIRY OF THOSE INDNIDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING <br />THE INFORMATION. I BELIEV E THE SUBMITTED IN FORMATION IS TRUE, <br />ACCURATE AND COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFICAM I <br />C / <br />PENALTIES FOR SUBMITTIN G FALSE INFORMATION, INCLUDING THE Zb <br />POSSIBILITY OF FINE AND IMPR ISONMEM SEE 18 U.S.C. § 1001 AND 33 U.S.C. SIGNATURE OF PRI CIPAL EXECUTIVE <br />$ t31s. (Penalties urrde. these sblwes may include lines up to ff0,000 end or OFFICER OR A ORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED ma+imum impnsonment of oenveen 6 morrths end 5 years.) C <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) <br />TSS b IN4N LIMZ7S YI[L BE YAI'YCD ~MD SETtZEA9LE SCIIDS LIMIT AFFLIEL tCF <=IOYR.iY6F F6ECIP fYENT; T55 :: <br />I&Cp LI1fZT5 MAIYSC fCF >LOTN~2YH@ P@SCI? EYENT SUEJECT TC 5U@CE- L'F PkOCF ZN I.A.e"". CI[ S <br />` GEEI,:E-~EE <br />r p i n c - * ~ ~~ <br />EPA Form 3320.1'(OB-45f ~' ~ reViou5'edition5 may nof>be;u.1;.~;3, ., ~, : ;(,H~pI,dCES EPA FORM T-40 WHICH MAY NO7 BE USED.) <br />; ~ C a CS //~I~ 4~ C~e Z ~-S~,S 3 . PAGE 1~ OF <br /> _ _ <br />