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PERMITTEE NAME/ADDRESS(lndlde Fcoilin•,VamrJGocarion i/Di//erenl) NATIONAL POLLUTANT DISCHARGE ELIMINATION <br />NAME S e. 11 LC A C Cd L C C ~ F A t. Y DISCIRAR GE MONITORING REPORT <br />ADDRESSpRlYER D <br />NAYUEY CO 81L39 ERMITNUMBER plg <br />FACILITY rU~ MONITORING P <br />99-o7•v~ -- <br />LOCATIO ':: Y i O DAY YEAR <br />~IAYUEI[ •'W CO 6jG3u FROM ~gy~-~' <br />:'!'7 N l:_ RrIA aGnulu f.lC C4l^ ^lY tPtG ~ •f na~n <br />'YSTEM (NPDES) Form Approved. <br />OMB No. 2040-00044 <br />(D(MR;9) n I N 0 R Approval expires 0537-98 <br />{sore E~~ <br />,l9MBER P - EIPlL RS1UT1 <br />LISCBAFCf TG 11IU/5!G! CFEFe <br />MO DAY ~- <br />u•~ ~v a~4 MU CIrF~~~~frl 1.,,.1 laao <br />na-vel Iw-3n NOTE: Read Ins6u-btioris beforB.cbrDpleting this form. <br /> _ ~ <br />UANTITY OR <br />OADING <br />) QUANTITY OR CONCEN~Ei'A~ION <br />On <br />) . DENC <br />FREO STMP~E <br />PARAMETER G <br />S <br />3) 4 <br />5) EX O <br />(32-s~) ~A ~GE- MAXIMUM UNI~~ 'MINIMUM AVERAGE MAXIMUM UNITS <br />(6Z6ak ANALYSIS <br />(64-68) <br />69-70 <br />Uli~ M CUUDUIT vF SAMPLE • ' 1 ~ 00 109A 4~9gX `~ ~' i:iL <br />~ <br />T!fkU Tki:ATl1E1tiT FLAh1 MEASUREMENT /~ <br />OO~~ <br />~: <br />O.QU <br />l/ () ks <br /> .,. <br />.. <br />. <br />SUU50 L U 1 4ERMIT I+E~ <br />~• 1- O ~ <rP 0 iri :~~ /f;' R9-~.~ <br />CF}'LUk;6T CROSS YALUE ,k~~fiEMENT 3UpA E~, <br />. [6D ' " " Otia ~- - <br /> SAMPLE <br /> MEASUREMENT <br /> - ' <br /> , t,. <br /> u ~ ~ •s ~~~ ~-I <br /> <br /> SAMPLE ~ - <br /> MEASUREMENT a ~Y <br /> <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT ~ ~.+ <br /> ` <br /> - =P ~)f <br />~ .e <br />; <br />` <a ` <br />~~= <br />`,. <br />r - i- <br />r, <br />'It '%y` <br /> ffEQU1REMENT l <br />- <br />1'., <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> ~k1~QUTgEMENT ~ - ~ ~ ~ ' <br /> ~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ~ . <br /> -='= REp~l7: ~ .~ <br />~ <br /> 24U)RE)itEMT ~ 5 ! ~ ~ `, . <br />. . <br /> SAMPLE <br /> MEASUREMENT <br /> <br />"-•P~AMIT- - .. t.,. .- ~> ', <br />~E(S1UJyf7)hMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LqW THAT I HAVE PERS ONALLY E%AMINED AND TELEPHONE <br />MY ~ DATE <br />AM FAMILIAR WITH THE INFORMA710N SUBMITTED HER <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON EIN; AND a45ED ON <br />SIBLE FOR OBTAINING <br />THE INFORMATION, I BELIEVE THE SUBMITTED IN ~ <br />FORMATION IS TRUE. % <br />ACCURgTE AND COMPLETE. I AM AWARE THAT TH ' <br />ERE ARE SIGNIFICANT P <br />PENALTIES FOR SUBMIRING FALSE INFORMATI ON. INCLUDING THE <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE tB U S C. 4 1001 AND 33 U.S.C. SIGNATURE OF PRI CIPAL EXECUTIVE <br /> 000 antl a <br />ma <br />include lines up ro 510 <br />ntl <br />r the <br />leMa <br />4 t3te <br />P <br />tti AREA ' <br /> <br />PR <br />NTED , <br />y <br />ene <br />es u <br />e <br />se s <br />s <br />. I <br />n 6 m <br />nths en0 5 <br />ears <br />) <br />i <br />t <br />/ b <br />P <br />i OFFICER OR A~I~HORI2ED AGENT <br />T <br />o0E NUMBER YEAR MO DAY <br />TYPED OR <br />I y <br />. <br />max <br />mum <br />mpnsonmen <br />e <br />xee <br />o <br />o <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Helerence alt edacnmenrs nere) <br />'f 55 D IkOM LZi7ITS wlZl Be. YAIYF:D AdD SETTLEABLE SCIIDS LI!!IT AFFLIEI FCA <=lOYfi~iUFF FEECIF PYEITj T°S S <br />IRUe LIMITS pljYEL FCF ~IUYk~14Hii F'RECIY EYEAT SUEJPf_T TC EIUAL'Ek CE FF.CGP IN I.A.i. GII E GEEI_E-=kE <br />~ n r T a r T <br />EPA Form 3320.1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) C D DA 0 / 99 C A i ] ~ 1 E 5~ PAGE I OF <br />