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PERMITTEE NAME/ADDRESS (Include FanGry Name/Lpcatian iJDijJerenq <br />NAME SE6i'CA CCAL CCNF1dY <br />ADDRESSD Ji A tI E k D <br />NAYDEN <br />CO 61639 <br />FACILITY <br />LOCATION 4 Y [. F 9 C O F31 6 30 <br />hT':N: G. i1UU E,iOYN, CE!4EkAL RAHAGFA <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR~ <br />(2-161 IIZ 91 <br />CCOC L111 i<a; E <br />PERMIT NUMBER DISCHARGE NUMBER <br />MON6TORING PERIOD <br />YE. ~-,d10_ DAY YEAR MO DAY <br />FROM V TO y ~ ~ o ~ u <br />(PO.211 . {T~'25) (26~2ZJ (28291 (3PSp <br />FDrm Approved. <br />r I NG :i OMB No. 2040-000AS <br />Approval expires OS-31-98 <br />(5U8h Kti) <br />r - Fl Flit FGUI7 <br />CI5CAAFGE TG 91CF CEEEN <br />-NOTE: Read instructions before completing this form. <br /> (3 Carty O <br />QUANTITY OR LOADING <br />57 IX Card Ony) QUANTITY OR CONCENTRATION NO. FREDUENC SAMPLE ' <br />PARAMETER 6 <br />3 <br />( ) (54 B7J (38-45) (46-537 (Sb61J EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM ~ AVERAGE MAXIMUM UNITS <br />(fia~ta) ANALYSIS <br />(64-68) <br />6&70 <br />k SAMPLE y - I O ( ~ <br /> MEASUREMENT <br />UU4UU 1 U D .- <br />-`PE ~v11F.`= ~ ~~:- UIFC4 tfl+ r~ r„' - !. T <br />tFFLUtbT GkOSS YALU - <br />-fi~OUIR~M~N7 ~ t~~s~ ~(~," ~~'- IfAY,tlOll `U <br />_ <br />~.GLIGS, TGTAL SAMPLE uC0"'C# 4rfirA>,•O t40 99 ]S} <br />S!JSrF:ADrL' MEASUREMENT <br />UOSSU 1 U U <br />~~MFY <br />PE >ttr ~~. <br />~ ;~ <br />- _ 1F <br />EFt'LJENT GAUSS YALD ~~~ <br />. <br />~~~IUtP@~iENt ~-~~ ttYr: '. 11~ ',~1,~~EN. !!1 FG/[ ,~M1$ <br />SULIDS, SF.TTL HALE SAMPLE ~ ~~~" °~ '' ~' ~' ( '- <br /> MEASUREMENT <br />UU54r 1 0 D "-ti~E~ifiA)i; 0 fP A A>F r,~., a0 ~- i 8 C ilE - <br />i:F'FLDENT Gk05$ YALUFi ~8D0li(EiEMEtuT :=cr ";t,#~B` iI;1~.I Eli CL/I ItCA4N <br />14iUk, UTA SAMPLE t 't -ri '~' ''IQ` I %) <br />(AS FB) MEASUREMENT <br />UiDUS 1 D G ~ ~IAQIT;.' <br />~~ <br />~ %„~. y <br />~ ,,. <br />~ CE/ 6i'•E. <br />LFFL1iEhT oh055 YALUS ~~r~~A)~- , <br />° ><=~xr p; ,~~'~-i -li- CG/[ . EC112b. <br />(JIL AMG G6E~S Y. SAMPLE O"G'Y~t" '~v~"r~ "~ '~~ ~~ I ) } <br /> MEASUREMENT <br /> PpERMIT; <br />tFFLUF:dIT GAUSS VALUE ~1~Q11I1761v1~Ni : ;~~~ ~ ~* 115 ; bai` EG/ I 6~M~ .: <br /> . ,, , <br />FLtJL, IY CONDUIT OA SAMPLE I U ) ~"~ >rbo >os '~ ~ <br />TkkU TS:EAT15Elf2 PLAT MEASUREMENT <br /> ~ ~ , <br />s FFLUENT GAUSS YALU FJ€abJfi~MDR1~ i ~~'~'~,~~r ~1, ' <br />4~~ !GD ~' ~ a9~z <br />>OL Dom, TO AL SAMPLE Q'x "~ rr4 ( ~ <br />GLSSULYEI) MEASUREMENT , <br />FU14S 1 0 0 ..pERM~ - Y40 C '~ c.~ ' C if A $ , <br /> <br />i•'F'FLUBNT GROSS YALU I <br />~~k~UIREM6fk'~' ra -1 M <br />" ~.~; ° ~ <br />b~ ,i'~' <br />Kd9~ <br />( <br />~F`~~Q~ <br />8IT7 !?i <br />CG/L <br /> ~- E , ~ <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT r HAVE PERSONALLY EXAMINED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MV <br /> INQUIRY OF THOSE INDIVIDUALS IMrMtEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB TRUE, <br /> ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIGNIFICANT w <br /> <br />PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE <br />7 <br />Y9 I <br />u ' <br /> POSSIBILITY OF FINE AND IMPRISONMEM SEE 1B U.S.C. § 1001 AND 33 U.S.C. SIGNATURE OF PRIN PAL EXECUTIVE <br /> <br />TYPED OR PRINTED § t3t9 (Penettres under these statutes may include hoes up rp E10,000 entl pr <br />meumum impnspnmerrt pldetw9en6mpnths entlsyeers.) OFFICER OR ALIT RIZED AGENT <br />CODE <br />NUMBER. <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />T55 6 IAOn LIMITS tiIlL HE GAIYEO E SETTLEAP[E 50L]CS LIFIIT AFFLIEE f0A <=l0YA,14Efi EAECIE FYE-2; tS5 E <br />SETTLEAbLc SULLUS LICIT YAIYED PUk )lOIB,]tlk19 PAECIP EYFMT SUEJEC TC EUACEd CP EGCCF ZI 1.A.1. Gll E <br />>•~--.cc gvE T ^ ,I F1 1'Gc ~!'?zITC=1Ur cER T '3 ~ ~ <br />EPA Form 332LL7 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NO7 BE USED.) fI0178 A99 8'!17 -155 ? ~ PAGE I OF <br />