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<br />PERMITTEE NAME/ADDRESS (Include Fac liry NamelLOrauon IjDijjexenq <br />NAME SEN;,'CA CGAL CC`4AAY <br />ADDRESSD fLAY EH D <br />NAY.DEN CO b1639 <br />~~ FACILITY <br />LOCATIOt~AYDEN CO b16JU <br />ATTN: G. 6UD UNUyy, CENEHAL Y,ANAGEk <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHAR GE MONITORING REPORT (brMR;BI <br />OCD( Zl Q • A <br />- ~ PERMIT NUMBER 1$CHARGE NUMBER <br />FROM <br />NONITORING PE O <br />Y ~ ~ MO <br />7 DAY <br />ui R <br />~ MO DAY <br />Ju <br /> <br />R0'a~y (26.P5) `~(i•64l) (2849) laual) <br />Furm Approved. <br />f1I N O H OMB No. 2040-00042 <br />Approval expires OS-31-98 <br />tsut~ct N~) . <br />f - P1l/L ~GUT7 <br />CL SCdAbCt IC ALEEftSCa~ GGICH <br />~IAr !.0 C19CAe6Gt ~~~ <br />NOTE: Read instructions helot'-Completing this form. <br /> (3 Cab Onry) QUANTITY OR LOADI (4 CeN Only) OEfANTITY OR CONCENTRATION NOr FREOUENC SAMPLE <br />PARAMETER (46-53) (5461) <br />~ (38-45)' (46-53) (5a-61) EX ~ .OF TYPE <br />(3T-37J ~ AVERAGE MAXIMUM UNIT ~ MINIMUM AVERAGE MAXIMUM UNITS <br />(6263) ANALysls <br />(6<-68) <br />6970) <br />P SAMPLE S " .><:r4 0 ~ ~ ~! <br /> MEASUREMENT <br />GU40U 1 0 U PERMIT <br />` ~ <br />i <br />` iL# ~ ;. ~ ,g ~ . <br />~ 1 <br />EriFLUEAT GROSS YeLUE N1fNT <br />pffOU~E lu <br />~ t~C-•;; !(~ t_. <br />~ ~ ~ .#1'~~f~i~...~ SC ~'1 <br />~ <br /> - <br />F . t <br />- , <br />50 L_, i L SAMPLE •i'''-: L~,. fi :C .~ ( I <br />sUSPENDkD MEASUREMENT <br /> <br />EFFLUeNT GRASS YALU ~FS]t71REMENT .: ~ :~' :' ~'~ '~'~1{ `.'l~fi <br />~. ~#6AIL] !I# bG/I ;°.; ~tGf~N .~ <br />50 I S• E SAMPLE ~'; . "` • . ", 4, ( a' <br /> MEASUREMENT <br /> t ,., <br />~ <br />f. F f L U E V I G HCIS S YALU :(iHL~UiRAM~N3 ti "~-~ ~ ~_ ,~~ i;~~~.~k "IFS ,' d L/ L !t T 1 <br />nUN, T ~ SAMPLE , ^'~,:: a: {` .,;n>< ~ <br />(AS Fi&) MEASUREMENT <br />U L U 4 S 1 U 0 r, }ICEIMLt: <br />~ x~ ~` . - '.« ~; <br />tFFLUF.NT GH05S. YJLUE G1U)~i~n8~N3 ;f'%r: 34`OA l~~ir <br />~ _ <br />~ y~(1. !~ tlG/I N~ - <br />(~ L AA CA6- SAMPLE >;. ... :. .•~: 9 5}.. <br /> MEASUREMENT <br />U1S56.' I U Q O L,? rP :.: ' ' <br />Ef'FLUENT GR059 YALU ~gU`RiEIG1Ct~T ` -• x;'~~ ~MSxh'!.#Y, !IG/I M.~.` <br />LUN, M C LT SAMPLE ( ~ 4 Z~"~ ~'; ~~ <br />T:1 [?U TFEATFIE~t PLAN MEASUREMENT <br />S J U S G 1 0 D _: --~EA(~IP'r. ~~ - ~ a ~ :~ o A ~i h <br />~ <br />SFFLUEr.'C GROSS YeLU LiEQ~!lR~M,~i ~ ~~`~'~ ~-D~~ !K# tG0 ~ Oyi! . <br />-,UL .+, SAMPLE ~ - oz' <br />UI_tS(iLV(;D MEASUREMENT ' <br />Y U Z 9 S 1 U U ' .p~AMI~'°, ' : L A 04~ . IE$' 7 ~" <br />' <br />~~ ~, -?- <br />tt'FLUdhT dROSS YALU ~OEGlUfRENIEN~' ~~~ ~ -. T <br />XtIY R3 t!G/L <br />_'-'I~~'~ ~'~ ~~'°~~~ = <br />~ ! ;' <br />NAME(TITLE PRINCIPAL EXECUTIVE OFFICER I OERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM TMAT 1 HAVE PERSONALLY EXAMINED AND TELEPHONE <br />LAW <br />ATION SUBMITTED HEREIN; AND BASED ON MY DATE <br />INQUIRY OF THOSE INDIVIOUAL B IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION. I BELIEV E THE SUBMITTED INFORMATION IS TRUE, <br />AOGURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT " <br />PENALTIES FOR SUBMITTIN G FALSE INFORMATION, INCLUDING THE <br />POSSIBIDTV OF FINE AND IMPR ISONMENT. SEE 1B U S C. § 1001 AND 33 U S.C. SIGNATURE OF PRI CIPAL E%ECUTIVE <br /> § t319. (Penalties untler these s terNes may mcWde lines up ro 510,000 end or OFFICER OR Alfi ORIZED AGENT R NUMBER ~h.R MO DAY <br />TYPED OR PRINTED maximum lmpnsonmeM Ol helwee n6momhs ends years.) ODE <br />COMMENT S AND tXPLANAI TUN OF ANY VIOLA I IUNJ (rrererence 811 artacnmenrs nere) <br />TS5 G IHUN LIBITS NIL1 &E IiAIYEO E SETTLEABLE SOL7CS LIMIT ePELLEJ FOF <=IOYN,2uEF FfiECIE EYEItp 7S5 S <br />IlrON LIlfITS MAIMED ECe ?IUIH,ZYNN PRHCIP EYt:NT SUEJECY 70 BUHCEN CF BGCCF IN I.A.i. CII f; GiE,1.3E - SER <br />T u n me w rv r o. <br />EPA Form 3320.1 (OB-95) Previous editions may not be used. (REPLACES EPA' FORM T-40 WHICH MAY NOT BE USED.) 0017 fl~ 9A 0 ! ] 7>+':$'~~3 PAGE 1 OF <br />