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PERMITTEE NAME/ADDRESS (Include FacdiryName/Leca+ron ~/Digem.u <br />NAME SF.NECA CGAL CCCFAAi <br />ADORESSDRAMER D <br />RArceN cD x1639 <br />FACILITY <br />LQCATIONaAIDrN CO 81630 <br />ATTNi G. HUD FR04k, .GElfERAL MANAGER <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDESf Form Approved. ~~,,; <br />DISCHARGE MONITORING REPORT (DMR; OMB No. 2040-0004 <br />a +sl n' 9t h I R 0 9 Approval expires OS-31-98'~~ <br />ccoccl~ i ... r n R ,(sues aAr) <br />PERMIT NUMBER ~ DlscHnRGE N'uine`Ea` `"~ F - F I d A I iKUS4 <br />•~..~. <br />MONITORING'PERIOD 5£.D. PCIC GSCRG 7C GFA.S1 CGA. <br />YEAR!;`„MO..e :'DAY YEAR HMO DAY -- <br />FROM yT+ x V1 TO yy -1~; d1 f4t RC CI_°CRAACE ~ ~ t>c: <br />rzo~zn1P~~zz3fe°, aa~2s) fzs~zzl fze 2sl f3o-3p NOTE: Read Instructions before completing this form. <br /> (3 Card Ony) pUANTITY OR LOADING' (4 Card Onty) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-67) (38-45) (46-53) (54-61) ~( OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS - <br />rsz sal ANALYSIS <br />(64-68) <br />69-70) <br />U1L !BU CREASE <br /> <br />Y I SU A L <br />SAMPLE <br />MEASUREMENT ~~nt:=a <br />~ <br />1 <br />( 54) <br />>•L~344 <br /> <br />I <br />QL QAYta <br />Afi>:~ :4 <br /> <br />(, J <br /> <br />?/ (~ <br /> <br />1 11 <br />84066 I 0 I .PERMIT' 49 >4>av NE ,C1IiT. 1 !S 1':z <br />; IllkiliCO >D~49wi ; w49 C iEEf ,' I5 L <br />E:PFLUEliT G8055 YALUE REQUIREMENT INS; QA'I ; <br />IC-0 s3 <br />~'r .. <br />qtr °a.." +,~adr, ~'_' ` ~'G~~ 14.C~~C . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - "`° . <br />~ w: -,,~.. Y+:;:r; ~ <br /> <br />REQUIREMENT <br />- <br />or <br />- ~*- m. ,; - <br />: z - <br />- <br /> s <br />~ y <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT <br />~~ *;?+ s <br />'~. ' i'~ ~ ~" ~ <br />'~ <br />T P`~ ""~~` ~,r~ <br />~ <br /> REQUIREMENT r <br />~, _ <br />l. <br />"~' "*` ~ <br />s z <br /> ~d. <br />m <br />~, . ... <br />t, SAMPLE <br />` ~ MEASUREMENT <br /> . .PERMIT ~ _ ,jh - ~fi` " <br /> -REQUIREMENT,' - ~ - - ---;~ f r ~^ <br /> SAMPLE <br /> MEASUREMENT <br /> - <br />~PEPMIT <br />" <br />' ~ 1 . _ xi k +~'r. ~r+U <br />i <br />v ~--- ~ ' <br /> , <br />y <br />: <br />, <br />REQUIREMENT - 4 34 <br />- ,::±, t +L...., <br />y <br />^- .u cr <br />,.v <br /> SAMPLE <br /> MEASUREMENT <br /> - .r~ <br /> ;REQUIREMENT ~ " , +`'~ <br /> SAMPLE <br /> MEASUREMENT <br /> a 'PERMIT . ~ , -.: <br />~ ~ '~ ,~: ~ ~: y <br />"^ .w <br /> REQ_UI_REMENT ! <br />~ ~ . <br />, ~ ~3.,x -a ^ ,,,. " - <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN <br />AND BASED ON MV TELEPHONE ~ DATE <br /> ; <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ODTAINING - - <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, ~ <br /> <br />ACCURATE 'AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICAM <br />PE <br />T <br />E <br />F h <br />w <br />Ui. <br />~ <br />(f <br /> NAL <br />I <br />OR SUBMITTING FALSE INFORMATION, INCLUDING THE <br />S O I ~ <br />o <br /> POSSIBILITY OF FINE AND IMPRISONMEM. SEE 18 U.S.C. § 1001 AND 33 U.S.C. SIGNATURE OF PSI ICIPAL EXECUTIVE .P' ^ <br /> <br />TYPED OR PRINTED § 1319 (Penettres antler these s2rutes meY incWtle Ones up to E10,000 antl or <br />maximum impnsonmenl of beM1veen6monrhs entl5years.) OFFICER OR AVfHORIZED AGENT <br />C OE <br />'NUMBER <br />YEAR MO DAY <br />GUMMhNI S AND hXPLANA I IUN OF ANY VIULA I IUNS (RelerenCa all affaChmant5 here) <br />TSS E IkON LIr1TS VIII Er: MAIYE:D ARD SETTLlABLE SCLIL5 LI!fIT APPLIED FCR <=lOYfi,i4yp FBAat'YP EYE17~ TSS b <br />I80A LIMITS YOLY£D rCF. ~lUYd,241iR PRECIP EYFFT SUEdECT 3C BURDEN OF PfiCCF Ili I.A.7: G3L C GFlASE-'_EE <br />19261 (OS-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />