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PERMITTEE NAME/ADDRESS Qnclude FBCiIIry Nmne/Locari^n iJO fferem) <br />NAME UOII1 r: ti °`~OII;+CSS it"!^^°I <br />ADDRESSRORIF. N;. t ^.?';'~ <br />P.U. "_~"' n"~ i <br />PAOrIIo ^_p 81421 <br />FACILJTY <br />LOCATIOND,1 iJ I h: CO 8142 { <br />ATTh: MILLIA~'+ ?. P'.AR J4., '1INE MGR <br />NATgNAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES) <br />OISCHARGE MONITORING REPORT (DMq; <br />l 7 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM . ~ 1 O1 TO 00 1 31 <br />(2621) (22.231 (24251 T2G2]) (28-281 (J031/ <br />Form Approved. <br />n T N O R OMB No. 2040-0004 <br />Approval expires 051-98 <br />~SCNG OF SH TO DEER T4A?L CTCN <br />NOTE: Read Instructions before plating this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Cvd Ony) QUANTITY OR <br />CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (59-61 _ <br />(3B-d5) 48-53) (5461) EX OF TYPE <br />(32~~ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> (szm) (64fiB) 6&70 <br />M SAMPLE iF##::44 ,^rYG44=3 F3G*~r ( 1~) <br /> MEASUREMENT <br /> <br />u0uu0 1 0 0 MIT '. T ; 'fir .##a ~ ~r~r ~ <br />#': 9~~"',i. ,~- <br />~ <br />FF'LUENT GROSS VALU ~M L. " i~;~~ `; *~` ~ ,.~*. -+"" Ota# ~ <br />`.~ ~ .F, 'e ' .; ~''. , .=E'~" <br />„ .., <br />LIDS, 'TOTAL SAMPLE #*At0# ##9r#*# ##*%i## ( 19) <br />S P E N U E U MEASUREMENT <br /> .a <br /> <br />CYFLUENT GROSS VALU <br />REQkf1~MENT . ,, <br />~ ~~'"~ <br />~ <br />'~~'_' <br />#.^rY. <br />/ .~`~+~ ~, . <br />•+' <br />- <br /> , <br />~1. , <br />,, ~ ., <br />:~OL1D5, SETSLE.IPLF SAMPLE =a*~=r G*~~~~ *#*'~+# ( 25) <br /> <br />~ MEASUREMENT ., <br />00545 1 0 <br />D Pf:RMIT '*'s't.~# `^ ~s 4tR17 roY ~='a~~ ~ `:~ # 4 - ~ ~~' <br /> <br />h:FPLUENT GROSS Ve~U <br />REQUIREMENT <br />(y <br />. <br /> <br />....: " <br />:yr*- I <br />r.;~ ° . <br />,, ;~, <br />IHUN, TOTAL SAMPLE :4t~xY# T: r.=sa3~A <br />. <br />/ ( ~~.~ ..,._ ~ ( 10) <br />(A:i Ff3) MEASUREMENT Yr <br />OlU4S 1 U D ~ PERMIT <br />" 4Dr10 ~ ### ?O~rbdk±blr ~~.~ ~ ~,: $'~„Q' t^;;. ~ ~~-' <br />EFFLUENT ::FOSS Y1[.U REQUIREMENT ~,'+~!.„~..", ##*Or T- " <br />0IL AND GkEASh' SAMPLE .#*aaa ##~x#*# ###>r3# 'kCf#'rr ( 19) <br /> MEASUREMENT <br />U3Sd2 1 U U PERMIT <br />` <br />'~ ~Ir`' ,.y` <br />~ ~~ ~,(l ~,` 4'a~~ Q111`!11 <br />t;FFLUE;)T •~CdU55 TAhU. REOUIREMENT ~,+ ~ <br />~ ~: #~Og ~ <br />„ k ~~~ ~ <br />M, IN C;7NU(IIT Ok SAMPLE ( 03) ~###*t S91#>t<.'.`-C #ir##>Y# <br />~U 'PRE:1'['^rENT ?T"", s. t MEASUREMENT ~ <br />SOU50 1 D 0 PERMIT °•.- ~ RT' ~' #Iff~"~ " if ~a~ +Pe~~tAfM d,~-: EERL!I Ii <br />EPh'LUEYT GROSS YaLr' REQU~kiEMENT ~ ?A ~ ~" !!CD f _ #,## ;.>; <br />~OLIDS~ TUT AL SAMPLE ~#~'~*'~ *~`#*'~'•= tw##~# 19 <br />( ) <br />it l.iSOLY Ell MEASUREMENT <br />"/Ul9S 1 U U PERMIT =;#O+Ot~otr ;i~?1401:C~1.~~ #.a ~~'~n9?R~rM# ~'p <br />~ "'` <br />~~*~"Q~`~~`' <br />. <br />~~~~" +- <br />+ <br />~ <br />FFLUENT a?^'~ i '1 F. I.U REQUIREMENT `-` ~ " . . , <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY E%AMINED AND <br />IN; AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION„ I BELIEV S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION IS TRUE, <br />+ <br /> ACCURATE AND CO~~IIII,,,AAAIIIPLETE I AM AWARE THAT THERE ARE SIGNIFICANT ~ <br />/ ~ <br />{T) <br />/ <br />) . <br />PENALTIES FOR '9UBMITTN G FALSE INFORMATION <br />INCLUDING THE J <br />1 / ~ / / /~~ ~ /1 ~~ <br />I ` <br />POSSIBILffY OF FIN <br />~LpND IMPRI , <br />SONMEM. SEE 1a U.S.C. § 1001 AND 33 U.S.G <br />SIGNATURE OF PRINCIPAL EXECUTIVE /~ <br />~/ ~U <br />%.,)~7 ~ ~ 1 p <br />/ ~ <br />C ~ -] ` <br />~~ O <br />TYPED OR PRINTED ]1 <br />TBIIT^III~~SM/IIB OI •.9fNBB^ a ~rnfnBS ena 5~ h^es up ro Sro.000 vld a <br />p yeeis.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence ell attachments here) <br />e;r'T'PLP.ABLE SOLI9S LIAiT APPLIES ON(.L IF <=lOTH~24HR PRECIF °9R'NT IS ~LA7t9C0. IF CLAIM APPROVED BT %i',I~^D~ <br />''~5 E INON LINTS PILL NUT DE APPLIED T7 REPORTED !1EASUR~ME"7TS-S P. F, i.A.2. ^G i FCT+ °URDFN OP PROUF <br />EpprForm 3324 ( -~5) Previous a itioris may no be use `• ( P CES)` A F T" I~ Y N ED`.) ~" ''~ ' • ` ' ' • PAGE OF <br />0T!1 15/99011 ~-1 72? ? <br />