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PEV!MITTEE NAME/ADDRESS (include Faci!!ry NamdLOwnan iJD fferenq <br />NAME 80WI8 KE;')UwC'-''~ LIYI'".p <br />ADbRESS BOiI I E ~!). 1 " I b e <br />PAOa[a CO 91u29 <br />FACILITY <br />LOCATION O Y L 2 <br />CO 81428 <br />9 'i'PN: MILLI A~ A. Hs'4R JR.. f!Il:B lSGR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />(3-16J (1]- 9) <br />r- <br />PERMITNUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO 00 17 31 <br />l2fY2r) (11771 (3i35) (38-4]7 (7B-ZBl laoall <br />Form Approved. <br />"I I N O R OMB No. 2040-0004 <br />Approval expires 05.37-98 <br />(i!I fIP 4C) <br />!' - PL*TAI. DELTt <br />^SCH~ OF 5R TO UFFA TPA1L ^T~9 <br />4a, N'7 D*SC.°. 11Rr,° ~ yy,, ~ ~-A i~ <br />NOTE: Read Instructions belore L'blhpleting this form. <br /> (3 Card Ony) QUANTITY OR LOADING (s Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) 54-61) (38-45) (46-53 (5481) EX OF TYPE <br />~Z~n AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNRS <br />ANALYSIS <br /> rs7m1 !6+-fie 69ao <br />JIL AND GRFASF. SAMPLE r. r.-p~~q ,)u <br />( ) ~t~;,,x„ • ',Y>h^4;`- vtvr:t <br />Y I S U A L MEASUREMENT <br /> <br />H40b6 1 0 J ;,:§ <br />e <br />#~'~:: F,5=1 ~ Mf ".~4 !~f ~ iVF"- ~~#3 ~^ <br />EFFLUENT :;ROSS VALU ; ` <br />~s ~ r -~~' N <br />=0 ~ " . <br />' , "` <br />f <br /> ' <br />n 0 - . ; + = ~LIR~ ~ ~ ~= F <br /> SAMPLE <br /> MEASUREMENT . <br /> <br />- y <br />~ <br />V"` ~ n:" <br />r <br />~ ,3 <br />~' <br />'' ~ <br />u <br />s ` <br />"~ <br />" <br /> E U MENT S <br />~ 3~& } <br />'r . <br />~ ; ~.' ,~ <br />: ,~ <br />u,: , <br />~ ~ ''!=)' <br />r <br />r <br /> -0 <br />„„ ~ ` , y ~ _ <br />. <br />5 <br /> SAMPLE ~ S <br />I <br /> MEASUREMENT ~ ~ <br /> - <br /> REQUIREMENT - - - _- .~ t' =s-_ <br /> •, . <br />5 SAMPLE <br />' MEASUREMENT <br /> <br /> REQUIREM7<NT ~ :-~ ,~;, ~ - , . ~ - .,~, <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT r.'tF <br />! <br />r <br />` } - 5~ ' <br />' ~ ` z : ~ +'; n Y~ ~~ <br />~ ~:1~,~.ryx: r ~ ; <br />e _ -~" « -:e <br />, <br /> gEQUIREMENT . <br />; <br />fir >T :: ,~~ ,I' ., ~ - <br />~~`:°~" s~s <br />° <br />at <br />~' ~; r <br /> _ . <br />, , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ - T, " ' <br /> REOUIREMEN7 s -~ - - - ~ -~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~." - ~ - - ~~ ,~ <br /> REQUIgEMENT ~ - - <br />NAME/TTTLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN <br />AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDNIDUAL S IMMEDIATELY RESPON ; <br />SIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEV <br />AC <br />URATE A <br />D <br />MP <br />T E THE SUBMITTED IN FORMATION IS TRUE, <br />- <br /> <br />, <br />/ N <br />C <br />CO <br />LE <br />E. <br />PENALTIES FOR SUBMITTING I AM AWARE THAT TH <br />FALBE INFORMATIO ERE ARE SIGNIFICANT <br />N <br />INCLUDING THE ~ <br />JJ <br />/ <br />/ <br />{ '~` /~ . ~ .r ~ ~ ~ ~ - <br />POSSIBILRY OF FINE AND IMPRI , <br />SONMENT. SEE IB U.S.C. § 1001 AND 33 U.S.C. <br />SIGNATURE OF PRINCIPAL EXECUTNE <br />~'~ /y <br />7 . - ~ O$ 7 <br />U ~ <br />~'Z <br />TYPED OR PRINTED mavm m( m~~mmem ol6ahrean 8~rl~q ~tl9utle lures up m 510,000 end w <br />p y~ry.l <br />OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> <br />GOMMtN 15 ANU G(PLANA I IUN UY ANY VIULA I IUNS (fiBlB/BOCB all al/aCnmBntS DRIB) <br />., ':.t'TLEABLE SOLIDS LIFI* APPLIES Ot+LY TF C1UYR~24NR PHECIP RYF"T TS ^LAI"FD. IP CLAN pPPRCY>~D uT a; r•n~ <br />::~:; ~ IEON LIBTTS will. MOT +~ 6PPI,T4D TO 3P.PORT?D '£ASUR°!?F.YTS-S P.? T.A.2, Dr, 5 FOF 50RDFN ('? PROOF' <br />EPA Form 332 3 (0 -95) Previous a itions may no be use ~ ' (aEP CES L~ A FO T~ 1 Dh NO 'BE D.) " ~ O r7n I ~ i n ~ n T I ~_ 7 ~ n ~ PAGE OF <br />J <br />