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NRME~EE NAME/ADDRESS pnclude Faciliry Namdlncarion 1/Di$erenq <br />HORIE AF,SOURCES LII".ITf.D <br />ApDRESSHOMIE N0. 2 MIBF ~- <br />P.o. eox uF3 <br />FACIUTY PAONIA CO tl1U29 <br />LOCATIONdOU I E CO 814 20 <br />ATTN: WILLIAh A. RFAf1 J~., 11NE HGR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) FOrm AppfOVed. <br />DISCHARGE MONITORING REPORT (OMR~ OMB No. 2040-0004 ' ~~' ~' <br />Approval expires 0531-9$SL; `~ <br />^ (SU9o VC) <br />^ PERMIT NUMBER DISCHARGE NUMBER c _ F I >tl A L D ~'A <br />MONITORING PERIOD '1$ f15 SF/MTN£ pRNG T7 D$:~P TRL ( ,. <br />YEAR MO DAY YEAR MO DAY __ ,~ <br />FROM 00 10 O1 TO QO ~t~ N] rTSCA~IPCE ) ,..k <br />(zazf) (xz~s3! (1d~25) tzs-z]! Basel 13o3p NOTE: Read Instruc[lorls before Lromblaling this form. <br /> (3 CeN Onty) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4653 54-61) (38-45 (06-53) (5467 EX OF TYPE <br />(32J7) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(ezm) AnuLrsl6 <br />(6468) <br />6&70 <br />JIL AND GREASE. SAMPLE ~'~~~~~ ( 94) 3G~-"=' ~~>r+R^'= xnY^~sa <br />Y I `. U A L MEASUREMENT <br />94Ub6 1 0 0 M1;pEq-d)t <br />T '~ .)!+~ ?.~I~!~'~'s,. ES=1 °• •~t0 ~. ~# <br /> <br />. fei7~?~0'i~- aa3 ~~_ <br />~ <br />'~j}~ ~ <br />~ <br />EFFLUENT GADSS tALU QUIREM~NT ; _~ r .0 &' t _ _y' ,~~~„~ x `: ._. <br />i.~ : <br /> SAMPLE <br /> MEASUREMENT <br /> <br />#rERMr~ +J~`y~y_ +~~ <br />y }b~'i`5f <br />~ <br />~5 <br />I kyr~ ~ ~ <br />~g ~ Y~ <br />~ <br />i <br />` .l1 <br />r~y~=2^ ~` ~i <br />~ <br />~ <br />~ <br />~ <br />fl ~:` N' •b( $~? <br /> <br />~~ <br /> V~R~.M4A(T '` <br />~..~;+~F~ .;~ N :ft <br />~ <br />i Fi' <br />~ <br />~ <br />~ ' If is .'3~ yl ~9 ~ °~ <br /> SAMPLE ~~ .P <br /> MEASUREMENT - ~~ ~ ~ <br />Y g <br />/ <br /> : « <br />= _ <br />~ , i <br /> REOU ENT ~ r ~ <br />~ <br /> <br />~ SAMPLE <br />~ MEASUREMENT <br /> PLrkiMl'~'. <br />:~ ~ ~~~ <br />T~ .,>I t. <br /> AEQUIF~E ~., <br /> SAMPLE <br /> MEASUREMENT <br /> ' " t s <br />{' ~ '' ~ <br /> pE0U1~1EMENT g ~ <br />~ <br /> SAMPLE <br />• MEASUREMENT <br /> PERMIt , ;' t <br />' <br /> " <br />REOU~iEMENT . 2~`- ~ ` <br />': <br />'r - <br /> SAMPLE - <br /> MEASUREMENT - <br /> ~.~ PERMIT -~~ <br /> <br />" a ~ ,<; <br />q <br />i _: <br /> HEG)UIREMENT ~ .c ~ - ~ <br />«,`sr- <br />NAME/TITLE PRINCIPAL E%ECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMIUAA WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMRTED HERE NALLY E%AMINED AND <br />IN; AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDNIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEV <br />A <br />ATE A <br />P E THE SUBMITTED INFORMATION IS TRUE, <br />AM <br />RE TH <br />T <br />ERE <br />NIF <br />T // <br />~ ., <br />r <br /> ND COM <br />LETE. <br />CCUR <br />PENALTIES FOR SUB <br />TTIN I <br />AWA <br />AT <br />H <br />ARE SIG <br />ICAN <br />G FA <br />SE INFORMATION <br />INCLUDING THE ~ <br />.I r~ <br />] /~ ~~ J~/II I , <br />MI <br />L <br />POSSIBILITY OF FlNE AND IMPRISONMENT. SEE 1B U.S.C. 41001 AND 33 U.S.C. <br />l <br />P <br />B <br />tl <br />re <br />I <br />// <br />000 SIGNATURE OF PRINCIPAL EXECUTIVE ~] ~ <~ ~ "~o~ S 7 ~i ~ 1 y <br /> <br />TYPED OR PRINTED enel <br />5 1319. ( <br />es an <br />er Mesa efmu <br />s mey <br />nc <br />ude <br />rtes up ro 510, <br />eM a <br />muimum Mpdsonmerrc of SeMeen6mpMhs end5yeen.l OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence ell attechmenGS here) <br />~SETLLEABLE SOLIDS LIMIT APNLIfS 0+1LY IF :=L)TR•7.4AR PRECIP p0''y'!' TS CLAT`~:D. TF CLATd APPROQEO kY Nrir'D, <br />T:S G IRON LIMLTS WLLC NOT riE APPLIEn T7 9EPORT?D MF.ASORE!1ENTS-~P.°. L.A.?, PC 5 FOP AucneN OF PR00° <br />~P~ orm 2o- - ~ Previouse itions ~ma'y no be Sed? ~ • (bE CES PAF T' 1 IIY O E E .) ~~' • y' PAGE OF <br />00~56/~P0~1~-12?7 <br />