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i <br />1'r <br />i <br />RERMITTEE NAME/ADDRESS PwrIIAr Facllln xwr/LacsNen ljDlQew.) <br />NAME riJaIc RESOURCES LIl1I~1'EA <br />ADDRESS 6U'aIn NO 1 E NO 1 HE:_T fSZRES <br />P.O. BOY 1480 <br />PAGhIA CO 61'12) <br />FACILITY dO~ile: H650URCF.`i LI.`tIPED <br />LOGTION <br />ATTN 91f LTaM E_ RRiR 1U_ tlD nF rlD: <br />NAiIONK POLIUTMT DISCNMOE ELMINATON 9VSTEM rrNPOESJ <br />DISCHARGE MONRORINO REPORT lOA4Rl <br />1-f6 117-19/ <br />r z <br />PERMIT NUMBER DISCNMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM 00 07 O1 TD UO 79 3U <br />!76711 /71.731 111-751 l7E771 l75-T9/ !36311 <br />Fonn Approved. <br />C7AL S"LIRA ;E !'O Uq~i ~I~o{304g-0400F1 <br />(s u R R + z) ~PProvel eXRiEOa oS31-se <br />F - FI1fAL 11L J4 <br />E'IN~? <br />NOTE: Read InstwolltNr befor' eoTmpletlny this form. <br />PARAMETER !3 GYrd Dory! QUANTITY Oil LOADING /1 Grd onryl QUANTITY OR CONCENTRATION NO- FPEOUENCY SAMPLE <br /> N6-53 /5651 l3BJ6 16-53 5461 of <br />l3I-371 EX <br />ANKYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167611 /µ66l !6A)Ol <br />PH SAMPLE y;:t.•;.rr i:fiF'.L'}'X a.s##a ( 12) <br /> MEASUREMENT <br />1104UJ 1 0 0 ~:::::PERMIT:::.. ~.':.G-01#~Oltc#~~~.: ~:~~ki <br />+~#~?4 ~ <br />.~ a~xa <br />~b Ya`.; ~:. <br />~ ~ fkp##>pext ~ . <br />i 0 <br />~~ ~ <br />:g <br />~ ~~~~:~~~ ~~~~~ E~1;fiI,Y :lI;.S'ITL <br />-, - , ~ REQLIIREMENT~. ~.:~ .. . <br />. <br />:. .. .. <br /># <br />,..~ ., , <br />. <br />. <br />. <br />I,.i~ <br />5 1 <br /> <br />- :;:. . <br />:i0Li 1)j, 2'1TAL SAMPLE ::##'L ::: #a###~% ##JI i`•, .;: ( 19) <br />S U :i P° A D F: ii MEASUREMENT <br />U1/53J 1 0 0 ;:::...PERMIT:: .. t?k#!9E##.. <br />~ ...#4#jR~32 <br />~ R;::: :,R:af#i4:Xc# :. ~~ T~ ~1:«~:~ :RA9 <br /> <br />- <br />~. ., <br /> <br />., [;EQUIREMENT ~ .. ~. <br />.:.. ~ <br />... <br />:'~ ~ <br />~ <br />,.. ,-. <br /> <br /> <br />~. . <br /> <br /> <br />A. y <br /> <br /> <br />- <br /> <br />- <br />y~ . <br /> <br /> <br /> <br /> <br />i <br /> <br /> <br /> <br /> <br />.. :. <br />r;t1LID:i, ScTTLEAh[,~ SAMPLE ;#:; ;:: r;tf'>-X := #####~- ( 75) <br /> MEASUREMENT <br />(:U`.145 1 0 U PERNIIT;.' :..:::~I~°t.'t#Ls~ls .: .'... #9k11~>M`4t.. #,^•; ;: :: LR~fAgr~# _ OE?I'IJI~AY.. : : <br />6:i F3 ~: '. ii:b'`Cr .: a&It S' <br />, 1 .- c Y 1J .REQUIREMENT ~~.:~~~, :~~ ~. ~:.~~ ~ #### ' ~~~~. .: .. .:. 0 A' .:.. G . <br />,II.~.~.~. :.!tX~ yL/L <br />. ~~l<'Y'~.~ ...~ <br />I1+. ~)h, '1'0'TAL SAMPLE :1:.#~.`-L':# #:.:e?#~: 3#S•'.:#:: ( 1 ~) <br />(A ~ P F:) MEASUREMENT <br />OlJ4`i 1 0 0 '-.:.PERMIT'.: ##~(ry1rA <br />~ <br />" <br />~ `; #i0.Cl#AI# :~zc #%ktRfAt,# <br />.~~ <br />• 5 <br />7~~ 0 ~„ <br />..~8~ ~ : ~ <br />, k~A 8 <br />FFLU'NT GRO55 YALU . REQUIREMENT <br />............' ~ <br />~ `.. . 0#;=# ~ . 3DDA AY:, AI:iY DIY tS;/L .., :':~~:;C.i[ <br />OIL AhD JNEASF. SAMPLE ra#r~# xr###~ .##~#;= a'=#:xoa ( 19) <br /> MEASUREMENT <br />1135 :i2 1 0 0 s:::-:~PERM17:.:~~:~:. ::' a~s~p~l#~..'~ ~.~ #IR"J#~lA. trt;: ::~.:i~~KK~O ~ fr#~~[s.:p~ ,~.:a. <br />.:.: <br />... .~ :u~r:r.r>* ~~A3 <br />' IREMEIJT~ <br />ij,f:QU "': ~ - .~~:~. ~ ~.~~ ~ ~ ~ : <br />, <br />CFE <br />LUENT ROSS Y LU .: <br />. <br />~~~ G3 <br /># <br />.~~ . <br />FLtiN, IN CONDUIT OR sAMPLE ( pj) :><*r,.t,.#;: `-[; #;:,~r ;,; ;: ;: -:~: <br />T;1RU TREATlIHNT PLAN MEAStREMENT (' <br />50UyU 1 0 0 `PERnlix~::::.. :::.RB84TIt : <br />. : 9e:PORT aFZ#ctzro ~Y~za~Lal. :u;.'-x:~~ a.t= <br />- <br />R~XIrT. N'>'C4 <br />CYFLUENT GRDSS YALU 'REQFlIF1EN1EN7~ ~.: <br />~6GA:.`AYG: .DATLI !l%: 6GU s:-~~ . <br />SULIDS, TOTAL SAMPLE #t#ao~ tovc~a ##~##;- ( 191 <br />UIiSOLYED MEASUREMENT j ~ I)-~ <br />702'i5 1 0 n PERnnIT.;.:::: ~#IY~+R~k~';:' <br />: :::.:y~t+X~@al ac: s. r:YaYE~1~sY <br />. t`I3/NAX:.. <br />Op `T:9LY r !1w <br />OH!155 YALU <br />i'YPLUEN'f <br />REQUIREMENT . <br />:. <br />'. ': < <br />;:., <br />?#Y{t <br /> <br />... :... <br />Q <br />~Y~ <br />R.T.; .HA.% <br />h,i/L <br />:. <br /> <br /> <br />. <br /> <br /> <br />. <br />NAMERI7LE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PFNKTY OF LAW TNAT I NAVE PERSO <br />AAI FAMIIIM WITN THE INFORMATION SUBMITTED H NKLY E%AMINED AND <br />EREIN; AND !ABED ON <br />-~ / ~ -~ TELEPHONE DATE <br />1 1111 l~~ 1~~ c~,n <br />W IC J~ MV INQUIRY OF THOSE INDINDUKS IMMEDIATtYV RESPONSIBLE FOA <br />OBTNNING THE INFORMATIO <br />I BEDEVE T <br />MIT <br />ED I <br />E <br />F <br />RM <br />T ~ <br />~ / // <br /> N, <br />H <br />SUB <br />T <br />O <br />A <br />ION IS <br />N <br />TRUE <br />ACC <br />MT <br />M <br />O <br />ET <br /> <br />'I~ , <br />U <br />E <br />D C <br />M0. <br />E. I AM AWME THAT THERE ME <br />SIGNIFICANT PENKTIES FOR BUBMITTINO FKSE INFORMATION <br />INGLUDINO <br />I D rL~ QQ <br />( J} i . <br />THE POSSIBILITY OF RNE MD IMPNSONMENT <br />SEE 18 U <br />B <br />C <br />1 1001 MD 93 ~ ' ~ -, <br />- I . <br />. <br />. <br />, <br />1 1BIa <br />V <br />S <br />C <br />uv <br />e1. <br />mlu <br />Ihr~B4 <br />L <br />Rd <br />F <br />SIO <br />000 <br />BIONATUIIE OF Pf11NCMAL EftECIJTIVE /) n ~! n <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />.. <br />F <br />r <br />ro. TFY <br />oF <br />iw. yo ro <br />, <br />. <br />rldnmui.lMn ilprlMnrRe/bLwwrsmpTlh+rd 6NVt/ OFFICER OR AUTHORIZED ADENT CODE NUMBER YEAR MO DAY <br />i}.vmmcn.o n1... ...1 ..,........1. ... ..1.. .1...., ........ n1..~e..... .1. ..m1......en.. n.. er <br />:Sr.TTLdA;fLE :ii)LIDS LT'1I'~ APPLIES ONLY IP <=1~YR,24H? PRP.CIP EYE>IT CS 'TLAI1vF:D. I' 'Ld"^. AP~~,)V:''D ~Y iJCDS <br />PSS 5 Ia~1N LI9I':S +iLLL NOT 8E APPLL°D TO 9EPORTr.D EIFASURSftENTS-S P <br />P. I.A.? <br />^G FOB '-1'~~,~^~~;^~ -I~ Da~~F• <br />'l <br /> , <br />, , <br /> <br />~ r <br />.. ~ <br />- <br />/C orrlt I PreLROUS adiuon Y e used. ~ C A A PAGE OF <br />' <br /> .: 1 - i / , <br />. 7 j .i, , - i <br />