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PERMITTEE NAME/ADDRESS (/Midi FsWryNar/Loeanen( III IIIIIIIII IIII III <br />NAME T6Hk jrt .M;". ;',K '_at. .4N( <br />ADDRESSTEHRDH CP.E LOAUJUT 9ss <br />1dLLU NI'!~~133 <br />PAONIk,'~j~ ^oo~ CO B1't 1 s <br />FACILITY '~ L <br />LOCATION /j~ &~j~+- <br />l?fN: KELLY~~RIfe.!b~:RF jPdRATIJN:; '!;R <br />Farm Approved. <br />~'cL`I FjVI) V1 P:I NOMBt1;~o,~204g-,OQ~04y.., <br />(SU'ii '.1C) AGProvd G~i~>;031-88 <br />F - FI!JAL L <br />h:I90R <br />~ _~ <br />~::.- NC UISC4AR~E I;;xXI "" <br />NOTE: Reed imtruetione bdore completing this form. <br />PARAMETER..: 13 Grd Ontyl QUANTITY OR LOADING (~ Grd OnlYl QUANTITY OR CONCENTRATION NO FREDUENCY SAMPLE <br /> <br />° 118531 /54611 (38-151 !4853 /54611 OF <br />131-371,: <br />` EX TYPE <br />~' AVERAGE MAXIMUM U MINIMUM AVERAGE MAXIMUM UNITS /Bi-sal µµY519 <br />l5bfiel 163701 <br /> SAMPLE ,-. r. ~. ., ~; x,^^-v .r. #; ( ;~) <br /> MEASUREMENT <br /> <br />040:1 i J J "PERMIT ~ #°:.J!CY ~' #~#4b"i.Qt~ . #:,•- ~ ~~ ~~~~ <br /> <br />:': ' <br />•~ ~' <br />#### ~ <br />~'O ~ <br />..r..6Y <br />`J~IT'1 <br />EFPLUENT ~HOS3 VALJE; REQUIREMENT ~,F~ <br />JOLT SA JTAL SAMPLE , ~...,. as#+as a#aaoa~ ( 14) <br />U J F E N D E L` MEASUREMENT <br /> <br />U53U 1 U D ..PERMIT #t=r#~Yr r;.,'kR#"de: ": .-~::«# :',«' <br />~. ` :< 7D 11,^.F/ ;R~l f3 <br />'FFLUENT :;R)SS YgLU6 REQUIREMENT .¢ . <br />%''" <br />~ . <br />OIlA YG <br />~ . <br />DAILY yX 't:;/L '1.UA'TR <br />0 SE ~GTf LEA RLZ SAMPLE ,^-Yak#rk .~#t;: #y <br />#yO,+C #fi# •t} ( ~5) <br /> MEASUREMENT - + <br />~F <br />U~IlS 1 D U PERMIT ,:«C-#.#w dYG?#~fF " <br />. k"-".-{c ~r`r'+~'-01 ~':i <br />' ;y::.#«G#-t UyFl i dIC'C:/ ;RAb <br /> <br />'FFLUtHT ~HOSS YALJE REQUIREMENT <br />' " <br />~-'`?~s~' ~ <br />#:;~: ,'~ ~ <br />. <br />~ <br />„ ~~'.: <br />~?:~. <br />r,,. <br />.RATLY MR <br />ML/L <br />ONTH~ <br />HO,Ir OTAL SAMPLE .'k :4 `.~ OPf-i#: ;-:tY#it# <br />" ( I9) <br />(A 5 P E) MEASUREMENT "? <br /> , <br />1D'15 1 U J PERMIT «:#3#'k ,: ;:##tr« ##: F#;F#blf~..; '3tid 5.0. -;t 11CEf 'RkA <br />PFLUENT GRJ35 YAL'Jd REQUIREMENT #~k~ ". " ':;:30"Dk VG DAZLY Mx M':/L - . <br />'NONTR <br />N GREA.iE SAMPLE ,`R 01;`x? ,': ;':#'k## .°.J3#O# «1« #r ( 19) <br /> MEASUREMENT <br /> <br />35y2 1 U U <br />- PERMIT' ,~S:g °~91# :LTR'-A OIC:- 4 #'3# CiYS##if.':: ~:: :91?OIhY 7R:.9i 1Q ;..1~'~.'IN ..1)k9 <br />FFLUENT GROSS VALUE REQUIREMENT ##Rb <br />~, OATi,Y Kx tiG/L ": 1~ &$N? <br />LOfi~ .. NDi1If .7H SAMPLE ( D3) Y•^.kCrr ### ## ..fi:':t-.• <br />HHU TRti ATA Eaf PLANE MEASUREMENT <br /> <br />UU50 1 U ] <br />' PERMIT PTIOYA'L REpdRT 3$pROrZc ': ::' #;:## # Ar'r~_~# #«# $'L'ALY 9TAN <br />;M <br />FFLUENT GHOJS YALJE :REnuwEMENT 30DA AYG. DAILY !!x : re ,D <br />:•., ;`###"" . <br />SA T A SAMPLE ;:~ 01.`•r:# #SOt##:= ~~#OSF f.«« #~~ ( 19) <br />ISSOLVED MEASUREMENT <br /> <br />7U19S 1 U D ....:PERMIT.. T .-#r3t+'f# #~# C?AO#~:. :r j'". <br />+Fr. <br />d£)'~nT s'- <br />~RLY <br />RAA <br />FFLUENT GROSS YALJE :REQUIREMENT: ~ ~ ~ ~ «,'::: '~~':~ ~"" ~~ <br />RAILY rex flr/L <br /> <br />_.: , <br />'~" <br /> <br /> <br />.:. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSONALLY E%AMIMED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED NEREIN; AND BASED ON - ' <br /> MY INDUIRY OF THOSE INDINDUAL9 IMMEDIATELY RESPON918LE FOfl ' <br /> OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE, ACCURATE AND COMRETE. I AM AWARE THAT TNERE ME <br /> <br />SIONINCANT PENALTIES fOR SUBMITTING FALSE INFORMATION <br />INCLUDING _ <br />e <br /> <br />KELLY FRITZLF^ , <br />THE POSSIBILITY OF RNE AND IMPWSONMENT. SEE IB U.9.C.11001 AND aJ <br /> <br />~ <br />"''1 nn <br />p~ <br />~?J'SOTJ <br />DD <br />Dt <br />~~ <br /> <br />TYPED OR PRINTED U.S.C. f 13te. /PF°Wdr. MINI dNY mMIF .IFF YcAn/~ Fws ~p ro ilaaW <br />rtl P~muimnr lmvim+weP/Mr.FFn emmeuwsYwa/ ATU AF <br />PIIINCIPAL EXECUTIVE <br />OFFlC~ OR AUTHORIZED AOEM AREA <br />NUMBER ~ <br />YEAR <br />MO <br />DAY <br />-_.-.-_-.__ -.._ _-._..-.. _._-. __ . -_._-._ ._ CODE <br />..... ......... ...... ~,.° ~,... .. n. v.v~n ~ .vna Ineoience sn errecnmenrs neFe/ . <br />SETTLEANL2 S]LIDS LL1IP APPLIES O4LY IC C= LU-Y~2A 2U-RR ~#KC1P h%t:ET ~5 CL.4I"^D. IR CLRIC-APP(IJY.°.D HY <br />4000y..TJS^F-IRDN^LI9IfS iILLL NOT 3E APPLIF.J TU REPOP.TED: i1 E.lSURdl:Eal'5--; 4 I.S~.lA~ PG 5 M1ND I. A.LDE DG 6. <br />Form <br /> <br />ue eMluone mey De ueeD. IREPLAGES EPA FORM T<O MqY NOT BE USED.) O 11 9 / 9 7 U 819-1254 <br />1 <br />