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PERMITTEE NAME/ADDRESS (/nclude Faciliry NmndLacafion 1jDi$erenQ
<br />NAME RUwIf. ''!(FJd ~'.: .a.7'('c .)
<br />ADDRESS 80 M i t' !::+. .' ' J :'
<br />P.J. '?7Y N~'.9
<br />DAOSIA LCi 81423
<br />FACIl1TY
<br />LOCATION,I .)N [ h;
<br />CO a142'i
<br />5. ~fA lR__ :1TNC Mf.~
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
<br />(2-I61 (11- 9)
<br />-~, ~ ~ ,
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 97 03 ••^,1 TO 7~ n3
<br />(26111 (22-23) (2425) RB-2l) R6~29) (3031)
<br />L~!OR
<br />(511:18 AC)
<br />I: _ cTN0.L
<br />1 r)p S'7/wlyc
<br />form Approved.
<br />OMB No. 2040-0004
<br />Approval expires 0531-98
<br />DcLT0.
<br />r•9VC TO l''r ,+ TRL
<br />t,•NOTE: Read Instructions before' ~mbleting this form.
<br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46-53) (sa-s1 (38-05) (as-53) (5a-61) EX OF TYPE
<br />(32J~ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS a+a-CJs
<br />P:i SAMPLE ~ ~38~r v##~#~' r ~+- • ~ ( 1 2)
<br /> MEASUREMENT
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<br />(AS PE) MEASUREMENT
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<br />NAMErTRLE PRINCIPAL EKECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HER NALLY IXAMINED AND
<br />EIN
<br />AND BASED ON MV TELEPHONE DATE
<br />/"/G C//1/r^ /GI• /J F ~ I ~,- INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION, I BELIEV S IMMEDIATELY RESPON
<br />E THE SUBMDTED IN ;
<br />SIBLE FOR OBTAINING
<br />FORMATION IS TRUE,
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<br /> ACCURATE AND COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFICANT
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<br />~ PENALTIES FOR SUBMITTIN G FALSE INFORMATION, INCLUDING
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<br />~j p , POSSIBILITY OF FINE AND IMPR ISONMEM. SEE 18 U.S.C. § 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTNE ''7 ~J 1 '
<br />J~ ~ ~ Q
<br /> § t31 B. (Peneltles under Nose stefufes mey Inclutle Imes up m f10,000 end w OFFICER OR AUTHORIZED AGENT
<br />TYPED OR PRINTED meamum rmprlsOnmenl of OeMeen6momhs entl5yeers.) NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence ell etrachmen4s here)
<br />JL"TELEAbLE SDLf.I~S l,irlT +~!'i,JES ObLC IF C=l0YR,24HR PRT.'C7F EVF4T TS CLAT•FD. CF CLAIN APPROY£D tlT k(ICD,
<br />'f iS 6 IRON L[9LTS NIL[ Y:1?' .': APP'..ii'.D 70 RFPORT~'D K°A :URe!!FN TS-SE? T. A.', ?^. 5 FCF. HURDEN OF }•qOC f'
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