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PERMITTEE NAME/ADDRESS pnclude FOCiliry Name/focmron JDlgerenq <br />NAME 8 (/ Y I i- ? c -: -., .. ~. ~. <br />_ II':IT^0 <br />ADDRESSBO~i :: Nip. '.T%,. <br />P • O • 1' 1 :i ~ T <br />FACILITY pAO'r .IA err :{1429 <br />LOCATIO <br />OYIc CO 91429 <br />~T';N: F1LLtr,ti r;A5 J4._ ~TYr t!G8 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATON SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR; <br />Ra51 (IR A) <br />nn <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />PROM 9 "J 0' ~. TO n q n ; <br />(Po-P11 R2-PJl RAPS) R5-P]) R8~P8) (30Jf) <br />form Approved. <br />OMB No. 2040-0004 <br />T V O R Approval expires 05-31-98 <br />(snRR uc) <br />r _ cTNAL ABLT6 <br />OS 7F 5;•:/~TN~ @hNf, Tfl 7cEu TRL'~.. . <br />NOT :Rea Instructlons~befor leting this form. . <br /> (3 Card Oniy/ QUANTITY OR LOADING (4 Cerd Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-61) 39<5) (4653) (54-61 EX OF TYPE <br />~-3n AVERAGE MAXIMUM UNRS MINIMUM AVERAGE MAXIMUM UNITS aNALYSIS <br />6&70 <br /> lePCJ) (Sa-5e) <br />uIL AHD GN~A S-' SAMPLE v~l~*r'< ( 94) ~~%~"~~~ '~~fi~#" ...y# <br />Y I:aU A L MEASUREMENT <br />94066 L D > PERMIT'; Rra~>ldG~r ~' ~ P.S=1 #~#~#>Iu >rAYft~# ~~ a^~ 6~M~Li 2 <br />EFPLUENT GP )"; :, TACO .$BOUfREM~N~- : E N = , <br />.'-=~ r ' " .: ~aa" a <br /> SAMPLE <br /> MEASUREMENT <br /> <br />"T e+ <br />~~ <br />I /+.i~ '! <br />; , ~ <br />e ~ r ~ i$ ~~ i <br />I <br />~ <br />~~#i ~i~ , X <br />~,~ <br />A <br />~ „ ~ <br />a~ ~ ''Si <br />~ ~ ~p <br />Ilz{v`: D' <br />~ <br /> <br />i ~ <br />> <br />~~ i <br /> ~ <br />R .~ ~~ ~, .'1~i' <br />}.~V ~aLp'( <br />: . <br />.y, <br />-.L" 4 ~ . I«:~' <br />•~i .tm `~_K <br /> SAMPLE <br /> MEA <br />S <br />U <br />REMENT <br /> yy <br />~~ <br />~~y <br />~ <br />~ { <br />~ ,~ <br />- <br />' <br /> REdUIR ~ ~ ' ; ~. . <br /> SAMPLE <br /> MEASUREMENT <br /> ': PERMIT -.a ~i'.I) - '.k: ' ; <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ,r;' y 12 <br />~ .r i . , <br />~ (, <br /> NT <br />P s f ,„ , <br />. <br />. SAMPLE <br />MEASUREMENT <br /> '"'PERMIT i a~ I„~. <br /> 1iE~1U1HEMEN7 <br /> SAMPLE <br /> MEASUREMENT <br /> .- <br />,- <br /> 9EQUJREMENT - ~ ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY E%AMINED AND <br />IN; AND BASED ON MV TELEPHONE DATE <br />,( ./ / <br />/ L C //I d] r ~JL~/I f 1C INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEV <br />MP <br />ETE E THE SUBMITTED IN <br />I A <br />TH FORMATION IS TRUE, <br />ERE AAE SIG ~ <br />J~ <br /> L <br />. <br />ACCURATE AND CO <br />R SUBMITTING <br />P <br />E <br />F M AWARE THAT <br />FA <br />RMATIO <br />E <br />NF NIFICANT <br />INCLUDIN <br />N <br />THE „ <br />/ <br />p <br />~/ D/ f/t/f T/GN 5 ENALTI <br />I <br />, <br />S <br />O <br />LS <br />O <br />G <br />POSSIBILITY OF FINE AND IMPRISONMEM. SEE 18 U.S.C. $ 1001 AND 33 U.S.C. <br />d <br />h <br />li <br />0 <br />00 <br />f <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />)G <br />~ i~ n /L. <br />~/`/ // <br />lJT <br />G~ <br /> <br />TYPED OR PRINTED er r <br />ece emtutes mey include <br />rnae up m <br />1 <br />, <br />0 end or <br />4 t318. (PeneRies un <br />mewimum lmpnsonmere or betweenBmarrths ends yaen:.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLAnONS (Rererence en ettacnments Here) <br />SET2iEAtlLC SOLLD.i !T?'Tt ,PPi.iF~S .~NL': LS' :=1GY3,24HR P3Y,CTPBVF'27^ T; ^.LA7':>:'C-. IF %'CAI*1 !~P2FOYfU t'!' 4~CCI, <br />•f 55 & IHO1: LIMITS ~+TLI V~,)'f ~~•E 4!~L:"7 '""~ 'tEPJhT,D If:ASUF?f"EVTS-SE4 i. A. 2, 4G ; FOT' RIJRSe.v OP PR00^ <br />aon42/9aott2-t 222 <br />PAGE OF <br /> <br />