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PERMITTEE NAME/ADORE85 8«rdr F«WryNw/LOOOUOn UDrpnwp
<br />NAME '-'Pit IJ~ '. ._; _. ... _ _., .,'
<br />ADDRESS ~ LMe:i .., ~'- 1 ,i~ `-t~, .:. ~~~. t. 'J {
<br />)yep L. _ •.T..-..,3T. ..- CLr.
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHARGE ELIMIHATON SYBTEM INPDESI
<br />DISCHARGE MONITORING REPORT lOMRI
<br />17-16I 17-791
<br />"JO~171~q rn7 1,
<br />PERMIT NUMBER DISCHFJIGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM :_ 'J TO ''" ') ~
<br />l1P2I7 171-731 llal5l !16171 128-191 /3431)
<br />Form Approved.
<br />.• • ,. t - r. ~nOMB~Now 2040-0004:.
<br />.., „ -. r ~, .:) Approval, a~Pi~ea.05-31-98
<br />~.
<br />NOTE: Raed Inetructiarr ba ore com letlnp thin form.
<br />PARAMETER !3 6rd Onlyl QUANTITY OR LOADING !4 Grd Onhl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !46631 /54-6E) ~ 138-451 !4653 !54-811 QF
<br />131-37I
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS EX
<br />
<br />!e1-eJ!
<br />ANALYSIS
<br />!yF-881 TYPE
<br />
<br />169-701
<br />CO'.I~'fClri LTY SAMPLE uphAt^ RS^:; ,': 'e +e y:,r~ ~ T11
<br /> MEASUREMENT
<br />r1J ~"'~`+'1 1 U 7 • ~ PERMIT #:+;r'k t: Ft ,•.'~Fkt;+rY 5=:: C: *.~.#~-'.<::a S~Srt 'tr C/`n'P I ~yu.~.
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<br />RR' ~'/ •n,p
<br />r. t_
<br />..cT L~J ...i )3~^Sti V 0.T. EIF REQUIREMENT ~ tr i,FrR i(1r A R
<br />iVY ':T v'
<br />. AT TY Y r•k
<br />_ M7MPH
<br />°r! SAMPLE ><'k ,"-.~k:E 0#4R: ;c {: t,tY##'. ~ T ~~
<br /> MEASUREMENT
<br />~.i LI'r Li li i I) 1I :: PERMIT ^.•CC ~>t7 *4#~^.4T Y, Y(t7 ,S ~`>~~:#tk',t `i ~iQ ~ ~ ~ ` FRRLY :({AB
<br />~P",UC:f .' 7POS'i V0.T,U6 :REQUIREMENT ''~~? tT~MIx~i1*I KA X~ fitfx 5!I .
<br />-;'~LZt):I, "J''0.L SAMPLE ~}x;;x r~:~^:r:'; r~,...#.. ( 1~)
<br />,'JjLt ;, •, ~_.; .1 MEASUREMENT
<br />,iJ~1U '? U PERMIT '`•~.0ttR01 '.r~FFRr:: .. 00.`#'k "k ". n"~Il_~.. _..E1.,.~. .. t',4f:R/ 'R0.'!
<br />i r. CJ~' 1E9TS 8' r,7~~
<br />' REQUIREMENT rA-'.:'k^ ~t)1+' .+~~.• •••-r tv xjr M.:/-. ,'~j ,7 r!TV
<br />O:.Z DS, T:)T!L SAMPLE =k+'-:'.`•~k :° ;: ;t .^•'._f:3 4`#i: •.~.~ ~ Tnl
<br />• 17 } O ~ ~; p g p MEASUREMENT
<br />)O~~II ~, ~ ~ PERMIT ~.
<br />~ ::~:;~~`A.q'.R k00 +°•r#GcAt „ O## 3=k#rA-°.-'=
<br />-"'f'LU F.h? G4^SS !L'1F REQUIREMENL : ~ QII}'IF ~4 Z~ns 4Vr ~Tr LY xg Mn/L t"ry)T^
<br />i01.S.DSF :;ET~L •"-'L~: SAMPLE ':okQlR. G,iph## ##t4^•::::< ~ Tr1
<br /> MEASUREMENT ,
<br />
<br />.:USES U 0 '! PERMIT :F;::?:, F,s *. 3tc+. : :a'. ^:t:^:y P°P~FT ".5 ~RL'G;; '?~.°
<br />,•
<br />'_"iI C_l''N:'."".~ oar r7d REQUIREMENT ~ ~ :`8f4 30D>+ AYr ESA'IY 9X ~T,/L 4~.}~ml{
<br />iJ L:i, ~I;rrl.:F'L`: SAMPLE ~`E1:iR'~Ik G-'~4{. .:~ ,t:fi;.xy ~ mac)
<br /> MEASUREMENT
<br />7'7 ~4 `t 1_ 7 ) PERMIT #u3R#? 'kR=~:t#" :;: >.=: YM`rr/k#'! oPnn R'P ~c n,^a„
<br />?ecJ
<br />tf IPA-~
<br />?'SLOt.°;T .,i'."`55 Y4LLIT REQUIREMENT l~~r AV.". r.'TLT 1!x ;./!. y~•:T'1
<br />~... J '; tt r.4 ~. SAMPLE ~°aC-;efiC Rr C;: Ik'%- .._.. ( 19)
<br />.JJIi EX rR-.':DE7 ~"^'rp MEASUREMENT
<br />];SSfi ]. U / PERMIT .. .,..~.oCi !t R'kn ID:k C- ;r:.`-.`• xrs:twfiS< .. whys T r r :)J]'I'/ 14R4
<br />_ ~LI7 B!.T u;i7; 'liT,^r' REQUIREMENT n{~: rc Tu~.r .,~Y ,-/1. ~ti.T
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cean
<br />AM fA Fr UNDER PENALTY QF uw THAT I HAVE PERSONN,LY ExAMINED AND
<br />MIUAR WITH THE INFORMATION BUBMITTED HEREIN; ANO BARED ON TELEPHONE GATE
<br /> MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOP
<br />
<br />
<br />Richard Mills
<br />OBTNNING THE INFORMATION, I BELIEVE THE aUeMITTED INFORMATION IS
<br />TR
<br />RATE
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<br />AND COMRETE. I AM AWARE THAT THERE ARE
<br />SIGNIFICANT PENN
<br />TIES FOP SUBMITTING FALSE INFORMATION
<br />INCLUDING '
<br />,
<br />Environmental I.~,al'leyer ,
<br />,
<br />THE POSSIBILITY OF RNE AND IMP11150NMENT. SEE 1B U.S.C. 1 1001 AND 7]
<br />f t 3 t B
<br />P 610NATURE OF PRINCIPAL EXECUTRIE ~ 970 870-2712 S 21 99
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<br />U.S.C.
<br />MI,Ib. Inbr el.r meenra ^eY heAlF. F.I.. W ro S IO,OOD AREA
<br />TYPED OR PRINTED .+0«nloillMn hprimrwnFOlMrwwr6mmT•W6y.ra.l OFRCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />t7VMMCrv I a nrvv [ArLnnn I Ivry Vr nrv r Ywl.n I Iona Inrrortrnce sn ertscnmmrs oars!
<br />.~Lir: a.N1r~ LT'IT"~ BOA T-'~~ •. ;e'r ~rLer,~Lc -~i73 (LJC tlF) 0.°; T,v n•;1v 7c' <_ 1^_-~,'r ;1!-t+{i nt~. C~c, _qe-rl
<br />C ..,tL!IEU. S~. T.0..? P: 1' F08 ~73~n'1 l~ ~q7:.p T)O+o~ ~`;. n a - - ^F
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<br />EPA Form 3320-1 108-951 Previous editions may be used. IREPLACEb FDA FORM T~FO WNICN MAY NOT BE USED.1 r) , ~ ,t / ~ ., r ,1 ~ -, _) T T , PAGE OF
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