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PERMITTEE NAME/ADDRESS p,.ii6 FrmryNwr/Lacalm dDl~.r.nq '
<br />NAME ••vr_i~r - ~. __ .... ,
<br />ADDRESS"I.-..~ ~r?;3 ..,C , „ _C. :F.i 'I,
<br />FACILITY
<br />LOCATION
<br />.. 'i Pk7 !!O;:1T-i 'rri r_' 7, !i i?4!4L l*9Y
<br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM lNPDESI
<br />DISCNARGE MONITORING REPORT IDMRI
<br />17-161 l17-791
<br />^nr271=4 7n~ +
<br />_ PERMIT NUMBER DISCMMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM .' TO ~ `I ~
<br />I76I1/ l77-731 !74151 176-17) 118-191 !36311
<br />Form Approved.
<br />.• • - T .., r . ~ ...OMB`Nm. 2040-0004-
<br />T.~ -. ~ ~ p`PProvel szP,i[PB OS-31-98
<br />.. ` .,-
<br />t NOTE: Reed Inetructlone befor complatinq this form.
<br />PARAMETER !3 Cerd On/Yl QUANTITY OR LOADING l4 Grd Only) QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !46531 154-611 138-451 106-53 I54-611
<br />E% OF
<br />TYPE
<br />l37-37I MALY515
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161.691 (64661 169-701
<br />r -~_ SAMPLE #~tt#;;~ ~-r.
<br />~^ ), L ., c ~ ~ n;; !; ~ 1 MEASUREMENT
<br />'707aU 1 ;1 eE PERMIT .;c;c~{:{: {c ".:###C# r`::k R#',k=kS^-"' l.n ~'oCnq•!• flBf.Y,/ iRAR
<br />'r;i,7EVP ~P>;S 7,L'J` REQUIREMENT :~#:# 36D. AYCr 6ATLv [!X Rte/ Nt)t1TR
<br />'ILY~r, PJT?NTT'.LL" SAMPLE ##4### #####: ###'.`Y# ( 1P)
<br />.C ~ S C L 9 ~:,'J MEASUREMENT
<br />711114 1 0 0 PERMIT #4#0#>'~ ~ 3#a7#~I# ##~ :`###*~t REPORT ~!?POP,R l N~f'/ ~RiI.B
<br />iC.iLf1E'L'T i.N7ii •1~L^, REQUIREMENT ~ ~ :,`-~t10 7EtCA AV" AT ° FAX Mme/ !4f3Y< T+ '
<br />,Ct '-'f'F'•2, PC}T `'N'-'~.i L" SAMPLE .#CCH~'` ~rYY{t :: .~$t'.::f ( 19)
<br />:I'i;.QLL''i7 MEASUREMENT
<br />`1137c 1 0 PERMIT '<:.=fig.. r,
<br />~ ,...'XM#{: ~ >:'-.:. w-.A..y.~ n,U~1 !',t'i iaf'r/ ;~A r~
<br />':'FLUB oR"+~~ a*T ^- REQUIREMENT ;ti:•::~ 'tnP* .5T'^. {TATTY '.±K '%/f. "f7N'""r
<br />' 473 A'1`~:_~ a, r" _ . [. SAMPLE .-... r,:.t.: `-r, r,:x~,.,.i: ( ' `1~
<br />^. ;r:JQ~~{,49Le MEASUREMENT
<br />i112i 1 0 U PERMIT ;-:Xfir`hr. ;.g•~;>rx , r,:;~.. P#~{-.. n:pnD~ 4~•r,~q" t c•.~Tv ;aaa
<br />'5'r'LUF.'i'P ~F't" ^.>; REQUIREMENT ::# 37nA 1B'; C1d7L4 Ky "'•/I.
<br />LtJ~'• IK ~01:0'II" Il SAMPLE 0,731 ##'tt:}r: ;:+Y?:-';='~ :'.-r..y,.
<br />}i 7 J T R E { C ~ ~ `~ ° ~ (, 'L ,'" MEASUREMENT
<br />70U`i0 1 U ~ PERMIT PP.PJ~P ~'E?;1 /: "^ ..^Mxt~~ ~i:•'•'.7;~;` ~##M"M x fi.. P?rr,t' MgTA`;
<br />', fJ EVT ~P'1 -, _- c+L',- REQUIREMENT 3!1 C?. AYC o.4rLY i:f 1!Gp `.'.^-
<br />)IL nil! :,HF~.3 ~ SAMPLE ~.. F.~"..e ( 7.d) '.:r#-~1F# -t-~#Y4C•y ly Y,:t:f^r:
<br />d i i~ l A L MEASUREMENT
<br />;4066 1 1) PERMIT ;<:Yr#{r ) Y r ,_1 ~#f:;<#': ^;: 1.-A-ltfi `.##r,.:": . fx ^:~ S p^¢L" T. 1717
<br />:r'4LUEPIP ~P:1 ~i :i 7".•r' REQUIREMENT St15T °.6`C N~=U -
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />NAME/i1TLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF T
<br />MILIM WITH THE INFO AW THAT I HAVE PERSONALLY E%AMINED MD
<br />RMATION SUBMITTED HEREIN: MD BASED ON
<br />- TELEPHONE DATE
<br /> MV INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />Richard Mills OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB
<br />
<br />i fJ
<br />l TRUE. ACCUIIATE MD COMRETE. 1 AM AWME THAT THERE ME
<br />INCLUDING
<br />SIONIRCMT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />'
<br />(970)870-2712
<br />8
<br />27
<br />98
<br />lanager
<br />Env
<br />ronmenta .
<br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 18 U.S.C. 1 1001 MD 73 eIONATURE OF PRINCIPAL E%ECUTIVE
<br /> U.S.C. 1 1710. lPwWlY. u!r rMw mNh..nrY L'N'ad. Ewa yo ro t 1D,000 AREA
<br />TYPED OR PRINTED .nssmuMMn Anpl.avnrlr PlbnrwnfinendlaAM 6Y.A•A) OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS !Relsrence e// ettschments here!
<br /><L1'-:i{NAfr' LI"C": 4'r7D ^-. 3F.iTL'i.3L' S7Li0S (L~1C riF1 4"T•° nV'!v T^ !- 1^-V^ '111-YZ ?'. 'rT„ cyc~.r *-
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<br />EPA Form 3320-1 108.95) Previous editions mey be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.1 rt r• + r , /'1 n ~.I n .T _ n 7 ~ r PAGE „ OF
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