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FERMITTEE NAME/ADDRESS OneIJ. FrWryHeWL«n~on l/DlpwwO <br />NAME TRAPi'EP RTN[N~, TN ~~ <br />ADDRESS TRAPPER q7"P. <br />P.O. P..IT l!,7 <br />FACILITY <br />LOCATION <br />t ATTN: 4'. f,OBDJR P_':TEBS, F:tF,S/GEN HER <br />PARAMETER 13 Ard OnlYl <br />116-531 <br />13?-371 <br />NAnoNAL PouvrANr ascHARGE EuMINAnoN srSTEM INPDESI Form Approved. <br />DISCHARGE MONITORING REPORT IDMRI q T V ~ OMB No. 2040-0004 <br />I1-161 17-191 7 <br />0000 3211 015 X (; ! c n v •~~ Approval e>~iree 05-31-98 <br />PERMIT NUM9ER DIBCHMGE NUMBER P _ r I q q i, n~ ~> ;, <br />MONITORING PERIOD s'"'DTE VET T°5'"Ign F')? D16A <br />YEAR MO DAY YEAR MO DAV ~f- <br />FROM - t0 - - 23r M~ DI ql-HAFT, ~' 17[ ( #!R <br />!?O•?U IZ?-? 1 !?1.751 - !?5-vI !?e-?sl 13a3o1 NOTE: Rsed ImtrucUarr bdor('aompletlnp this form. <br />TY OR LOADING /1 Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br />151-511 138-~51 /16-631 154-61 EX DF <br />ANALYSIS TYPE <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /u-esl 66-661 169- o <br />CERInDA~NAIA <br />Ar3A 1 U U <br />FFLUP.kT ;FOSS VALIJ <br />CSD STiT~:F: 96gP A!= <br />A;~FrC 1 :! ~ ;1 <br />Ph'LUENT SR755 VALH <br /> I 71 <br />SAMPLE 3C#2?# RaRaaR ~ *.c-~c-o tpr.,••,.• ( ~' T) <br />\SUREMENT <br />~PERNIIT:::S: ~: ~:~ <br />' .~~ :#~. .~::. : `:.. 91#~~?~#~::.. #II3 '11..:r:: ~.:~ ~:~~r::~: i~: : :C;.~id'###~EL: ~ ~ ~~~#.k.xt.:^: <br />~ ro- ;.T~q~:'~~ <br />r.g~t: <br />1111REMENT: . <br />; .~ ~:.. :.-:.:.. ~. ~ :.: :: .:.:.... ~..:::.'-~.;. ~.: •:~:~ #30R '::':~~(:;~!.~?ri~~:~ :~ .::(..:.:.~ ... ~~::~ ~~ ~ ~ rrYT <br />SAMPLE $-". -FC ~>k QVC#r# #+.`-:`'-.•• ...` ~ 7j~ <br />\SUREMENT <br />~~.:F.'ERMIT' <br />iEOl11REMENT~. <br />SAMPLE <br />7EASUREMENT <br />.`. PERM.LT'.- <br />iEQUIREMENT ~~ <br />~~ ~ ~ SAMPLE <br />LRY•'~~VFQ+C~It~RX.:'r.::l....:. ~O.t.~I~IP~.fk~...~f'FNT I~:.:~ I~'C'E!L <br />r~.'~.~....:. <br /> <br />SAMPLE <br />. ..: ........ ..... .. ... . <br />:REOUIREMENY: :.. ~~~~.::....:..: ~.... .: .. ~:.: .. .: <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW TNAT 1 HAVE PERSONALLY E%AMINED AND TELEPHONE DATE <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASFO ON <br />MY INQUIRY OF TNOSE INOINOUALB IMMEDIAT0.V RESPONSIBLE FOR `. / <br />1'1. Gordon Peters OBTNNIMG THE INFORMATION, 1 REDEYE THE SUBMITTED INFORMA710N 19 7~~ ~~~ 970-824-{i{i01 DO 01 2: <br />President /General Manager SGNEFICANTA ENKTIIES FOq SUBMITINO f/~LSE N ORMAT~ION INGLVD NG / <br />THE POBSIBILITY OF RME AND IMPNBONMENT. SEE iB U.S.C. ! 1001 AND ]] iIONATURE OF TRi1NCWAl EXECUTIVE <br />U.B.C. ! 131 e. IMrM.. urNr M~ .brora nrY YsAM Frs. W ro ! 10,000 <br />TYPED OR PRINTED .nswmuirwnL,w'~eyn.eraar..e, snronN,W SYrr+l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRslrrsncs a//attachments hsrel <br />SES~I.A.2• PP 7-4, FOR DEPAILS OF TEST PROCEDORE, RRPORT LC'"0 - ST ATISTI"AL P'TT•T r.TT"AT° Y4Ir'p I•; <br />;g Lt: AL SO 5UA OP TEST 1RGARiSPS, AND ATTACH ACOTE T01(ICIT7 :'rST RPPORT FORK T'1 n'7. !'1~PTc': r)F' 4L[. <br />i' R • - I ar v I FiFn r <br />`\~ EPA wm 3.720-1 108.951 ProV10Ue editions may be used. (REPLACES EPA FORM T.jO WHICH MAY NOT BE VbE :1- ~ <br />- OD133/99 047 1-10 3? PAGE 1oF ` <br />