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PERMITTEE NAME/ADDRESS (/nclude Faciliry NamdGocanon ifDifferenr)
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES) FORn Appfoved.
<br />DISCHARGE MONITORING REPORT (DMR~
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<br />9
<br />- OMB No. 2040-0004
<br /> (4.161
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<br />Approval expires 0531-98
<br /> PERMIT NUMBE DISCHARGE NUMBER ~ _ c• r ,; 4 , ;, ~ ~, A „
<br /> MONITORING PERIOD r "' ~T I ',; )
<br />~' ~`~ T ~ ~ T a '• r ~''~ ~' v
<br /> YEAR MO I7AY YEAR MO DAY
<br />FROM 9 n n T 71 TO "/ D ^ 7 ~ ,~ ^, r. ;: y 'T ., , o ~ ~ ~ p r- :• ( I "~..`
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<br />PARAMETER (4653) (54fi1) 38-45) (46.53) (54-61 EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS avatvsls
<br />70
<br />69
<br /> (62ui1 (64-68) -
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CER
<br />AM F NDEfl PENALTY OF
<br />WITH THE INFORM LAW THAT I NAVE PERSO
<br />ATION SUBMITTED HERE NALLY EXAMIN
<br />IN; ANO BASE E
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<br />~r TELEPHONE DATE
<br />
<br />Richard tills INQUIRY OF THOSE INDIVIDUAL
<br />THE I FORMATION, I BELIEV S IMMEDIATELY RESPONSIBLE FOR OBTAINING"•
<br />E THE SUBMITTED INFORMATION IS TRUE,
<br />T THERE ARE SIGNIFlCAM l
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<br /> ACCURATE AND COMPLETE.
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<br />970-870-2712
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<br />NUMBER
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attacnmenrs nere)
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<br />3320.1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) m PAGE OF 1
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