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PERMITTEE NAME/ADDRESS pbrL f:WryNw/Jocanm UDrpwmO
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<br />LOCATION
<br />r MMENTS AND EXPLANATION OF ANY VIOLATIONS lR6/erence ell eEEechm6nu hers!
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<br />EPA Form 3320-7 108-951 Previous editions may ba used. (REPLACER EPA FORM T-40 WHICH MAY NOT BE USED.) r „ r ., ~ / ~ ~ r _ PAGE 1 OF
<br />NATIONAL POLLUTMT DISCNMGE ELIMINATION SYSTEM INPDESI
<br />DISCHT R6 E MONITORING REPORT lOM9/
<br />PERMIT NUMBER DISCHMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM " .. TO '- ~ - -'.
<br />!1017/ !?T-131 /7475/ !?677/ /78-79J /3631!
<br />Form Approved.
<br />c C " T ~ (`J « T': T T. v [OMBj No. 2040-0004
<br />(r 1_ ~ r n , T Approval e>FPiSes OS-31.98
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<br />NOTE: Read Instrucdoro before eompletinQ thin form.
<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !~ Grd OnlY1 QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> le6531 !5451/ l38a51 14653 5451 EX GF YPE
<br />l3Z-371 MN.vss T
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !63.631 !5/.581 !56701
<br /> SAMPLE .. ( , I
<br /> MEASUREMENT
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<br />NAME/[1TLE PRINCWAL EXECU7NE OFFICER I CERTIFY UNDER PENN.TY OF LAW THAT I HAVE PERSONN.LV E%AMINED MD
<br />AM FAMILIM WITH THE INFORMATION SUeMITTEO HEREIN; MD BASED ON TELEPHONE DATE
<br /> MY INOUIM OF TXOSE INDINDUN.S IMMEDIATELY RESPONSIBLE FOR '
<br />1
<br />{ chard A. I4unson OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS •
<br />- TRUE. ACCUMTE AND COM0.ETE. 1 AM AWME THAT THERE ME
<br />SE INFORMATION
<br />SIGNIRCMT PENN
<br />TIES FOR SUBMITTING FN
<br />INCLUDING
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<br />. lre f7'e~ldent ,
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<br />. 970 723-421 9 1~ !)1
<br /> THE POSSIBILITY OF nNE MD IMPRISONMENT. SEE 16 U.S.C. E 1001 MD ]] gIONATUflE OF PRINCIPAL EXECU7NE
<br /> U.S.C. f 131 p. fMMIeN. Indr r/NAr .YNna nrY ichM rw. W ro t 10,000
<br />TYPED OR PRINTED AMwnAwirwn`Nwf+arnrnf of Mrr.An 6nwnera rW6y.Ara/ OFFlCER OR AUTNOR2ED AQ'EN7 CODE NUMBER YEAR MO DAY
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