PERMITTEE NAME/ADDRESS (1MiaY FAeWryNoWLeeaua~VDl))bw0 NATIONAL POLLUTANT DISCNAAOE R3MIMATION 9YSTETA (NPOESI Form Approved:
<br />NAME S e e s c A C OAL C O tf P Ali Y DISCHARGE MONTTORINC~:~(IPOIET /DMR! ~ 2
<br />7-/ei ,~}~ nas D I SCNA RGE ;0::T12Q p~~~e
<br />I
<br />e~Be
<br />k
<br />ADDRESSDRIIibH D ;~.;" (90Bfl YY). ::2c' i ~
<br />i~
<br />I aAYDtiN .CD 81839 PERMITNUMB R - scNAAOENUMem a -" rZSA ~ ~;;..,
<br />nltlQe
<br />_ -
<br />FAaLrry ORING PERIOD
<br />'?~
<br />~Y ~ M YEAR MO DAY
<br />k
<br />LocAnoN
<br />~
<br />.D,;
<br />tlAYU6Y CO 81630 FaoM ro 03 . 31
<br />El~BSE• ~ i~*
<br />thisform
<br />MEln
<br />~o
<br />b
<br />•
<br />.
<br />p
<br />mp
<br />s/«
<br />•. Rs wctlorr:
<br />6YSW:~.• l3OD Bi73Rlle 8Er6HAL IIAN-GER no- ;~ 2<-7s~ 126-771 128-191 /30.311. ='~ ~
<br /> PARAMETER l3 Grd Onryl QUANTITY OR LOAD .. _ I<Grd Onryl QUANTITY RATION ~ +(j10, : ENL,'
<br />TREG
<br />U SAMPLE
<br /> l37-371 !/6531 15/-67 /,48-Ibl !<G !5<-BI fx ~ F
<br />O
<br />' AIIALy518 TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS•:. l~f:ssl ',lµ581 les7o)
<br /> FLOiie LN COlIDUIT 6d
<br />tlRU T!tEA'TREY4 PLAN SAMPLE
<br />MEASUREMENT
<br />D_ C L
<br />G - I ~ v { 03) rIilM~il4
<br /><
<br />.~.
<br />' >'
<br />~ +><an><aa b'a'+~~~'
<br />~ ~
<br />-
<br />
<br />50050 1 0 0
<br />
<br />.
<br />R&
<br />_
<br />`
<br /><«
<br />~X~L :
<br />'
<br />.
<br />;
<br />.
<br />'
<br />~
<br />:;%
<br />;:::.:.Oi!'0~#~~.
<br />. 4±tl~;?TSM4+fl`:
<br />:
<br />iO* ;:. _
<br />z~`-. ,
<br />: ~:~
<br />.Y'~+
<br />.,
<br /> EPFLU :Y2 CiD Y L8 ,
<br />,FEQUIREMENT: .....
<br />.
<br />;
<br />.: ..,., . ...,
<br />.
<br />.
<br />...: ...: :.::. .
<br />......
<br />~;,,::.::
<br />.._ ~ _ Q •~., :
<br />:,::.r;;:.;
<br /> ' SAMPLE ~ >
<br /> MEASUREMENT ~''~ ~~
<br />~.
<br /> ,.:~~. ~PERMIT.~ ~ : ~ ..
<br />~;; .:~:.
<br />.:
<br />~
<br />
<br />:..
<br /> ~REQUI EMENT ~ ..:~,.
<br />..:: ,...... ., .:
<br />X:~., .
<br />.
<br /> SAMPLE -
<br />~~
<br />•
<br /> MEASUREMENT _ ~ ~` '
<br />:
<br />ti ~~~
<br /> .PERMIT .: .. ~:: A r .^.: ~:,.:~:~~ ~-. ~~ .~ :,:
<br />
<br />... ~ ~ ~ :. ' :.
<br />
<br />
<br />'. '.:: . .,.:':'~~: ;~:..
<br />-
<br />
<br />w i;'::~s::.f<. '%"•:'~~<~~~•,~~r::
<br />
<br />
<br />
<br />..
<br />.. ....
<br />
<br />
<br />
<br />
<br />:: ~~:4'
<br />
<br />.'':'Yr...: ~ f
<br /> REQUIREMENT. :. ...., ~.~,;.,."a ...
<br />:.: :~~.... ... .
<br />.. :. .. *
<br />...-. :«...... s.....
<br />. . ,
<br />~::: ~ ~ PERMIT: ~~ ~ ~..:::.;::~ ~ ~..y'~:,~~ ~;::.:.. -
<br />. ...:
<br />;.: •.
<br />::,;.
<br />' :REQUIREMENT .: ~ ~ z,: ~ .;... ~:`:~:.~ ~~'
<br />... ..
<br />SAMPLE ,
<br />MEASUREMENT F
<br />REQUIREMENT ~ ~: ~:ii :':: ... :. ...-,..:~:;~~':. ~~~~~
<br />:..
<br />SAMPLE
<br />MEASUREMENT
<br />. ..... ~ ~~ Y i:.'.:: ~ . ;..
<br />.. ,....a , Yrpq: ,..:. ..... .. ~~
<br />PERMIT ~ . :. ' ~~
<br />.. .. .... x.~:.::. :. ~ •~~• ~~.
<br />.REQUIREM.ENT ~ :. .:N .:: t. ";.-.>~:,:. .. ... :.. ~~. ~.
<br />SAMPLE
<br />MEASUREMENT
<br />:. ..
<br />.REQUIREMENT: ~~ ~ ~ '~ ~~ '~~~ ~ ~~~
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERnFV uNOER PENALTY pF~tAw TNAT I NAVE PERSONALLr E%AMweD AND ~ TELEPHONE DATf
<br />AM FAMILIAR VrrTH THE INFORMATION SIAMETTED HEREIN; AND BASED OM
<br />MV INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ~'~
<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INF011MATON IS
<br />TRUE. ACCUMTE AND COMR.ETE. '1 A/A AWME'THAT THERE ARE
<br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING ~
<br />THE POSSIBILITY OF nNE AND IMPRISONMENT. SEE 18 U.B.C. E 1001 ANO 7J BIONATURE OF INCMAL EXECUTIVE
<br />U.S.C. ! 1 J t e. lArnMl~1 udw Ows Nrl/roF mFY iI[ANI Bnrs Iq ro t 10,000
<br />TYPED OR PRINTED .,,Y w,rv..tm~r, hpr:vwlvr et A.wwl ema~rNA W 6 rwa/ OFFlCER O UTHORRED AGENT CpOE NUMBER ~ R MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe/srence e/l sttechmsnts here/
<br />T55 LIKI! PILL 8E WANED AMD SL'TtLEABLE SOLIDS LItlIT APPLIED POR <=l0iR,2tNH PRECIP EYS94= 45S 6
<br />SEYtLCl8L6 SOLIDS LI!!IT WAIVED P08 )lOr@e24NB PRECIB EYEY.T S08JECT TO 80YDER DP RSOOP 2i~ I.3e2. OIL E
<br />EPA Fwm 3320-~.IOS-9Ei Previous ediGOns may e~us ^' ~ (R ,I=ORM ~<0,(1(ENI6,~( IIAAY~{QI @E USED.1 PAGE OF
<br />pOp~O jpB091+t-0921 ... 1
<br />
|