Laserfiche WebLink
PERMFF7EE NAME/ADDRESS (IMidr FaeWryXr/Lu•nm I/DljlfveuJ NATIONK POLLUTMT DIBCHMOE ELMINATON SYSfDA //NPDESI Fonn Approved, <br />NAME DISCHARGE MONRORING REPORT (OMRI <br />SBYECA 6014 eotlPapY 11-161 17-,3~ ~HAOrIC tlBt TESTI~~~~e sB <br />ADDRESS DxaY C'R D ~ ~ (gDd@ rY) <br />HaYDSr CO 41639 uM R OISCHARGENUMBER r - rtrat <br />FAauTV ~ ONITORING PER OD : RIIIOB <br />YPA DAY YPdR ' ~ MO DAY ~_ <br />LOCATIONYAYDEM CU d1b3U FROM D TO ~ ~ :.a i44 r0 DISCraRGE ( { oaa <br />at= Y t (i. B D D B S D Y TI ~ 6 BN 6 Y A L tl i M a G E k 110-1 /1 l21-131 !14151 !16171 /IS-19 lJq,giJ NOTE: R.ed Imtructian 6efon SdfipNtMO ale farm. <br />PARAMETER l30.rd Onlyl QUANTITY OR LOADING. lI;GId~Onlyl QUANTITY~p•CONCENTRATION ND, FflEOUENCY SAMPLE <br />/4653/ 154-611 ~'. .l3BJ61 !1653 /51-61 OF <br />l31-371 ~ EX ANALYSIB TYPE <br />AVERAGE ~ MAXIMUM UNITS 1 ~ ~'M.INIfAUM AVERAGE MAXIMUM UNITS let-eel 161-6g1 166701 <br />:BPPBCS STat@$ 7DaT SAMPLE pIRB[#OR 4aQaQQ "r,: ;.: a7QQba ar?#101611 ( 23) <br />L'HB CEliIOUAPHMI A. MEASUREMENT <br />TCP 3 B S U D PERMIT ' 41a4+01R 4 s.arR~fi. ... a~1a :...~,~; «,; ' ;; ; pNW!..:!Q1+k: ' ` '::~~;~L!d!?~:' e8- ..x~::! .. f1~~.3t ... <br />SEtr COHHdMTS BELOY REQUIREMENT, : J. ;swat ~, .~s <br />XEFPEC7 :iTata6 7DaT SAMPLE aaaaaa aORCIt. '; NII#s~Iot a1a00fi# ( 23} <br />CYB PIHE?al~LBS MEASUREMENT ,2 :, <br />~:~... <br />tCB6C S 0 D .;..:.::PERMIT.. .:. ~. ., dCl7!bO~FP .~i1atR 8!91>Y:'f.~.. .. ...: :~:... .~:: :::.:... - ~:. ~: :...~.~... <br />SEE COHtld9TS B¢LOY REQUIREMENT.:;,. .~ .. .::: . ,. ~. abt _ ..; :~:..' ~~ .~~..':..~ ..~;i_:;:ca..;}~.': ::>::.,. ,.. ::.:...:. .. <br />SAMPLE ~ A ..11 <br />MEASUREMENT 1/`C U{~; ~. I ::. ~ r V, v ~ U v^--c <br />. . <br />::. ..... <br />.... PERMIT. ,.~ ~..~~ :~ .... .. .. :,.... <br />...: ..........: ,. ... ..: ...:~:.'i. ;. ' 3 i';a is :::Eer:.';::..: ~:::;; ~~~ <br />... ..:..:... :.;V:::, .:., per...':'.:.; .. <br />}} <br />:REQUIRE ~ ... .: .. :. ...:. ~~ r.': ~.`. <br />MENT u <br /> <br /> .REQUIREMENT: ..., ~. .:,: ..... .. ...: .... .. .:..::, :f.::.:.-~:..,;;:~.:~::..,..• {~ ~ :~iti?"~`~r' '^a;':=<S'„i <br /> SAMPLE <br /> MEASUREMENT <br /> :.... E .... T ..:. ... ~ :: .:..:......... <br />; <br />:, <br /> <br />;:.,... <br /> EQUIR <br />EMENY <br />R <br />,.I <br />.. <br />~. <br />... <br /> <br /> <br />':. <br />:~:':~..-:~.': <br />: <br />' <br /> <br /> <br />.:..a.: i:.: <br /> <br /> <br />..... .: <br /> <br /> <br />:.:' . . <br /> . <br />. <br />. <br />.. ... ~ <br />. .. .. .. ... ..' . <br />.::..[...:: <br />.. .'. ., ....' ...r ,..:.:... ... <br />~ <br />:: .. .. ... .:. <br /> <br />.. . .. <br />,. <br /> <br />iii:.. ... .. . .. <br />:.:5.: <br /> <br /> <br />. <br />.::..... . :.i.::.i . <br /> SAMPLE <br /> MEASUREMENT <br /> c.< ,. <br /> R <br />ENT. . ...:. . :.... .:.: ~. <br />~ <br /> .. <br />....: .~ <br />....:. ... <br />:.... ...,..:~,.:.:. ~ :: ........ <br />.,.r ~::.. .i <br />. ~ :..:..:. ...... ... <br /> SAMPLE <br /> MEASUREMENT <br /> <br />~~~~~PERNIIT~~:.:. ~... <br />' .~:. .... <br />.......... <br />... ... ... .... <br />. <br /> <br />.......:.. . <br />..: .. ... <br /> ~REQUIREM NTi <br />E .:::;~ ......:...:.:. <br />::~s :~::::~,.,.:. .:. :.:. .; ~:: ..... ..,~ .: <br /> . . <br />... .. h....<:. .:.~::' ':..a <br />.... <br /> <br />....:... <br />... :........: <br />:..::..:. ~. <br />y. .:: ....::....:.:.::':: .' <br /> <br />..:..:.::. <br /> <br />f::... ~.:::...:. <br />NAMERITLE PRINCIPAL EXECIJTNE OFFICER I CERTIFY UNDE11 PENKTY OF. <br />AM FAMIL <br />M WITH THE INFO UW TNAT 1 HAVE PEABONALLY E%AMI <br />MD BA <br />RMATION BUeMITTED HEREIN NEO MD <br />SED ON TELEPHONE DATE <br /> ; <br />I <br />MV INQUIRY OF TNOSE INDIVIDUALS IMMEOiATELV gESPONAB <br />OBTAINING THE INFOIIMATION; I BELIEVE THE BUBMITTED INFORMA LE fOR <br />TON 19 <br /> TRUE. ACCURATE MD COMP[ETE'. I AM AWME THAT THE <br />IN <br />SIGNINCANT PENALTIES FOR SUBMITTING FALSE INFORMATION RE ME <br />CLlgINO <br />G <br />j ~ <br />Q <br /> . <br />THE POSSIBIL`tTY OF RNE MO IMPRISONMENT. SEE 1B U.S.C. E 1001 MD ]3 7 <br />SIONATIMLE OF <br />EXE <br />IRIVE ~ <br />1 ( <br />' <br /> u.s,c. E 53/Y. 1Pa1•N'•• uwr ee. mnm, m•r IIMId• 6n., w ro s roa00 PJtINCNAL <br />C <br />TYPED OR PRINTED wwmviiwJn irWm+wrFO/b•n•wnemmN•rd6yral OFFICER OR Ar/TTIORIZED AGENT ~pE 'NUMBER YEAR MO DAV <br />EPA Form 3320.1 108-95) Previpue.~ijione mey bs used. (REPLACES EPA FORM T . O~WHICH MAy,NOT SE.USED,1 .PgGE OF <br />Qoaast~.aogta•.g313 1 <br />