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PERMITTEE HAMEIADDRESS (!-"-ErWryNa•/lu•um IJDyLrS
<br />NAME 3E1A{~i'E :f ~1~li v~+r _.
<br />ADDRESS TRAI'i'F i' ~"i4
<br />Cali..:
<br />
<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLUTANT OISCNAROE ELIMINATION eY4TFM l/y/'GCJ/
<br />DISCHARGE MONITORMO REPORT /OMRI
<br />11-f51 17-791
<br />COU 3 115 COS A
<br />PERMIT NUMBER DISCHMGE NUMBED
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM TO
<br />110.111 l11-13! l1i15! /16171 l18-191 /36311
<br />Form A ~ proved.
<br />FONC R. TO f1IDDLEGN')Bf'1°f~~f4D-0A4~,OH
<br />(c I, P R F y) APProvelle~p)r~g05~31.98
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<br />NOTE: Reed InstrucUorr Mfore eompletinp this form.
<br />PARAMETER !3 Qrd onryl QUANTITY OR LOADING /e 6rd only! GUANTITY OR CONCENTRATION NO. FREOUENCr SAMPLE
<br /> l15-531 /5A-8Il 138-151 !15-63 15i5/f X
<br />131-371 E µ~rAS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS lerdl~ 1.851
<br />! 159-701
<br />n SAMPLE 1,: :~-:Ya'r Q~?44#'a fiY, #fk::# ( i2) 5
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<br />MEASUREMENT
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<br />JUyUU 1 ~ V PERMIT 4 '-k ~YJi $# 4#t: 6e~ a#aaa~ ?J.Q BER LY N`.;IT
<br />'rYLUEt:T ,.'G4S 'JALU REOUIREMENI" - ###XA MfM..~dti.('. rR~~I",'1}M S'1
<br />u~, :.':.SL SAMPLE ;'+444GS. ad;Ari.A# #a4444 ( 191
<br />:1 J 5 F' E N U h: MEASUREMENT ~ G S' - t S ~ ~d Gl/Itf
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<br />:.FF1.U8NT .,ROSS YALU 'RE73. IRENIENS
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<br />MEASUREMENT
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<br />EFt'iUENT GROSS YALO, :REnU1KEMENT 4:`?'f: ?QL/I„AVCi .LAI.LY pX 9L/L .,
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<br />n ::• SAMPLE .: :x ~.: r: :;::p;::x : ': r,.a#^nL ( I9)
<br />(AS 1r8~;, MEASUREMENT G.GIa Ci. Lie O ~~J ~/,(d
<br />u;(iv~ 1 0 ,0 PERMIT %Ji::R4k+C: :.:.3:z;:~ ##:x Saa4479 ~.C f,.O EIG j` ,HA.h
<br />.-t:LUENT GRO$5 !AL'1 .REOUIREMENT~~ ~.; - #*:+:~:x 3fCJ! AYG f.AIIY >4X M;/1. ~ NON.TR
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<br />., ~ MEASUREMENT .~ - Nff ,11
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<br />.Ft'LUENT GBOSS YALU ~EO.UiREtu1EN'C':
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<br />r .,.~ U SAMPLE ( 03) #*#a;; 44 ya#a #t~:u-'1'`
<br />:iaU TREATNt:NT PLAN MEASUREMENT O
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<br />cEFLU$NT SROSS YALU ~.fiEOC11REN1ENT
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<br />i~.°>OLYFJ MEASUREMENT ~YLO ~r~U v //V
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<br />i.F.°LUEN1' GROSS VALO REQUIREMENT. C ir:v C!f.1F .AVO LAIiY N.X t!G/L
<br />NAME?ITLE PRINCIPAL EXECUTNE OFFICER I cItRTI
<br />AM FA Fr TINDER PENILLTr GF LAW THAT I NAVE PERSONALLY ExAMINEO AND
<br />MILIAR 1MTN THE INFORMA710N SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br /> MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATON, I BELEVE THE SVBMITTED INFORMATION IB l / A ~ -
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<br />4J• Gordon Patera TRUE, ACCUMTE AND COMALETE. 1 AM AWME THAT THERE ARE
<br />INCLVDIMG
<br />SIGNIFICANT PFNALTIE9 FOR SUBMITTING FALSE INF011MATION %
<br />C` 970-824-4401 98 ] 2]
<br />President General Mena ti ,
<br />THE POSSIBILITY OF NNE AND IMPf1130MMENT.' SEE 18 U.S.C. ! fODf AND 7] i1pNATURE OF EYiINCMAI EXEClTI1VE
<br />
<br />TYPED OR PRINTED u.B.c. 7 !ale. lMA~e.• MIe.. N•r wnm• nl.y YNA.a• mr• w m f IO.OW
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<br />OFFlCER OR AUTHOR12E0 AGENT AR A
<br />CODE NUMBER YEAR MO OAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe/enncs N! ettechments heTel
<br />1'S~ 7U'inL IitO~ ;, T;+~"_ J[L:. ;!~ NAI'JP•J• A9J Sc'TTLFAr'1.3 E.7LiLG ii°IT I'FFLi°C fC5 <c}nY:±.24i!° F'r.F:(:I? Y-`pI•-
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<br />.n rr aY°~E:c ,~ tlT :+. ;' MItiNTUIY BarrDar.• IL6Lv•- r.~ujn(L.'-FPCiTEC-
<br />EPA Form 3320.1 100.951 Previous editions mey bs used. (REPLACES EPA FORM T-AO WHICH MAY NOT BE UBE0.1 ~ C ~ 7 1 / 9 7 ] : 11- : 6 U f, PAGE iOF Z
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