|
PERMITTEE NAME/ADDRESS (lnchde Faeil/ry NamNlocadnn IfAf(ermt)
<br />NAME ~t, E'F'~. ': ^I'.I , ..
<br />ADDRESS ~ _ p ~ o :... ;` I ~ ~ °.
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FOnn ApprOVOd.
<br />DISCHARGE MONITORING REPOAT (OMR) OMB No. 2040-0004
<br />CI'.J ,
<br />r, PERMIT NUMBER DISCHARGE NUMBER (y I + )
<br />t ' .1 I.
<br />MONITORING PERIOD ' ~' ~ ° ~~ '°C ~•'-' ~ .S ".'~ :. it LC
<br />YEAR MO DAY YEAR MO DAY __
<br />FROM .~1 -~J J1 TO ',1 ~i ~~ ~ s-1SC`[Ai.;~:- I__I.
<br />".C F' .
<br />
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER EX OF TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,wALrsrs
<br /> SAMPLE x::p ^r ~, ,'r: r:s': r::~~::<, ::
<br />~
<br />y ~ 1~) ~
<br />/
<br />~
<br /> MEASUREMENT 1 ~ + O 7 ~Vl~fy
<br /> . ..
<br />
<br />'1 ', L
<br />RECtU[q
<br />y ~'3
<br />.} :x r. r }
<br />i'',a.
<br />_
<br />; I;
<br />T
<br />~ 'r
<br /> SAMPLE
<br /> MEASUREMENT
<br /> `" °~ `
<br />`~ '~ T "
<br />ii ~T
<br /> AEU EN'C , ~ ,t
<br />I 1
<br />hW.- s
<br />} f, .:3 ~~,,,- 4. _ ,
<br />i -4:,
<br />y!q '•~~t. s-,
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ~'Y^~ MIS'
<br />~
<br />z
<br />~ F: ~ F:
<br />',~ a +}3 r -i; i•
<br />_-
<br />s r
<br />"` : „ v
<br />" rAa ~x r,;,,
<br />¢ •~d t
<br />"Ja k N ;$
<br />$ d* '.
<br />~ p°?'?
<br /> EMENT
<br />~~~ ' r ,;
<br />. 5~ ~
<br />;
<br />s :+r
<br />,. ^ar£ .
<br /> SAMPLE
<br /> MEASUREMENT
<br />
<br />
<br /> 4 ~
<br /> SAMPLE
<br /> MEASUREMENT
<br /> ,
<br />a.'. rt '-~'
<br />~'k~ ~'
<br />~°+h
<br />'
<br />~ t
<br />r
<br />'i ~~.+.vs~ ~_~
<br />
<br />~+
<br /> REQi11REMENT " s~
<br />*,+r h: r"AY+ra 2 ~~, S: =i.
<br /> SAMPLE
<br />] .S~ - .
<br />t4
<br />SAMPLE
<br />MEASUREMENT
<br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER
<br />;J, GOZdon Peters
<br />F ~.mi~ent/Genera! !'li::9~e:r
<br />TYPED OR PRINTED
<br />COMMENTS AND EXPLANATION OF ANY VIOI
<br />I~NT) ~• .
<br />I Cerbly under penalty al law that ttris dowmenl and ell ettachmenLS were
<br />prepared under my diredlon or supuvLSlon in aaordance with a system designed
<br />b assure that qu~ed personnel properly gettrer entl evaluate the inbrmation
<br />submlttetl. Based an my Inquiry of the person or persons who merege the ryetem,
<br />or ttase persons directly rasponslEle for geNering the IMOrmatlon, We inbrmation
<br />submitted Is , to Ne best of my knowletlge and belief, true, eccurele, entl complete.
<br />I am aware Ihet there ere slgni8cant penelaes for submitting false iMOrmallon,
<br />Inclutlina Ne poealbiliN of fns and imprisonment for krowirq violations.
<br />INS (Reference all attachments here)
<br />~~// TELEPHONE DATE
<br />"),.,~~'. ~"t~` 970-824-4401 O1 07 '!5
<br />SIGNATURE OF PRINCIPAL EXECUTIVE
<br />OFFICER OR AUTNORRED AGENT NUMBER YEAR MO DqY
<br />. .. `.- T;I'C?1, it?" ..I:..-_ ....I. .° .!'i .'P...'1°Lr .ll.li:~ i.?.,I, d.'f,,..D r`" C ? -' ~ ,5, ~-_
<br />... •~;:fJr. .l F' ...:):IF aE:OI .. ._.. .,.,~~.. 1.F.3. u;,.TTC: ,r.,_.., 1?cl ;Li ~'.' .)'1' _. _. In -
<br />EPA Form 3320.7 '3/9) rlbvious edrtions'rda'y tie tis~d. ~ `' ~' `" ~ ' ~ - ~ ' ' ~ -~ '` " ' ' - ~ c , r PHIS I$ A 4-PART FORM PAGE 1 OF ~
<br />
|