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PERMITTEE NAME/ADDRESS pndude Farilin•Name/Lorarion fDiBerenU <br />NAME gEMECA CCAL CG."EASY <br />ADDRESSDRAIIEH U <br />BAYDF,N. CO 8163'1 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMRI <br />f2 f6J (1l~ 97 <br />C;000O[221 D]Y w <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY <br />LOCATIONUAYDEM '"'•Q0='81030 FROM <br />ATTM: G. NUU BEOMN, GENeRAL 1'F.NAGEk <br />Farm Approved. , <br />C I N C e OMB No. 2040-0004 ~, <br />(g U B k ! Y) APProval expires 05-31=98, _y <br />F - FIM11 FG~1T! <br />ACUTE -ET TE_T111G FCF C1kA <br />Yea NO [IECk1FGE ) _) a>Cs <br />NOTE: Read Instructions belo P completing this form. <br /> (3 Cerd Ony) QUANTITY OR LOADING (4 Cerd Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-67) (38-45) (46-531 (54-67) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br />70 <br />69 <br /> rba63f (64-68) - <br />J <br />( <br />I.IOU ~TA7'HLr 40H11 AlU SAMPLE "°~'''"^: r°~'~::° - opaaoa ~9ia>Q7 ( ~,"~,) <br />CERIODAPNNIA MEASUREMENT <br />TAA19 I U U PERMIT. a'RtD >rf ~'• M i <t10 ~" ~ Y>•i Ili F EF- •`.t~ ~~j1 .r `fiA L! <br />EPf'LUENS GROSS VALUE REQUIREMENT ~ ' loop. `{~-L <br />'(1~'^ s~ `~" CE IT <br /> , , , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - - - `~ +-~'pl <br />°F'~ "k~ <br />` - <br /> -REOUIREMENT ~~ <br />; <br />~ ` <br />P~ <br />~ <br /> , <br />_ <br />~ 1r-x <br /> SAMPLE <br /> MEASUREMENT <br /> -,PERMIT -. :' ~ -. ''. <br />- ,`-5 <br />~ r T~" a~ t ~ ;~ t`x <br />'~ - - . <br /> REQUIREMENT ' " - - r <br />,_ ~ <br />~r h,~ - - ~ ' - _ <br /> .. <br />. <br />*, r <br /> SAMPLE <br /> MEASUREMENT ' <br /> - PERMIT'.- ,~ ~' <br /> <br />' r'#'^ ~% ~h'~"-~9.{ <br />i~ <br />~ <br />h ~•, <br /> 'REQUIREMENT - - . ~ $~~ _ <br />~ <br />` <br /> . s'~ ,t y _ <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT - ' ~ -~ <br />~ '~ <br />~ ~ ''-" <br /> REOI`11REMEN_ T <br />' -; ~ ~~ ~ ~P '~ _ F „ t ~' " <br /> SAMPLE <br /> MEASUREMENT <br /> -:PERMIT . ~' ~ ~`'~' ~ ~s F `~ <br />F „ ~ ~ 4 t4 <br /> REQUIREMENT -~~ - ~ <br />• ++`~ ~ `Y~ ; <br /> SAMPLE <br /> MEASUREMENT ' <br /> '' a~~PERMIT r , <?~ `4?'~ .,_ r ~ is ,_, <br /> RE~LIIREMENT ~x .' ` <br />` 4 <br />~ <br />~ ~ <br />vj <br /> 4+ , 9. <br />,3A?..~, <br />. 3, . <br />, <br />Y <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY E%AMINED AND <br />ATION SUBM <br />TTED <br />EREIN <br />ND BASED <br />N MV TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUAL I <br />H <br />; A <br />O <br />S.IMMEDIATELV RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATION IS TRUE, <br /> ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBM <br />TT <br />N I AM AWARE THAT THERE ARE SIGNIFICANT <br />F <br />F <br />R <br />T y~`7 <br /> I <br />I <br />POSSIBILITY OF FINE AND IMPR ALSE IN <br />MA <br />ION, INCLUDING THE <br />G <br />O <br />ISONMENT. SEE 1e U.S.C. § 1001 AND 33 U S C. <br />SIGNATURE OF PRIN AL EXECUTIVE ~ Ul/ <br /> <br />TYPED OR PRINTED 4 t31 B. (PerwRies under mass slelNes may Include lines up ro St0.000 antl or <br />maximum tmpnsonmenl of Genvaenbmonnu end5yeers.) OFFICER OR AUTH RIZED AGENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />D <br />COMMENTS AND EXPLANATION OF ANY VIOfATIONS (ReIe2nCe al/ aftaChments here) <br />gkE PART L A.u Fad LLTAILS OP TEST PkOCP.DURT. A2iCriT LCMt5T CILUYICN )a EPFLUEN7) kN1CA IS LEiAA[ TC SCX <br />OP TEST .ORGANISAS (IC50) ANG ATTACH ACUTE TCYICITI TEST FE6CkT PCif iC CAF. <br />EPA,Form 332111 ~(OB-95) Previous editions may not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED:). <br />• t. <br />PAGE 1 OF <br />