Laserfiche WebLink
PERMITTEE NAMElADDRESS (Include Faciliry Name/Gocanon ifbij(erenq <br />NAME <br />.:HAPFeH RIhING. ]VC. <br />ADDRESSI R A P F E R C I h F <br />F.C. a0S 18'1 <br />FACILITY C H A I G C G b l o t <br />LOCATION <br />TTh: M. GURLGb PkFS G :1 ;n <br />NATIONAtiF+OILyLUTAATOISCbIARGE EUMINATdONSYS iNFbES/ "~ <br />RAR <br />MONR <br />R <br />NG REPORT <br />DM <br />D <br />ISC I <br />( <br />O <br />GE <br />(246) N7~ 91 <br /> S <br /> PERMIT NUMBER DISCHARGE NUMBER <br /> MONITORING PERIOD <br /> YEAR MO DAY YEAR MO DAY <br />FROM C C C ~ C TO ' <br />f~0-21) (22-2J1 (2d-251 f262I) (28291 (30-JQ <br />For7D Approved. <br />OMB No. 20400004 <br />F I N C fi Approval ezplres OS-31-98 <br />(SUHfi Ifl) <br />f - FIbl1 CCFAT <br />ACU1E :F1 1E°_1IbC ECF L'1SA ~~ <br />{ b' { . <br />### hC []SChIIFCE ~~ ~ ~## <br />NOTE: Read Instructions befor mpleting this (d ~ ~ ~, <br /> (3 Certl Onry) QUANTITY OR LOADING (4 Cerd Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SA <br />PARAMETER (4653) (54-61) (3845) (46-53) (54~61J EX OF TVPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(s2~ ) ANALYSIS <br />(6468 <br />- 69-70 <br />LCSU S-LATHE 4dHR ACU SAMPLE Y*'~+Y~x~ ~+aa#v# ###### otKtc# ( 11) <br />L GFICD APH NIA MEASUREMENT <br />A ti j N 1 U U s s'rt`~~ , ~ ~14'AXSAuR r/3i1i11 r, <br />~ <br />~ >: o # ~~ <br />.~ <br />" `..I~~p~l+~## <br />. ~IIP~E+i~i# , F F - ~ <br /> <br />j ~ <br />FE'LUEN'I GRO c ENT - <br />_~; "^ . <br />' :;,~F4 d ~'t' `` <br />~ i ~ ~ E I «s~ - <br />LCSU 5TA'tFE 96HH ACC SAMPLE "'#Y#'x ###### ###### ###### ( ~_) <br />FitiEPHALES MB1Tx6UREMENT <br />'AAbC 1 0 0 ;_ii#ALr#fA :T+p~#ar1;-~ +t## Iv."';:~'F: F ~ ~ ~~ !F- I,~ k.'~.~ •tl;iE <br />EFF' UENT G Y U ~~ ~~ t+C3# ~ ~ ~:v .''P`" > a~ s~- <br /> ~~ <br />~ <br /> SUR <br />t1ENT <br />MEq <br />. .> <br />r ,.,~E <br />w <br />~ <br />. . __ - <br />~p, <br /> ENF ' <br />` <br /> SAMPLE <br /> <br />MEASUREMENT <br />- D <br />~ / "~ <br />- G~~a <br />)~ , <br />'. <br />- - - <br /> ... <br />P ~ <br />~ <br /> SwF <br />pEq <br /> <br /> SAMPLE <br />' MEASUREMENT <br /> <br />R ,._. <br />~ ~ r <br />~ <br />~ <br />y " <br />'z ~ <br />`~ <br />" <br /> <br />) <br /> ~IjAENF <br />f~EDL1I ' <br />~ ~ "+ <br />. <br />^ 4,e <br /> SAMPLE <br /> MEASUREMENT <br /> .PER~1.~~yiT <br />T <br />I <br />' - - ~ - -7„: <br />"~' , - , <br /> EME <br />N <br />IiEQU1F - 1 <br /> SAMPLE <br /> MEASUREMENT <br />PE ~ : ,,. <br />„' <br />+:, <br />, . <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMIOAR WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HER NALLY E%AMINED AND TELEPHONE <br />EIN; AND BASED ON MV DATE <br />INQUIRY OF THOSE INDNIDUAL S IMMEDIATELY RESPON / <br />SIBLE FOR OBTAINING <br />~ <br />'~ <br />~ <br />EV <br />9 <br />R <br />O <br />I E <br />HAD ~/ <br />970-824-4401 <br />/'~ <br />' <br />T ^^ <br />M <br />R DD ~4 Z7 <br />E~ <br />RATE <br />AND <br />OMP <br />F1. GO ZQOR PQCe IB ACCU AM AWARE T <br />T TH ERE <br />ARE SIGNI <br />CAN <br />PENALTIES FOR SUBMITTIN <br />Pre$idnnt/General lfanager POSSIBIUTYOFFINEANDIMPR G FALSE INFORMATI <br />ISONMENi.SEE1eU.S. ON, INCLUDING THE <br />C.§1001 AND 33 U.S.C. $IGNATUREOFPRINCIPALEXECUTIVE <br />4 1319. (Peneltres under those <br />TYPED OR PRINTED maximum ~mpnsonmenro/befwae statutes may Inclutle lines up to 510,000 end or <br />n6montns end5years.l OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />~:- I.n.2. PF 7-9, FCF CETAILS CF TEST PflCCFCUFE. P+EFUF1 LCSC - 51~1ISTICAI FCIb1 E°_111A7E Fh]Ch ]5 <br />Lr.'1NhL TG SO%~ CF TE57 G6GANISI'IS, AND ATTACH ACUTE 40%LC1TY 7ES1 FEFCF.T FCHtl TC ClF. CCFIFS CE ACL <br />Elite t orm ~ 2b-'Y `( -9 ~ Previous editions mey of be used ( P -E RM -4 W ~ Y BE •) C C 10 8 / C C C 7 1 1- I E i 4 GE I OE <br />