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PERMITTEE NAME/ADDRESS pndude F nliry NamrlLoratinn iJDiBerenO
<br />NAME r1iL~ frY 7 C'DAL CC''!PA RY, L.F.
<br />ADDRESS`7LGwYU MINF
<br />71J1 STATE H;G?'kAF ld
<br />"EExER CO 8101+~
<br />FACILITY
<br />LOCATION •'
<br />L`!V: J. L'. HAftMUN, :,ESFrtALcF?•
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ
<br />DISCHARGE MONITORING REPORT (DMR;
<br />(2J6) (1 ]~ 91
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<br />:'
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />FROM
<br />MONITORING PERIOD
<br />YEAR .::^'MO DAY"~ ~~ :~~ YEAR MO DAY
<br />
<br />(20~YtJ R2?31 fPa-251~ti~` (Y6~2]1 (ZB~29) (3031)
<br />Form Approved.
<br />OMB No. 2040-0004
<br />~'~ ° ~ Approval expires OS-37-98
<br />(5;181± ;f.)
<br />F' - F'?NhL CUFA1
<br />c n•GC-Tr.N r)'+'C!I TO l-(`I''D SPS` CP.
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<br />NOTE: Read Instructions before completing this form.
<br /> (`3'rBa d•Only) QUANTITY OR LOADING '~ ~ ~
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<br />~ (4 Cartl Only) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46 53) (54 67J (36 45J (46-53) (5461) EX OF TYPE
<br />(32~37J AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />(5s u3) ANALYS/S
<br />(64-69)
<br />(69-70
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HER NALLY E%AMINED AND
<br />EIN
<br />AND BASED ON MY TELEPHONE DATE
<br /> ;
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING I
<br /> THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE. _ ~ ~. I r
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<br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT ""
<br />i ~' ' r ~
<br />r
<br />_ 1 J`; FIA , •• ~ t PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U SC § 1001 AND 33 U.S.C. rr''Tt IIII
<br />SIGNATURE OF PRINCIPAL EXECUTIVE -1 )J ~ZY - JLt"~
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<br />TYPED OR PRINTED 4 1319 IPenames untler rnese slermes mey include Gnes up ro St0,000 and or
<br />maximum rmpnspnmenl of beAVeen6monrhs entl5yeers.) OFFICER OR 4UTHORIZED AGENT AEA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />~~.'.°T'L'ALLt: $OLT.Dt LI'~IT 4~rLI.F:S ,"JNLY TF ~=lUY%,:(1NF. PF:F.CIP EYE.ItT I.: C_A?!'':ii. IF CLAIt? A7Dn.7VL'C FY '.;'.'i,
<br />'T:;:; ~. !h(>A L7rITS SILL NU'I e= APf'LIF'D T~ 9SPnPTFD ^!r•'ASi1EF.M£Mi$ - S°L I. A. 2, Pr.. S f01f" RURDFN OF PP.CDF
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