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PERMITTEE NAME/ADDRESS (/nrlude Faciriry NQTPlraearlen ifDiperant) <br />NAME TRAPPER "ItiI"(~, Ir;~. <br />ADDRESSp}(APPF'3 `!itiE <br />2. ~. 'SJY l'+/ <br />FACILITY <br />LOCATION <br />A~.°T`I: i• (i )}15:x. P: 'C •'rf'~. /'7 ~.,;i~~f. :1 <br />NATIONAL PpLLIftANT DISCHARGE ELIMINATION SVSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />••r rl ~ , <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM `+ TO u 1 O j 3 1 <br />Form Approved. <br />OMB No. 2040-0004 <br />~tIH.~~ <br />(~ lR `In) <br />r' - .. VAL <br />HU'r.IFF/aItlc: iiTR TO Gds( ~ULi:d <br />h"° n~ ~.~cHARCF I I ~.;.A <br />NOTE: Reatl Instructions befor~pleting this form. <br />M; r'p.. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER EX OF TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS aNUVSfs <br />J:L ANll ORL'AUt SAMPLE .: ;`' ( ''i) >kG?0=k>X #i. tr',r ": Vt L=r,::k+k~# <br />V 1 =% U A L MEASUREMENT <br />>i4Ub6 1 U U ~;': EHMFf- "At#KrNt~$- R ['qR~ E~•=r ', -. <br />~ <br />„ '•e ~ .'.~ G#~ <br />~:YF'LUE;+T GE<OS:, VALU H>=,gUItiEMENT IYi3T Ml•X ,:'-I' },' <br />~ ;;,~ vo,. i"' Q#6# <br /> SAMPLE <br />~,~~ MEASUREMENT ~~ ~ ~ - <br /> , _ <br /> ' ~'~ PERMIT <br /> HE4UlFiEMENT <br />.lx <br />~~ <br />r :j: <br />~ ' <br />T ~ <br /> SAMPLE j - <br /> MEASUREMENT <br /> ~f1EdUIREMENT , ~ '~~~ ~ ! ~ <br />"~! , ~'~ <br /> <br />r <br />, ,, <br /> SAMPLE - r~ <br />r <br /> <br />MEASUREMENT <br />( / <br />I <br /> " "PERMIT - ~ . 1 =„s .."" <br />+p ~s~ s s ` 4; ~- <br /> R~gU1REMENT <br />]f. y <br />( <br />M x <br />~ N <br />k <br />_ <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br /> REQUIREMENT .„„9 ~', x;;,, . ,w , nrs`, <br /> SAMPLE <br />. MEASUREMENT <br /> s. <br />~' -#'EAMI~` 5" <br />~ ~ S 3r. t <br />. .+_ tr ~ ~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> =,~ERMIT . ~ , , ,; ~, r u <br />" ~ n . ~ ~ <br />~ <br />~ <br />^~= . <br />'~ . <br />r <br /> R~(lUIIfEM~1dT 3 ) r ~ r ;~ <br />` ~~ ,. P~ <br />' r ~ :~ <br />y ~, " <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I Ceniry under penalry of law That this document and all anachmerHa were <br />i <br />i <br />di <br />i <br />i <br />i <br />d <br />t <br />d <br />d <br />i <br />d <br />d TELEPHONE DATE <br /> gne <br />prepare <br />er my <br />rect <br />on or superv <br />s <br />on <br />n accor <br />ance w <br />th a sys <br />es <br />un <br />em <br />to assure that qualified personnel properlygatherend evaluate Nelntormallon ~~~~ ~_ <br />~ <br />r <br />+- <br />W, Gordan PeCeTe submitted. Based on myinquiry of the person or persons who manage the system, <br />or Nose persons dlrecfly responsible br gelhxing Ne inlortnation <br />the Inbrtnetion J / <br />• <br />- 970-824-4401 ~I Lei 2f1 <br />President/General Manager , <br />eubmided i <br />to the b <br />t of m <br />kn <br />led <br />e and b <br />lle(true <br />accurate <br />om <br />lete <br />d <br /> y <br />g <br />p <br />. <br />s, <br />es <br />ow <br />e <br />, <br />, an <br />c SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED ORPRINTED l am aware that Here are sigMrant penalties for submitting false inlormatlon, <br />includin the sibi0 offne and im risonment for anowin isolations. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY V1utA nUNS (nererence au artacnmenrs nere) <br />,.. ~ TAT-L iHON LIf1IT3 HILL RE wAIVE9, Atli? SETTLEAPLE SOLIDS LI!II'f APPLIED t")H <=10Y$,24'fFt PRECIP EVEdT- <br />BURllEN qF PROOF P.E~IJIiiE'1dNTS UNDER I.A. 3. TDS '"OllITORING - I.tt.3. UIL G3EASE - 5EE I.B.1.(D). <br />EPA Form 3320.1 R /99) revious edlttons may be usetl. ~ • n D a 7 r E n n n ~ ~TIjiIS; ~Ai PART FORM PAGE ~ OF _ <br />,I <br />i <br />~ y;! r <br />