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PERMITTEE NAME/ADDRESS Qnc(ade Faci(iry NameJLornnon iJD~ercn,) <br />NAME <br />ADDRESSnkAoPc2 ~.itil; <br />FACILITY-nAI.. ,._"ioL`, <br />LOCATION <br />' 7L'N: ~,e. (iJriU.i"i PE:'}~ rto. C<::.i ~.' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMq) <br />^ PERMIT NUMBER DISCHARGE NUMBER <br />MONRORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM '? 1 U 1 U 1 TO O 1 U) <br />Form Approved. <br />OMB No. 2040-0004 <br />'!INOR <br />(S'J9k hN) <br />c" - FIP+AL <br />ACUTE' k4T TESTING FOd 027 <br />f.7 GI:,CHARGE tt •'•r'"k <br />-NOTE: Read Instructions belo >7Mpleting this form. <br />Mc:r'AT <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION ~ NO. PREOUENC SAMPLE <br />PARAMETER EX of TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ava.ys(s <br />~:~J :i I'AT-R L' 4tS `iP ACU <br />~ SAMPLE ::: '~:::.: -, •. :`.:tr:k'.:t ;.;+#:: :3 ~ Z.~.) . <br />.:t:HCJDAPN9iA MEASUREMENT <br />P , `7 ~ d 1 U U <br />'PRRMI7' !:=S'~cRC:A #RUgt#6 ~:r't <br />~~ k,"ry <br />~ #,0, , <br />ER- <br />^'FL~.I~NT 6303 VALUE REQUIREMENT ~ ~ ~ ~~3.0$ ` 'v ,5'r~ '°" ~+~;->~'~" <br />L:SU STATRE: Yblld ACU SAMPLE :. 'x.=•:;:•; ~'Y*itdt #O#=iYtLj ~ 23) <br />r• I 9£ p f! A L £5 MEASUREMENT <br />14oC 1 U U :'1'ERfv11T~ a.'';erkiF#IS -p>Ot##iP0` "eC ~fl" .. ER-. <br />k"r'LU~'tiT GdJSS VA~LQ£ ~REQUIREMENT ~ ~ ~r:t:: N ~ •=~; '"+*- -p~ ~~s-: <br /> SAMPLE <br /> MEASUREMENT <br /> • . PERrdIT ~ y ~~ ~ <br /> <br />" <br />" ;;,~. ~ ~ ~ n.. <br />kb• •.. <br />~""t' <br />- <br /> <br />~ <br />~~ <br /> <br />~ <br /> REQUIREMENT ' <br />' ,~ „~, „~ <br />: ~ <br />"° <br /> SAMPLE <br /> MEASUREMENT <br /> "'PERMIT - ~ S~ ~ _ - ~, rJ ;~ ~ ~ <br />; •!~~ ~ t*a *,.: <br />~, <br />: <br />+= rn ~~, s <br />~ ~` nK.;_: <br />~~ ~' " r <br />"- ;~.a, <br />~ a <br /> REQUIREMENT P , <br />,~ 1 . , <br /> SAMPLE ~ ."1 <br /> MEASUREMENT V . <br /> ,Y t 'k ~P~ ~' ~ ~ ~~. <br /> REQUTAEMRNT .^. 'g w 3::nt, <br /> SAMPLE / <br /> MEASUREMENT l../ <br /> ' ~` ` ~ <br />', f ~ ~• <br /> Rk <br />QfllliEiVIENT ~' ti. tY y. <br /> SAMPLE <br /> MEASUREMENT <br /> i <br /> RE.QUIREjJIENI ( D A 4 R xiF I ~ <br />Y <br />_ S. <br />NAMERITLE PRINCIPAL E%ECUTIVE OFFICER I Ceniy under penalty of law that this documanl and all anachmenls were <br />i TELEPHONE DATE <br /> <br />- gnetl <br />preparetl untler my tlirection or suparnsion In accordance wnh a system des <br />to assure that qualilied personnel properly gather and evaluate the inlorma0on - ',/ <br />~„ <br />~ ~~ ~~" , <br />W. Gordon :Peters subminetl. Based onnryinquiryoltMpersonorpersonswhomanageNesystam, <br />Iha infonnatlon <br />or those persons direc0y responsible br geNenng the infom~atlon 970-824-4401 01 U4 26 <br />President/General Manager , <br />submined ls,tothebest olmy knovAetlge end belief, true, accurate, entl complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I and aware that [here are significam penalties for submitting false inbrmaiion, <br />indudin the ossibill cifne and im risonmenl for knowm violations. OFFICER OR AUTHORIZED AGENT A NUMBER YEAR MO DAY <br />~~ <br />~~p~. <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aft attachments here) <br />.;.£ I.Ar2~ PP T-4, t'Ok DETAiLB OF T'r.ST PROCdD'JRii. HF.POkT LCSU - STATISTICAL ^JIN'[' ESTZNATE AHICH 7:, <br />~'THAL TO SU+ JF TEST D9GA4ISMS, ANb ATTACH ACDTE ?OKICITY PEST kF.PORT F05+~ TO DM.R• COPIES OF ALL <br />EPA orm 0.1 ( EV Previous e i Ions may be used • ~ ~ T ~ ~ ~ ~ ~ ~ ~ ~ 'rF`il ~ IS ~ ~ OR E • ' Q <br />