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PERMITTEE NAME/ADDRESS (Include Faeiliry Name/Locanon i/D fferenr)
<br />NAME I'dAoPE3 ~I "~1:1 re Ic;,,
<br />ADDRESST R A [r P c" ~~ t;
<br />FACILITY _`tAIG ~D 91b25
<br />LOCATION
<br />91'-I';,: R. GJi2J[)`~ t'd:c. PsF.`i/'~~). y~^,~
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES)
<br />DISCHARGE MONITORING REPORT (DMRJ
<br />^ ^PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM U ) 1 TO O 1 0 3 31
<br />Form Approved.
<br />C I V U P OMB No. 2040-0004
<br />(SJtlR 'iif)
<br />F - FI'iAL
<br />DIS~',?AitG~ TO HOi:SF. GULCH
<br />CG F.4 T.
<br />NOTE: Read Instructions beto ~e )plating this form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER EX oF. TYPE
<br /> AVERAGE ~ MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANal.vs/s
<br />f'.t - SAMPLE rP1/•.xAr: 4t~4#0# - ###CGr ( 12)
<br /> MEASUREMENT
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<br />I '7 )4e 'C07 ~.~. ., f~ SAMPLE ~ •.u::7:: :: r,:3 t: r: A :•: ;:.t,.
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<br />(A S I-$f MEASUREMENT ,
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<br />L i ~ D 1; Y E U MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICedily under penalty oNew that Mls tlocument end all anachments were
<br />i
<br />di
<br />i
<br />i TELEPHONE DATE
<br /> prepared under rtry
<br />rect
<br />on or superv
<br />s
<br />on in accordance wish a system designed
<br />- to assure that qualified personnel property gather and evaluate Ne information ~ / / ~~___
<br />~ .
<br />W. Gordon QeiET6 submitted. eased on my inquiryotthepereonorparsonswhomenagethesystem, C. e 970-824-4401 DI D4 26
<br /> or Ihose persons directly responsible for gathering the inormation, fha Inbnnation
<br />President/General Manager submihed is,to the best of my knowletlge and belief, true, accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE
<br />
<br />T1PED OR PRINTED I am aware that Nera era significant penalties for submitting lalse inbmtation,
<br />inclutlin the ossibili of fine antl im risonment for knowin violations.
<br />OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />I:VMMtN I A ANU tXYLANAI IVN. V r ANy VIVL.A I IUNS (F(ereterlCe all aRdCllmeOfS ^Blef
<br />L'~S °. 70TAL IP.O~ LI;7IT~ Y[LL RE ..4IYF,D, AND SETTL"nA9LE SOLIUS LI(1IT APPLIEi) FOR <=10YA,24RR PRECIP cYL'al'-
<br />iF.E 9URDF.N JF ?ROOF RF.~UIREMENT5 Ut7UElt I.A.?. TDS Y.7"IITURING - I.3.3. OIL f. GPEASE - SEE I.B.1.(D). 30
<br />A orm •1'( 9) revlot7s a itioris may a use ' ~ ~ ~ S ~ ~ ~ PHIS IS A ~-PART FORM PAGE . OF
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