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PERMITTEE NAME/ADDRESS (Inclydc Faciliry Namr/Locarion JD~erenq
<br />NAME
<br />TRAPPER ill NISG, !h',.
<br />AODRESSTPAPPF.R '1I!:E
<br />P.O. d`VX 17T
<br />FACILITY C H A 1 G
<br />LOCATION
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<br />fi. [.~ M• G~k dO,^I 2t TF4J, PCES/v','.'N i~Dp.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDE'S)
<br />DISCHARGE MONITORING REPORT (DMR)
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM :. 1 1 TO '~ 1 0 3 31
<br />Form Approved.
<br />OMB No. 2040-0004
<br />".INrJR
<br />(SU$R !IY)
<br />F' - FitiAL
<br />DISC~iHG 'TO FLU!1F. ;IILC
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<br />NOTE: Read Instructions before plating this form.
<br />M~PAT
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER - EX OF TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~~rs
<br />~" SAMPLE ?:CS ~4 ~G«aaa :F tth¢:k:,: ( 12)
<br /> MEASUREMENT
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<br /> MEASUREMENT '
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<br />~~ MEASUREMENT
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<br />tPGU6NT 68055 YALU REDUIREMENT ~.
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<br />REOUIRENIINi`
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<br />.LIDS, -TOTAL SAMPLE $ ;:'k;~ a><taaraa a#~trau;t ( 10)
<br />.LSSOLYeU' MEASUREMENT
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<br />NAME(TITLE PRINCIPAL E%ECUTIVE OFFICER
<br />' ICeniry under panaly of law that this document antl ell ettachmemswera
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<br /> Based on myinquiry o/the parson or
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<br />W. Gordon peters .
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<br />the information 970-824-4401 OI 04 "b
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<br />PLesideAt/General Mena P.L ,
<br />subminedis,tothebestofmyknowledgeandbeliel,rrue.eccurata,andcomplete. SIGNATURE OF PRINCIPALE%ECUTIVE
<br />
<br />~, TYPED OR PRINTED I am aware that there era 6igni(ceM penalties for sWmltting false Inlormalion,
<br />inciutlin the ssibiii of line antl im risonment for knowi violations.
<br />OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/stance all attachments here)
<br />"35 L' TOTAL~IRDN LI81T5 'TILL 3E w6IV?,O, ANC SETTLEKHLE SOLIDS LI)'.IT APPLTF.D FDR <=l0YR,24HP, PHECTo .u,Vt::+^-
<br />ScE RU!LDEN OF PHOOF RE.)ULREME:NTS UNDER I,A.3. TUS 21JN[TORING - I.U.3. OIL ~~ 'SkEALSE -,g SEE I.8.1.(0).
<br />PA Form 33 7 9) revious a illons may a use ~ ~ y • 0 U 39 3 / 0 U D 71 7HI 1 35 OPART FORM PAGE I OFZ
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