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PERMITTEE NAME/ADDRESS (Include Fanliry NamrlLarnnon ifDi$erenr) <br />NAME TRAPPed ;Ti!:IVC,, Ih,.. <br />ADDRESSI+HA PPc:R !`: NE <br />Y.9. U~). L•il <br />FACILITY ChA IG .;~ IO;'rr <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <br />--, - <br />PERMIT NUMBER DISCR GE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM '? 1 1% i .t 1 TO 01 l <br />:7Z'1JR <br />(ST+N NM) <br />P - FIYAL <br />pQND To ul:~r <br />Form Approved. <br />OMB No. 2040-0004 - <br />PYFATT GULCH <br />NOTE: Read InstruMlons before'CDhlpletingthls Torm. <br />!7Jf'AT <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />RAMETER EX OF TYPE <br />PA <br />" AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~-ysfs <br />JIL AND :wR CA ~. SAMPLE ~ ( .:i4) ,r: {: ~::;: r• :::k;::3'.:. '.-=k;: r.fi~: <br />'v 1 i U A L MEASUREMENT " <br />t+tJ6b L J U PERMIT. 'otv#4d>a <br />~ ltEP19At" S':=1 ~O~k~Oll#0 ^~ 1~'MF ~'~?` ¢9+#" ~'~ - <br />,.:F'FLUE:+T Gr!") VALUE' REQUIREMENT ~ ~ Itf'?T "MXX `. ['=ti - - -mm- `~. °• iYO4 <br /> SAMPLE <br />~ <br />~ <br />~ <br />' <br /> MEASUREMENT <br /> '~ PERMIT - -. ~ - /~ ~ . .n ~;^~ 3 ~„-, <br /> iEQUIREMENT / - ^ ,_ , :=t * ~.; :~ - ;, .~ <br /> SAMPLE <br /> MEASUREMENT '~ <br /> ~'PEFiM1T <br />^ <br />~ ,'x ~r ~ : ~"~ <br />~`?~ ~ <br />~ ~; a w~~ <br />°, , . <br /> REQUIREMENT ~ _-' <br /> <br /> <br />- .: <br />~ -" 9 <br />~' <br />~ <br />:.x <br /> <br />.; <br />, <br /> <br />y <br /> SAMPLE / <br /> MEASUREMENT ! <br /> "".PERMIT 1 ! ;' '= t , <br /> <br />iii S <br />' <br />e , -n[ •` <br /> <br />RE©UIREMENT <br />- <br /> <br />" <br />~ {. ^1 .~i-h ryy ^Xy{. <br />x,, , , 4^ -,- ~. <br />,~a.;_= <br /> SAMPLE (~ <br /> MEASUREMENT v <br /> ^' 7 4'st ~ 1 .+.~ ~ r +;; <br /> REQUIREMENT j:. I 7 iM.., 3 { r 'Sit •f <br /> SAMPLE <br />~ <br /> MEASUREMENT <br /> ^ ' <br />- gEJ1REAA <br />~NT- <br />~flt3 . h~ <br />r~. ( I h <br />" h,~ %., <br /> , <br />, : i <br /> SAMPLE <br />~- MEASUREMENT <br /> ~y.~ „ f Ft F,~ l <br /> I1GWVrr~Y..nI1GNT • ~* yT, Y ~ ~, r ir.. H tr. 1, 4~ <br />*.: el I~i h(~i"• <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I Certify under penalry of law that this tlocument end ell ettachmenk were TELEPHONE DATE <br /> <br />' ~ prepared under my tlirection or supervision in accordance with a sysem designed <br />to assure that qualified peFaonnel properly gather and evaluate the Inbilnalion <br />/~ _ <br />~ <br />~'~ <br />W. Gordon Peters submitted. Based on myinquiry of the person or persons who manage the system, <br />the inlonnation <br />the information <br />ersons directl <br />onsible hr <br />atherin <br />or those <br />res ~ <br />La.-v <br />i' 970-824-4401 QI 04 ^_b <br />President/General Manager , <br />g <br />g <br />p <br />y <br />p <br />submitted is,to the best of my knowledge and bNiet, true, accurate, end complete. SIGNATURE OF PRINCIPAL E%ECUTIVE <br /> <br />' TYPED OR PRINTED l am aware that Here ere significant penalties for submitting false inlomietion, <br />indutlin the ossibib olfine antl im risonment for Nnowin violations. OFFICER OR AUTHORIZED AGENT NUMBER YEAH MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) . <br />:SS 6 TOTAL IR(ih LInITS MILL dE ~A24ED. AND SETTLF_AiiLZ SOLIDS LIMN AFPLID FOR <=16YR.24HH PR~.CTP BYe:t!^- <br />'i :'E BURDEN )F PROOF RE(~UIREt1 ENTS UNDER I.0.. j. TDS `ONITOR I:iG - I. H. 3. OTL S SHEASE - SEE L I{.l. (U). <br />A orm 33 -1 ~ 99) ^revlous e i ions may e u ed' ' ' " -' ' THIS IS A 4-PART FORM PAGE <br />nnl~IlinnmT~-I~so 2 OF <br />~ <br />