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PERMITTEE NAME/ADDRESS pnclude FaciGry Nama'Loca(ion i/DRerenrJ <br />NAME. 58N£CA CGAL CCHCAKT <br />aoliRESSDHAYBH D <br />HAID6'H - CO 81:` <br />FACtun <br />t-OCATION~AYUEN CO 916J0 <br />AT1N: G. flUU EHG4N, GENERAL MAfiAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT (DMR; <br />' (z 161 ff]-91 <br />t~IIOE 1 D ~..i. . <br />.~. EyyR~MI~T NUMBER DISCHARGE NUMBER <br />~;. <br />.;' FROM <br />MONITORING,PERIOD <br />YEAR MO. DA Y YEAR MO DAY <br />~y ~y u ~ ro yy uy ~u <br />(LU LII (12-131' 12925J~4'~. IL4L/1 (Ltl-LY/ (JU JI/ <br />Form Approved. <br />f,I q 0 h OMB No. 2040-0004 <br />Approval expires OS-31-98 <br />(SUB& AV) <br />P - PI6iL tiGUit <br />CISCNR'6Q1 2C 9A6E CSEEB <br />.:F, <br />~~~ N0 t4"lCY~iLE (~1 oa>o <br />NOTE: Read Instructions befor. completing this form. <br /> (3 Card O <br />QUANTITY OR LOADING ~ <br />5 (4 Card Only) QUANTITY OR CONCENTRATION ~ ~ N0. FREOUENC SAMPLE <br />PARAMETER 6 <br />3 <br />( ) (54~61J (3B~45J (4653) (54-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNI~ MINIMUM ~ AVERAGE MAXIMUM UNITS ~ <br />lsz 631 ANALYSIS <br />(64-68/ <br />69-70 <br />U L lND GBEASE SAMPLE `~{~'('''`~ ( 54) 4Cno00 +00990L 9{;{y{ <br />Y I S U A L MEASUREMENT <br /> <br />B4i)66 I U G PERMIT 41PA>glpni ~ l5=1 ~ i ~7•IE il4"iiO+D" >O tt~: ~ ~L;,} ISGIIi <br />r FFLUCAT (:ROSS VALUE REQUIREMENT r = r• IC=O t 1u`-zA~",k3 c {'{'y - <br />- ~L ~~~ <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT <br />.REOUIREMENT - ~ <br />T ' " a~ ^" <br />r =.' " <br />~~~"~"i_e-'+s` f ~~ ~ , - <br />.. ~~.-"y. <br />. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> `- 'PERMIT. <br />fREOUIFiEMENT ~ ` v <br />K~ '~ t~ '~ :..r <br />'~,i .P -, <br />;-, ~~;,, , " <br />~- " <br /> SAMPLE <br />. <br />MEASUREMENT <br />a a "PERMIT'" <br />- i ury ,, ;~ 't3r`•k + <br />l ' -1~:' <br /> <br />• <br />;REQUrIREMEyT <br />. -. <br />' . <br />~3, - <br />r <br />~ . <br />-~ ' .. ., <br /> . ' , <br />~ t. <br /> SAMPLE <br /> MEASUREMENT <br /> h <br />~ i <br /> REQUIREMENT. - -~ <br />' <br /> <br /> SAMPLE <br /> MEASUREMENT " <br />. -:'PERMIT- -~ - . - ' ;. , °~ t[ <br /> -. <br />REQUIREMENT` _ <br /> - - <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> REQUIREMENT. : ~ ~ - - ~ ~-°k `T - <br />arr , <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY El(AMINED ANO <br />ATION <br />UBMITTED HERE <br />N' <br />ND BA <br />ED <br />N MV TELEPHONE DATE <br /> I <br />. A <br />S <br />S <br />O <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICAM <br />PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUD <br />NG THE v <br /> . <br />I <br />POSSIBILRY OF FINE AND IMPR <br />SONMEM <br />EE ~ ~~ <br /> I <br />. S <br />1B U.S.C. § 1001 AND 33 U S C. <br />3 <br />9 <br />P <br />kl SIGNATURE OF PRI CIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED § 1 <br />1 <br />. ( <br />ene <br />es under Ihese sWMas mey inclutle lines up ro E10,000 entl or <br />marimum lmpnsonmenr or beMeen6momhs eno5yeers.J OFFICER OR AUTHORIZED AGENT <br />J <br />COPE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />TSS C IKON LINIiS VIII BS LAIYED L SElTLEABIE SCLICS LICIT ABFLIED FGfl <=lO.YN,2UE8 fhECIC lYEN1i 7:5 G <br />IRON LIMITS NAIY£D.FGE ~lUlA,1UHH PHECIP EVENT SUE?.EC1 TC rU6CEY"CC PFCCP IN I.A.:. C11 E 6ElISE - SEE <br />r u i n Tnc Yn YT 7![lYr• _ T c l[ <br />EPA Form 3320-1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHI6H~MAY NOT-BE USED.) pp135/ 99 D 417-16~ ~ PAGE ~ OF <br />