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PERMITTEENAME/ADDRESS pnclude Facifirv NameiGocanon i/DiJferenq
<br />NAME. SRNtCA CUAL CCtflkY
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<br />ADDRESSDRif:EH p
<br />HAYDEH
<br />CO 816]9
<br />FACiurY
<br />LOCATION
<br />dAIDEN CO r11 b!0
<br />1TTN: 6. tiUD iihOfiH, CE4ERAL MAN4~ER
<br />' NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDESJ
<br />' DISCHARGE MONITORING flEPORT (OMR~
<br />(2~t6j IA. 9i
<br />CGOCU[121 O1ra A
<br />PERMIT NUMBER ':" DISCHARGE NUMBER
<br />i_ -
<br />MONITO§i11JGyEFiIOD '
<br />YEAR, MO. DAY,fi YEAR MO DAY
<br />FROM ~?~ g,- Ii 7 µ~ p ^1 ^J U 5 U V
<br />(20 -t 2229) (r< 25) , (26 2)J (28291 (30 31J
<br />Form Approved.
<br />P.I A G k OMB No. 2040-0004%
<br />ADproval expires OS-3t-98
<br />(SUER bb) ~y
<br />F - PIbEL 6OUTT
<br />DISCHASCE TC SAL•E CFEEA
<br />apt: JO iISCHAAGE +~~/) >VnC
<br />NOTE: Read Instructions beforrfcompleting this form.
<br /> (3 Card Only) QUANTITY OR LOADING r ~ ~f4 Certl OnryJ QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />I
<br />PARAMETER (46-53) (54.6IJ ~ (38-46) (d6-53) (54-61) EX OF TYPE
<br />I
<br />(32.37) AVERAGE MAXIMUM" NITS MINIMUM AVERAGE MAXIMUM UNITS
<br />!826+1 ANALYSIS
<br />l64-6a)
<br />(69-70
<br />PH SAMPLE aa~4t"F aaa!!;a aaaaa=. ( le)
<br /> MEASUREMENT
<br />
<br />UOgUU 1 U 0 PERMIr_ aa~iORla
<br />; iV! ~ - xA0 •~., ~{;va ! ~ - C NCB/ NSIiU
<br />EFFLDEHT GH055 Y1LU! REQUIREMENT _
<br />,- ~, `~ ya+aa ~ ~' `' "
<br />SCL1D5, TOTAL SAMPLE 'tF~`'~ v:;.arctc
<br />- a:../ava>rC 1 IS)
<br />SUSPENDED MEASUREMENT "
<br />00130 1 O U
<br />EFFLUENT GROSS Y11UF -PERMIT-.
<br />REQUIREMENT 4i!!!O!- ~ aAl4il~;.t1 L9t
<br />;~XI, x-
<br />i.~=
<br />~ #,
<br />r ,,~"'!-,,,;
<br />~~ ~
<br />E!G/L ':-G ~~EI
<br />CGN!"El 'i1F~.
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<br />50LLU5, SE'TTL AELE SAMPLE as;`ona aa>•v;:a a
<br />av s. ~ ._
<br /> MEASUREMENT
<br />OOSVS 1 0 U ~PERNIIT - Xz ao ta~~ aav, 1:"~ E1 i, q- CE1~',I t6AN :'
<br />EYFLUEkT GRO55 YALUE REQUIREMENT: iXYtl ~, h /j EtI, E'I/L 116N71f -
<br />iRUH, TUTBL SAMPLE :4.;aYx~ a~a:::.:a aol.!!o ( ]5)
<br />(AS f'E) MEASUREMENT
<br />UlUVS 1 U .0
<br />~
<br />- PERMIT a a!v 's9a s taa as
<br />-`.
<br />'~~'; ~;
<br />° "
<br />*#*~"°>
<br />-.A,~
<br />EA
<br />EFFLUFNT GR055 VALUE .
<br />REQUIREMENT ii :a <
<br />.
<br />_
<br />~~,~<+~ y ~~~~~.;~1 CG/) ~ p ~
<br />~a
<br />OIL AND GREASE SAMPLE uc';:ca: ;,a>,~::_~ aaaoa aaaaaa ( 1S)
<br /> MEASUREMENT '
<br />Uj~ti2 1 O ' O PERMIT aX+ 49! vaaaX+ i X:):S a4~ !>a ,. lit.' ~`jJi p.618
<br />EFFLUENT GROSS ti1LUE ;REOUIREMENr X:+'f " ~ '~N3i Ei>t CG/E ~~'Mx`" ~` "^
<br />FL04, li CONDUIT OF. SAMPLE ( U3j ~co~aoa aaaaaa cc:;'a
<br />79HU THE:ATtl E~iiT PLAbT MEASUREMENT
<br />SUUSU 1 D Q PERMIT., BRFC 2 BETrONT 41i49i7F Ifa7i 7 A~C ~~[~'Y (N'J2A
<br />EFFLUENT GH055 VALUE RE~
<br />UIgEMENT .
<br />~QD
<br />~ AY6 E3~II7 !(1 !GU ~ r CXdf tl`~
<br /> _ - ,, u ;_
<br />~ ;,~,,,,
<br />SOLI US, TOTAL SAMPLE avr>aarl r.ar•4 r.. >x :.aa4atp ( 15)
<br />U ISSOLV EO MEASUREMENT
<br />YU29S 1 0 U PERMIT ', '- 14t+¢4Pi ?!A#~a! Y tCyi #!!{Rt~„`
<br />~
<br />` 'E3QlF,~A NEltN7 ~~17- ~31B ;
<br />tFFLUEI+T GROSS YALUE `REQUIREMENT Xaaa *
<br />'-
<br />,'~ _ ~'tTI. iN6 6lILl EtX C.G/I
<br />"
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN
<br />AND BASED ON MV TELEPHONE DATE
<br /> ;
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING '
<br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 13 TRUE, /
<br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />PENALTIES FOR SUBMITTING FA
<br />INFOR
<br />ON
<br />NG
<br />INCL
<br />D -a`^ ^
<br />
<br />,
<br />LSE
<br />MATI
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<br />I
<br />THE
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE t8 U. S.C § I OBt AND 33 U.S C
<br />-
<br />SIGNATURE OF PRINCIPAL EXECUTIVE D
<br />TYPED OR PRINTED manmuml tmnnammenr of~mee ~6 r~rrosnrhs entl5utle tines up ro Ste,l%1U antl or
<br />p years) OFFICER OR AUTHORIZED AGENT A
<br />E
<br />NUMBER
<br />YEAR
<br />MO
<br />DAV
<br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS (Re/erence all attachments here) „ . '
<br />T'S5 E ILiON LIlIITS fTlLl BE wAIYED G SETT?L EAIILE SCL1G5 LIl~Ii iPP1I8D POR <-lOYR,I4E11 FAEC]F E-!NT) 7S5 E
<br />I50N LIlIITS YAIYED FCi ~lUYh,2VHR PRECIP EYENT SUEJ°CT TO ElURDEN OF PiGCP IA I.A.:. ClL 6 GFEA'_E - SEE
<br />t u r n snc rnur s~c++!r r o+ c ~ _
<br />EPA Form 3320-1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MA' YROT~~B,tE USED.) QQ~g 8 f 99 C E 1 ~ ~~.6 g 3 PAGE Z OF
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