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PERMITTEE NAME/ADDRESS (Include Facihry NumeiCarnnnn i/DiBerenq NATIONAL POLLUTANT DISCHARGE ELIMINAifON SYSTEM (NPOES) <br />NAME DISCHARGE MONITORING REPORT (OMR; <br />SIiNE.CA CCAL CCE!FANT a+sl !n-sJ <br />ADDRESSU ii AFIER D .- -~ ,~ ~ ~~ - <br />NAYDck CO 9I6~' PERMITNUMBER SCHARGENtl.,~F <br />FACILITY MONITORING PERIOp <br />LOCATION' DAY YEAR MO DAY <br />11ATDbN CO 8163U FROM ~- ~'~ TO ~> <br />A 2 T N: G. f: U U E H U: h a GENERAL C A H A G E H .r ~ s) n<ss) rzswl rze zs) rso-s,/ <br />Form Approved. <br />C! I H 0 M OMB No. 2040-000 q! <br />Approval expires 0 -3'I~B <br />(SUHH Ni) <br />F - FI111 FLUT7 <br />C"hc;a:C :ET 7E57I6G FCF GCYA <br />_YI <br />.NOTE: Read Jq~ I~efore completing this form. <br /> (3 Card Onry) QUANTITY OR LOAD 14 Card Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (59-61J .(3845) (46-53J (54-67) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> fsz~s3) (1i4-5B) 69-70f <br />bEEF~c* :;TATRE /UA1 SAMPLE ~'A~#g# rL#t1^O -` ####:I'r L#t# ( ~?) <br /> <br />~dR CEiI ICfDAPdetIA <br />MEASUREMENT ~ <br />U O ' <br />TCHJ(; 5 1 0 ~: ~ PEyMR fPp, ~ +1 Oq ~# ~ * .- ## tqA f F- <br />SE:G CUfStl£pT5 BELGr F~EYSUIREMENT ~~r' <br />_ K:fi•~ y~yQ s~ <br />~::; CE-7 <br /> . <br />, „ <br />~LFFECI STAT E 7DAT SAMPLE ~##A aaa#au a<t>4~a# I. ,;e#t# ( ;.) 0 I <br /> <br />'Lli PIH£PHALES <br />MEASUREMENT <br />V <br />IdV 4 <br />~ <br />CEbC 5 2 U f?ERMII ~0# . <br />' ~ My °~ ! EF- 1 ' <br />SeE CU;1hEyTS bELUY REQUIREMENT '• qq## hq'' <br />! `- <br />^~ + . <br />° <br />x~ CE17 <br /> ;~ , v, ., <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> ~ <br />lu <br />E ~ ~ ~ <br />` ~ ~ <br /> 1 <br />WT <br />Qbl•3E ~ <br />.~ <br />:.} <br />~, <br />x ,, <br />h <br />~^ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br />~ ~ ~ "^' ' ~' , <br /> H&A~ <br />~ <br />f ~ yo '~ !u <br /> SAMPLE <br /> MEASUREMENT <br /> +p ~ <br />~gMlfi~ ~ <br />~ f,, <br /> * <br />y.~ <br />,~GI.VIAEIN~~ L ..;+ r •a I.. y4 <br /> SAMPLE <br /> MEASUREMENT <br /> .= I~kAMIT„~ * ~ ~;~I ~~" >~ ;. ~~. <br /> EQ)JiR1E~LEt~T ~, ; <br /> ;~ z ; <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> PfiFM11T' ' . ~ ~ 1 r ~,: <br /> <br />NAME/TITIE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMIUAq WRH THE INFORM CA 'THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY E%AMINED AND <br />IN <br />AND BASED ON MV TELEPHONE DATE <br /> INQUIRY OF THOSE INDNIDUAL ; <br />S.~IMMEDIATELY RESPONSIBLE FOR OBTNNING <br /> THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATION IS TRUE, / <br /> ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMITTI I AM AWARE THAT THERE ARE SIGNIFICANT <br />G F <br />LSE I <br />FORMATION <br />INCWDING T <br />E <br /> , <br />H <br />N <br />A <br />N <br />POSSIBILITI' OF FINE ANO IMPRISONMENT SEE 18 U.S C 4 1001 AND J3 U.S.C. SIGNATURE OF Pffd~ CIPAL E%ECUTIVE <br /> 4 t319. (Penenies 1/IIdB! fIl&SB 519IIIIBS may include lines up ro E10,000 end or ~ <br />R OR QTHDRIZED AGENT <br />FF <br />C A <br />TYPED OR PRINTED maximum lmpdsanmenl of Gefwaen6monfhs and5yearsJ O <br />I <br />E pE NUMBER, YEAR MO DA <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 330-1 (08-~J5) Preyid ~~ ' o ~ yApJj7.p;,p~~~.~ - (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) nan~c iae n~ e~~ 1~e s"' ~ PAGE ~ OF <br />