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PERMITTEE NAME/ADDRESS (Include Faci(iry Name/Gocanon ifD$erenq <br />NAME <br />ADDRESSp R A u y ~~ r< - <br />:r <br />' COMMENTS AiJD EXPLANATION OF ANY VIOLATIONS(Re/erence al/attachments here) <br />g T:5 5 TOTAL IRON LIty.T1 r+fLL I+E a~.IYED, A9D SETTLEA$Lr SOLIDS LIl"..IT APPLIr6 FUI~ <=10YR,2LLHR PREC7P EV.°.N1'- <br />Sr:H tSUHDEN OF PROJF fik,'U7!Eth°NTS UN9?H I. A. 3. TDS MONITJRING - I. 6. 3. OIL F, G.HEASE - S.EE I.i9.1.(D), <br />' PA Form 33 -1 9) revtous editions may be used. ~ - _ _ _ _ _ _ _ _ _ - T}iIS IS A 4-PART 1=nann oAOr= ..~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMA) <br />`7IS01< <br />~r'' '' (SU3R NY) <br />PERMIT NUMBER DISCHARGE NUMBER P- F' I N A L <br />Form Approved. <br />OMB No. 2040-0004 <br /> <br />°'*"' ~O dl6l. t Dp!I D ) 1 TO UT GU LC`; <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM O1 C'I D1 TO ~1 03 31 ^~•~? h:) Di SCY.AP,GE ~ ( +''°'• <br />`~ <br />NOTE: Read Instructions before pleting this form. <br />'~ '• S a • t' J ~ ; -' °_ . h 5, P P F. ~ / u E ': <br /> QUANTITY OR LOADING OUANTIT'Y OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER EX OF TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /~-YS/S <br />1~.~ SAMPLE cr,:#•:-:;: :x Ytrt~Gt ##::fi$:c ( 12) <br /> MEASUREMENT <br /> t <br />-'Fk'LUENTGx~sj YALU t;'- <br />. ¢+~. ###a ,I,~_ F ~'~,' ~•~ <br />::JLIDS~..Tf.3T,;, SAMPLE #'xFa#a #+P#### O#4##+t ( 19). <br />'JSPt'NDBD; MEASUREMENT <br />,.,1.~3U 3 U 2 ~ _~ iilk! ~ #4... ri <br />~ ~ u- <br /> <br />r'YLJE4'T G1RU.,5 YALU <br />~;a~° », * :, <br />"'~ ;zt~ <br />r,°;<'= <br />`~`~~ `~ <br />i) <br />~ <br />G L <br />' <br />7 <br />%LIUS, SBTSL Ed SLE SAMPLE #a#`°~~ ;~~"''-r+~ ~~~ ( 2S) <br /> MEASUREMENT - <br />~t :yui 1 4 ~~` <br />~ <br />t <br />~ PER~IIY,~ =, <br />. <br />''# ~ <br />~ ~'Fr #4dr!`. <br /> <br />~ <br /> <br />.. " <br /> <br />. 4 .. <br />.~ <br />, <br />F L'J E Y T & HOBS"F REOUIREM~ - ~n ~. <br />.' ; <br />~ ~ ~ :~~ <br />.. , ~ ML <br />~ <br />: , i'OTAL ~ ~. SAMPLE #ae#AR6 Rxi4;tdR t;#;=t <br />( 1'1) <br />'•~ <br />(AS PE) MEASUREMENT ~ <br /> ' y~Y y. ~~ i <br />'FLUENT GRrJJ VALO N`4 -'"~ rn~ "`~~ 'fig ~' <br /> <br /> <br />, <br /> <br />. <br /> <br />, _ <br />r. <br />~7L AYD G E~.Sn ''SAMPLE a44saa G•~~n h ###### dr##;N3+7a = 1q) <br />'- MEASUREMENT ~ <br /> -^, . :., r, .. r ~.. r <br />L e~ Laetir cHDSS vALU. A - ~-rr. #~r# "a ,,.,~ a'; <br />iLJ,, IN C'~)ND'JIT UR SAMPLE ~ ( 3) - ##^rr°•`•~= v#~xC=?..: ~y#,## <br />Cr t'; i aRATgF.HT PLAN MEASUREMENT <br /> ~ ~ <br />~: "LJR`It' ~GRO55 vALU R~ )REMENT 30Da1 '~ I ~ ~' ~ tIGD . `" <br />' ~~ <br />r <br />+~ <br />`, <br />z ~ * ' <br />' <br />t' <br />µ <br /> , <br />. <br />~ ; <br />k a t r. <br />~.;LIDS~ Tl7TAL SAMPLE •'~~"'x~t ~a=xa,-: ~~#$~~ ( 1ti) <br />;) : i S J L Y 8ll. MEASUREMENT <br />r .z.~ '" icT r; o} d <br />!~ <br />~~~Q1fl <br />i L U B N# R S S YALU `AEQl1Pp NI <br />EM z a <br /> , <br />~ f <br />NAME/TITLE'P AL EXECUTIVE OFFICER I Certify under penalty of law that this document and all anachmerHS were <br />d <br />d <br />i TELEPHONE _ <br />' DATE <br />~ preparetl un <br />er my <br />nag <br />on or supemsion in accordance wish a system tlesigned <br />' <br />Gordbuj~ters <br />W to asswe that qualified personnel propedy'gather andevaluate the information <br />itt <br />d o <br />in <br />b <br />d <br />G <br />m <br />f th <br />th <br />h / ~r <br />A' <br />I L <br />~~~`~ <br />, gmry o <br />su <br />m <br />e <br />. <br />aze <br />n <br />y <br />e person or persons w <br />o manage <br />e system, ~ <br />i <br />970-824-44D1 DI O~V 2G <br />P; esideriti~eneral Manager or those personstlirecllyrssponeiblebrgatheringlhBirrlormation,thainformalion <br /> submitted Is , to the best of my Mnowledge and beliel, true, accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />' -TY~ED OR PRINTED I am avrere Thal mere are signdlW nt penalties for submitting lalse information, <br />incWain the ossibin otrne end im risonment for Mnowln violations. <br />OFFICER OR AUTHOR2ED AGENT A <br />NUMBER <br />YEAR <br />MO <br />DAY <br />