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 />
|