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PERMITTEE NAME/ADDRESS (include Faciliry Name'Locanon i/Dijjerenq
<br />NAME +r7APPEit :;_ ;~ '. T'~":.
<br />ADDRESSpRA PFD': ;i ',, ,
<br />P. O. I"iA i:; /
<br />~N.AIG ~ -.lr 1
<br />FACILITY
<br />LOCATION
<br />
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMA)
<br />^ PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM i ~~ TO U l l1 3 3 1
<br />form Approved.
<br />OMB No. 20x0-0004
<br />-"j'4JP
<br />(Si)9R ~N)
<br />PORD t3 TO MIllDLE PYF,ATT ;ULCt!
<br />` NOTE: Read Instructions. before plating this Corm.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FflEOUENC SAMPLE
<br />PARAMETER EX OF TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS - ~~~fs
<br />' SAMPLE ~##:#r #~##?# DI#G#~.'.: (~ 72}
<br /> MEASUREMENT
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<br />- ]LIDS, .PUC.t.L SAMPLE '-#~'?R# #IkRYt.Or :, :..EtOA '( 7,9) .
<br />~: ~ d ,^. LA D E D MEASUREMENT - ~
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<br />.:7LIDa~, SEPfL:,.,1,;. SAMPLE .-#ts~ ...r_~:~ e;.:~~;: ( 25)
<br /> MEASUREMENT
<br />7J~4y 1 U C. PERMIT G#at4gr#~' -.:.:Ard #a;-. r:-~: #(K;?- ,~' ~.~11Af.~, $ ... ~':(~:
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<br />REQUIREMENT
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<br />(A S F :) MEASUREMENT ~
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<br /> MEASUREMENT
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<br />'r LOENT GP) ,:i YALU REDU)pEMENT ~ err,.:- '"_' $ MG L
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<br />-LIDS, ,~t,~..L SAMPLE ,•. rX ~:: Je:r.-~^4.~ :33#+:: :::'s ( 19)
<br />.~Li97LY ED MEASUREMENT
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<br />-'ZLJErJY G :~i:, VALU REQUIFIEMENI"~ : .'; + '~ `: r.:;rr ~` !1G L 'S+' , ~ t ~,
<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER ICendy under penalty of law that this document and all anachmenLS were TELEPHONE
<br />- DATE
<br /> prepared untler my direction or supervision in acmMence with a system tlasignetl
<br />MsssurethatquaHnetlpers°nnelPr°pedygatherandnaluatelhainl°nnaticn ~'~
<br />c`
<br />'d. Gordon Peters
<br />submiltotl. Based on myinquiry oltha Demon or perecns who manage the system, ~,
<br />` 970-824-4401 Ol 04 26
<br /> the inlormatlcn
<br />°r those persona dir°ctly mspmsible ror gathering lhaimormation
<br />?resident/General Manager ,
<br />l
<br /> submitled is,to the peal or mykrowledge and belier, true, accurele, end comp
<br />ete. SIGNATURE OF PRINCIPAL E)(ECUTIVE
<br />TYPED OR PRINTED Ism aware that tlrere are signiM1CaM penalties for submitting false inbrmation,
<br />includln the ssibili of Me and im rlsonment /or krgwi violations. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />°,3 ~; TOTAL LKDr7 LI!!ITS N1LL dE MAIYF:D, AND S°TTLF.ABLF. SDLIDS LIMIT APPLIP.D FJR <=l0YR,24fiR PAF:CIP EVENT-
<br />.-..,, uU2UEN JF' PHOOF HE~UIkE1:ENT5 U."79£R I. A. 3. TDS tlONITOHING - I. 5. 3. OIL S GREASE - SEE I. 8. 1.(D).
<br />EPA Form 332 -1 / 9) revious a dlons may a use ~ ~ ~ „ _ ., „ _ „ _ _ THIS IS q{PART FnRM opr_e nr.
<br />
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