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PERMITTEE NAME/ADDRESS (Include Facility Name/[acarian if Diffe.enp <br />NAME r:.)L['~YO CCAL CO!:Fp!(Y, L. P. <br />ADDRESS(. U L O+ Y O 11I N t <br />51,11 STATE YIGHYAY 13 <br />FACIUTV n e° !; ° R CO 816 tl 1 <br />LOCATION <br />/. ^"^~[ .i. 7_ 41F MON_ CS'K PBA I. NAK AG FN <br />MONI TOe RIN-G~ERIOD <br />YEAR MO DA VE NEAR MO DAY <br />no ou o ~ ro°: 00 00 ~a <br />(2g2j) (12231 (2425),= (262x1 Ra 29/ Wuat) <br />Form Approved. <br />OMB No. 2040-0004 <br />"I \ 7 n Approval expires OS-31-98 <br />(SvOR %G) <br />- F f N A L ltOP AEG <br />~c">? ?I? SED PG~IC YO~TAYLCR~CE - <br />'%k'^ NO 87 :;L'HAhCF. ~~ Aer,.k <br />NOTE: Read Instructions before completing this form. <br /> (3 Card OnryJ QUANTITY OR LOADING;.- ( Ca. •OnryJ ~ QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53J (54~6,1J _ 3*~;~, (38-45)' , (46-53J (54-61) EX OF TYPE <br />(32-37J AVERAGE MAXIMUM: ~ ~' <br />~. U, ITS <br />! MINIMUM'.' AVERAGE MAXIMUM UNITS <br />(sz~! ANALYSIS <br />(64.68) <br />69-70) <br />i-~fL API L, .=YL:,ASE SAMPLE ''•':~4~rik ~'t!1j-J) ,; rfkk3~1~ .: ~OII91;=0 f:k}A f. ;=r; <br />r MEASUREMENT ..yr ,~ <br />''-'v8h I U U ,- PERMIT ~= ~ "3'~ ec-l 9L+R~!IS "- `~~',~ 4rY'> S $EIiLY l~j-5 ~4 ttI <br />:FPLUi:tiT GF <br />OSS YALl1I ~E0UIREMENT; ~~ I'~" <br />~ <br />? ! <br />=0 ~ "~ <br />~I f 'L'~'~` <br />. : ~ <br />r =; O . <br /> SAMPLE , <br /> MEASUREMENT ~ '~ <br />x^'' <br /> ' -: . TM F.g .. <br /> flEOUIREMENT ~- ry <br />: ~ r ~{," <br />. :,, ; }~.-> <br /> SAMPLE <br /> MEASUREMENT <br /> ~ ""PERMIT ' ~- - as r: <br />- A ~.. ,s~ ~,~sr,~~ <br />-_; <br />~ <br />"` + <br />- <br /> REQUIREMENT ~,~_ ,,: ; <br />,_y <br />,,,~ <br /> SAMPLE <br />. <br />' <br /> MEASUREMENT ' <br />.., .y~ <br />z <br /> j ~ PERMIT <br />"~ .. <br />~ ~r'»~,. i -Y'µ x~ ~r <br />~~ <br />-~ <br />~~ EM <br /> REOUIREMEN~T~ ~ ~` ..;. - <br />, '''" «..~``• ,a ~ <br />~ <br />~~ yt. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> -Ip - •PERMIT ~- <br />REQUIREMENT ~ - <br />~ - <br />~ ""- s~,~" <br />~ +,~ ~ ~ - •" <br />," ~- ;. '" ~ ~ ~ <br />,'." - *~ y, <br />ate ~ <br />,: <br /> SAMPLE <br /> MEASUREMENT <br /> <br />I; .;PERMIT - <br />ly -. <br />y ,;y~> <br />~ <br />~ ~ ' ~ <br />e <br /> REQUIREMENT - r i_*' i <br />., " , Mx,.i <br />? ,I - . .rt j , •. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> .-PERMIT" < '~t£" '~`""?NtS~ "t~ <br />yy,~• ~ ~• ~ ~r` <br /> REQUIREMENT,. '~ ~ - ~- <br />NAME/fITLE PRINCIPAL EXECUTVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND ` <br />~. ~ TELEPHON E DATE <br /> <br />' AM FAMWAA WITH THE INFORM ATION SUBMITTED NEREIN. AND BASED ON MV <br />. J <br />/ <br />` <br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING / <br />] <br />i ' <br /> THE INFORMATION. I DELIEV E THE SUBMITTED INFORMATION IS TRUE, ~ <br />' <br />V <br />~ <br />`` <br /> <br />ACCURATE AND COMPLETE. <br />O <br />I AM AWARE THAT THERE ARE SIGNIFICANT / <br />J <br />r <br />' <br />/ <br />I r ~ I ~ , ~ ~ ,~, / ~~I r , ~ PENALTIES F <br />R SUBMITTING FALSE INFORMATION, INCWDING THE <br />POSSIBIUTV OF FINE AND IMPRIBONMEM. SEE to U.S.C. 4 IeDI AND 33 U.S.C <br />SIGNATURE OF PRINCIPAL EXECUTIVE [~ <br />~J <br />Q~ y~-~~,e ~•~ <br />n 3<'~ <br /> <br />TYPED OR PRINTED § t3t9 (Penettuu under these statures may include lures up ro Et0,000 end or <br />maximum lmpnsonmenr of betRreenSmonMS end5years) L,iOFFlCER OR AUTHORRED AGENT AEA <br />C p <br />NUMBER <br />YEAR MO DAY <br />COMMENTS AND tXPLANATION OF ANY VIOLATIONS (He/e2nCe a// attaCllmen(S Here) ' <br />3!:T1'LF.dBLF, SULZDS Li7![T A?PLIES ONLY IF <=10YR,24!lir Fk?CIP EY£1-! I5 CLAI'1ED. IP CL 'a~PPFSOYED 9Y bQCU, <br />'155 6 IRU!y LI!!ITS h+ILl. 9GT bF. APPLIED TO REPORTED .-P..4SUREt4£lt15.= SH£ I.A. 2, P6. S F~~UAD£Y .QF FROO.F <br />~ya} rrevtous eD!uons may no[oe_ use.D. ,!nerlslcts CYq Fo <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR; <br />(2-, 6) (n- 91 <br />~rnnnucTR~ _~~~ nnR e <br />PERMIT NUMBER=~>;~~ja •', ~*" 9' DISCHARGE NUMBER <br />:,mart,:' r <br />FROM <br />" ~ ~ ~ ~ PAGE. OF <br />ON03-#007 ;. ;Y+; , , <br />