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PERMIT7EE NAME/ADDRESS (lerVdr F:mry Na./L«.uo, JDIp..w9 <br />NAME Sa;M:,C:A CURL CO!1FA::Y <br />ADDRESS D k A w t R D <br />HAYJ6N CO ti1639 <br />FACILITY <br />LocanoNHAYJctt CO 81G30 <br />ATTN: u. rUU AkCwN, GF.tickAl. MANAGER <br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM (NPDESI FOFm Approved. <br />DISCHARGE MONITORING REPORT IDMRI .. r ,• r , ~ OMB~o. 200-0004 i <br />17-16, ry7-191 '. _..Ff," TQ -FZBr.. , <br />;:v0000711 CO `_ A ("i1FF 6~) ApProveL e~p~r4 j05-''d1-98 <br />PERMIT NUMBER DISCHMGE NUMBER F - FINAL 1 <br />MONITORING PERIOD <br />YEA MO DAY YEAR MO DAY <br />FROM U 1 TO Y .< <br />r2a•;r~l rn-sir rzsasr n67n rza-asi r3o-311 <br />'~T±I C`L <br />." hC l:ISCHARGE (-_( f'•. <br />NOTE: Reed InetrueHone before completlnp this loan. <br />PARAMETER 13 Ord Onlyl QUANTITY OR LO G II Ord Ontyl QUANTITY OR CONCENTRATION NQ FgEOUENCY SAMPLE <br /> !46531 /54611 l3B-451 !46531 /6461/ OF <br />131-371 EX TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS r6Z <br />691 AN'uYaS <br /> - 164681 (64701 <br />~ U ~• U A <br />SU:iPGNJEu SAMPLE <br />MEASUREMENT ^{:p~k ~k ~" .,;': (e ;: gpt)>;Ca II <br />o <br />l O <br />( 13) <br />O // <br />3~ <br />~ <br /> t 1 <br />00530 1 0 0 PERMIT rn+kTMU:k r:=aLIU>t;k ~~n ,.:w.:~rlC,px~ 35 7C IVI;E/ ;?AB <br />EFFLUENT GROSS YALU REQUIREMENT ~ ~~~~- ~~~ 30DA AYG CAIIY NX n~/L ^'~)+:T.'; <br />OL US, S' L°A6LE SAMPLE <br />MEASUREMENT ?•:=;A~a#~ {:.^;r,: r,::k rypCOaA /, <br />~ <br />1~ /^ <br />~ <br />/ <br />L~ <br />( ?-) <br />v <br />~ <br /> V• ( <br />e ~w <br />(10545 1 0 U PERMIT f%'~r+~ 'k:;c ,a:e:k ;,hr,, • r.: ,::: cto+RO;~~ <br />: ~: PP FCP.T FFF(l7' <br />!' I INr-c/ ~;;q:z <br />cFFLUENT ~kU55 YALU :REQUIREMENT <br />'~ ~=" ... . <br />; 30Dp AYG . <br />:CAIIY ."K <br />`L/[. <br />M )h:; <br />RUN, C' AL <br />A <br />j FE SAMPLE <br />MEASUREMENT .-'.°'k ~:^::+ ::::~:?;:~ gs?>cOQ9 <br />o <br />38 <br />D <br />3 g ( iq~ <br />0 II <br />` <br />( <br />, <br />) a e /30 ~~ <br />UlU4; 1 0 U PERMIT 'k vY,: {,+.# a:b~:aO #~}:~ ~>; y:}ty <br />~e0 <br />6.0 ~. rc <br />V_ / <br />,kn1 <br />EFYLULYI GRO55 YAL1J REQUIREMENT fi4-k:k ~ .;. JQ.CA AYC CAIIY ii 1S r/;/L '10CiTi <br />" AN v .A ~ SAMPLE v::kR :k ;: .'::e Yt :;; :, +'j~!; (:Ba L+41a>R ;..-•, <br />(17> <br /> MEASUREMENT N <br /> <br />0,3`,y2 1 U 0 PERMIT :,,^.rC:r~ 'Y><;trr. :;;+.^ ,:Cy)t4# OOtdO# ~.C 't)NT'Iy :RA!' <br />CFFLUE::'i GRCS.`'i YALU REQUIREMENT O::v{: TNST a'AX ~!:/?, GL''?:I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF UW THAT I HAVE PERSO <br />MILIAR WITH THE INFORMATION SUBMITTED H NALLY EXAMINED AND <br />EREIN <br />AHD BA 1 TELEPHONE DATE <br /> ; <br />SED ON ~ <br />~ ~ <br />4 <br />a <br />S P MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />1 <br />A <br />` OBTNNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATON IS <br /> <br />' TRUE. ACCUMTE AND COMPLETE. I ANI AWME THAT THERE A11E <br />SIGNIFICANT PEMALTES FOR SU6MITTINO FALSE INFORMATION <br />INCLUDING r <br />~ <br />~rl O E''' <br /> <br />4~ ~ 5 . <br />THE POSSIBILITY OF RNE <br />D IMPW <br />V <br />/ ~ <br />~~ ~ <br /> AN <br />SONMENT. SEE 18 U.S.C. ! 1001 AND 9] 610N <br />T <br />F ~ J <br />TYP dR PRINTED r y'd ~3~~ lAxW6.. uWr rMr mrunr m.Y ~.AN. Firws Iy ro t IO,ODD A <br />URE O <br />P CIPAL EXECUTNE <br /> inplanwlr o/errwAM 6mon,Aa YId6YA.rA/ OFFICER OR ORIZED AOENT CODE NUMBER YEAR MO DAV <br />L.VMMCrv IJ ArvU CAYLANA IIVrv VY ArvT VIULAIIUrvS r/!B/B/B/ICI I//IFIIMTBBfS OBFBI <br />T -ia 6 Idi)N LIMITS HILL Bc MAIYED AND SETTLEAbL° SOIIJS LIMIT ADFLIEC FCR <=1CYF,2U8R PRFCIP F.YENTp T55 ;. <br />1kOF LIMITS 4AIVFD FC6 >l0YR,24Hk PRECIF EYdhT SUB.7ECT TO P.Ufif.F~ CF FFCCF IN I.A.2. OIL. L CRF.ASF-SE <br />l.n.l.n. Tns Nf7NTTFT6T4G-C F: 7-R-t.v, <br />EPA Form 3320-1 108-951 Previous edlbona mey be ueed. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 0 0 04 9 / 9 710 31-1513 PAGE ~ OF <br />