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PERMITTEE NAME/ADDRESS (lurb FsoiryNa./Lxuian dD~.nnq <br />NAME SE,I I. L:.A CVA: C:1 "'F'n 1'i <br />ADDRESS U HA R : R D <br />HAYUP,'N <br />CO 81639 <br />FACILITY <br />Lo~noNHAYuiiY CO 91630 <br />ATfN: G. `sUC P'.'ti,Wh, G:''IEnAL :7AriA':'' <br />NATIONAL POLLUTANT DISCHMGE ELIMINATION SYSTEM (NPDf$1 <br />DISCHARGE MONITORING REPORT IDMRI <br />I-181 II7-191 <br />COOOCC221 CO `_ W <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORI G PERIOD <br />YEAR MO DAY .EAR MO DAY <br />FROM 1!i V1 T1. 9 [ ' <br />!76111 l77-131 l7I-151 !26771 l78-291 134311 <br />Fonn Approved. <br />? C U? F. Y t T T :: ~ i I Y GOMB lyq. 20140-0004 <br />(5 U E A 1 M) Approvelle>fplr4 ? 5-31-98 <br />P + STD;:. J ~. <br />MI `: ~ y . <br />NOTE: Reed instnt~ before completing this form. <br />PARAMETER !3 Grd Onlyl QUANTITY OR'LOADING 11 Grd Onlyl QUANTITY OR CONCENTRATION N0. FREQUENCY SAMPLE <br /> !46-53 l54-8//~ l38J51 lsb531 154-81 <br />EX GF <br />TYPE <br />132-371 µ,uyys <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !sa-sm !5/-881 159-701 <br />CCU STA'f;-IY UBHH ACI SAMPLE ..;::xt~~ `•'=#00' x$' ~{{qsq at'~::::x ( 3) -~ ' <br />Cc'.IiIUUA?HNIp MEASUREMENT ) <br />f~~ G <br />2A.lUb 1 0 U PERMIT r:rlt ~Tp4 ~•,.~~.- 000 ~<'C <br />{k~~:` n.~ti+.'-)=' ~E <br />h- <br />TRLY R <br />IAA <br />k:FFLUE;IT ',ROSS VALU .REQUIREMENT ;;:;:~~.. v~Z(IE ~}.KT' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />, <br /> REQUIREMENT ~~' ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <br />~ <br /> .REQUIREMENT 'f <br />: <br />~~ ~~<:: <br /> . <br />t. ,. <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 />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENILLTY OF LAW THAT I HAVE PERSONALLY E%AMI NED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INF011MATION SUBMITTED HEREIN; AND B ASED ON <br />~-- <br />1 MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIB LE FOR ~ <br /> <br />~MA~ <br />~ V y Lj OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORM <br />TRUE, ACCURATE AND COMRETE. I A/A AWARE THAT THE <br />F <br />RMATION <br />IN <br />' ATION IS <br />RE ME <br />CLUDING <br />7 <br />~ <br />~ <br />S <br />, <br />31GNIFCANT PENKTIES FOR SUBMITTING FN.SE IN <br />O <br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE to U.S.C. E 1001 AND 33 70 65iW <br />U l <br />Y <br />LICJ <br />roll0 <br />000 <br />WtA <br />mror <br />v <br />ircAAlA enr. <br />f[3[s <br />P <br />2i <br />S <br />C SIGNATURE OF PAIN AL EXfCUTNE <br />RA <br /> <br />(TYPED OR RINTED , <br />.. n <br />y <br />. I <br />er <br />A Ur <br />Aw <br />w <br />U. <br />. <br />. <br />uq ar mrrimnr inodmrwer et NrwEAn ancnela rMbYwtl <br />OFFICER ORA RIZED AGENT A <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe7erencs s// ettecAments here/ <br />SLE PAdT IAA.4 'rOP UFTAiLS JF TEST PNOC„DUk;;. 3E'PCF:T LD'aFST ^II07ICA (': FFf1L'EI?) iiHICfi IS LET9AL TO <br />SU» OF :L:3T ORGANISMS (LCSO) ANU ATTACH AL:Uf'. TJXICITY T2~T FEPCFI FCF~ TC CNP. COFTFS OF ALL <br />up! GN/1T TON RIICT RF' SC4T TI1 F'Dl -- <br />EPA Fwm 3320.1 108-961 Previous editions mey be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.1 0 0 06 2 ~ 9 710 31-151 's PAGE i F <br />