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PERMITTEE NAME/ADDRESS p.a~4 FsdiryNaJfer.nm dD~p <br />NAME S6h:::;A CGAL L:OF:k'A1~Y <br />ADDRESS DRAwr.F; D <br />HAT DEN <br />CO 81639 <br />FACILITY <br />LOCATION H A Y/ E K C u 'f i o 3 G <br />ATTt+: G. otiD bKJVN~ GE:lFRAL MA!iAGEd <br />NATIONAL POLLUTANT DISCNMGE El1MINAT10N SYSTEM INPDESI <br />DISCHARGE MONITORING REPORT IOMRI <br />11-161 17-191 <br />C00'OU221 C09 A <br />PERMIT NUMBER DISCNMGE NUN+9ER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM l L 1 TO '1 ! c <br />l?421/ 121-731 111.151 11617/ I2B-191 134311 <br />Form Approved. <br />r9M No::20 OOQ f) <br />' ',CHAFJ; 'PiiIa BA .. ,. .4Oi....~ <br />(S U E H F F) Pprovelle~p~rLS ~OS-31-98 <br />F - FIDAL + <br />YIMCR ' <br />vav NC LISCHARGS ~ .;r, <br />NOTE: Rssd instruetlom bsfo eomplstln0 this form. <br />PARAMETER 13 Grd On/yl QUANTITY OR LO ING (1 Grd Onlyl QUANTITY OR CONCENTRATION NQ FREDUENCY SAMPLE <br /> 1d653 154611 /3B-451 !0653/ /5461/ <br />~ EX DF <br />137-371 <br />MALrsls TYPE <br /> AVERAGE MAXIMUM UNfTS MINIMUM AVERAGE MAXIMUM UNITS Isz-6~1 !64681 !6370/ <br />OIi. AN GIiE:ASE SAMPLE >~{~3:;# ~ 94) +60+it:pd Arr,';r:- ~•.r;.;;. <br />Y i~ u a L MEASUREMENT . <br />,~ <br />b4JbD L 1 V PERMIT R~r>x-.-r kEPC1RT PS=1 Pi~OllOU: 9>a';4~~G ;`GS*~;L: '- .,. tHCE/ I:.UAi <br />hFt'LUENT :,hOSS YALU REQUIREMENT INST MAY NC=O {!~.>pT~; <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />~:- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> ~REQUIREMENT~ . <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF L <br />MILIM WITH THE INFOR AW THAT I NAVE PERSONALLY E%AMINED MD <br />MATION SUBMITTED HEREIN; MD BASED ON i TELEPHONE DATE <br /> <br />~j <br />y, <br />~ <br />.- ~yps MY INDIeRY OF THOSE INDINDUALS IMMEDIATELY RESPON9BLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />, <br />y, <br />L <br />_ TgUE. ACCURATE MD COMPLETE. I AAI AWME THAT THERE ME <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />C L+ V I ~= , <br />THE POSSIBILITY OF RNE MD IMPRISONMFNT. SEE 18 U.S.C. E 1001 MD 35 SIDNATUR OF fRiINCIPAL E <br />ECUTNE <br /> U.S.C. f 1 Gl e. IPrWM. rwtlAr NAr. AbNb. mAy ic/u>. r.». w ro f 10,000 X AREA <br />TYPED PRINTED ArN a+muinun%IYV/ALYYIMrII PIeIrvfM smwdrA rN 6YAr/Al OFFICE OR AUTHORIZED AGENT CODE UMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRslerencs el/sttechments here/ I <br />TC>:i E IkJH LIMITS FILL &E 11AIYE0 AND SF.TTL~AdLE SOLIDS LIP I' PFFLIFC FOP <=iCY5,24HH PNCCIP EYF,R'T; ~f5~ & <br />IdJti LI"IIIS 'WAIVED FOH >lOY:tF2uHR PdECIP EVoN2 SU9JF..CT TO F'CRCFfI CF FFCCF iH T.P.2. OIL E GFEA>~-SFT' <br />i.h.l. D. Tf1S Ml1H TTf1F TG _-SL'i F-2_T c- <br />EPA Form 3320.1 108-951 Pravioue editions mey be uead. (REPLACES EPA FORM T30 WHICH MAY NOT BE USED.1 G C I D y / 9 7 ] U 31 ~ 15x+3 PAGE IOF <br />c.;~,, <br />