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<br />PERMITTEE NAME/ADDRESS (include Faciliry Name2ocativn i/OrBerenq
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<br />NATIONAL POLLlRAN7 DISCHARGE FLMINATION SYSTEM (NPOES) Form Approved.
<br />DISCHARGE MONITORING gEPORT (DMR; OMB NO. 2040-0004
<br />(sa6J n'- e) • ~ p Approval expires 05-31-98
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<br /> PERMIT NUMHEA DISCHARGE NUMBER e, - r - r: ~ . r r) c r r
<br /> MONITORING PERIOD v .•1 r r r p r •- ~ • r t- r V' r,l u v
<br /> YEAR MO DAY YEAR MO DAY
<br />FROM 79 ^" 1? TO 7n '1T Tn ti,<•: ~.. .. .-.. ~s~-,'~t- 1 { tar ~:
<br /> NOTE: Read Instructions befo plating this form.
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<br /> (3 Card Onry) QUANTITY OR LOADING (4 (.`eN Onry) QUANTITY OR CONCENTRATION N0. FREOOENC SAMPLE
<br />PARAMETER (46-53) (54-B7) .fir 38-45) (46-53) (54-87 EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />(ezm) ~~~/S
<br />(64.68)
<br />69-70
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<br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY EXAMINED AND TELEPHONE DATE
<br />AM FAMILIAR WITH THE INFORM ATION SUBMITTED HERE IN; AND BASED ON MY
<br />~
<br />INQUIRY OF THOSE INDNIDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING
<br />';
<br />Richard hAills THE INFORMATION, I BELIEV E THE SUBMITTED IN FORMATION IS TRUE. .:
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<br />ACCURATE ANO COMPLETE.
<br />Environmental Manager PENALTIES FOR SUBMITTIN IPM AWARE THAT TH
<br />G FALSE INFORMATI ERE ARE SIGNIFICANT ~ -~ ~~ f, /.
<br />ON, INCLUDING THE 970-870-2712 7 28 99
<br />POSSIBILITY OF FlNE AND IMPR ISONMENT. SEE 1a U.S. C. 4 1001 AND 33 U.S.G. SIGNATURE OF' PRINCIPAL EXECUTIVE
<br />
<br />TYPED OR PRINTED 4 13r9. (Penetties under Ness a
<br />meaimvm lmpdsonmem of OeMee mbles may inciutle I/MS up m j/B,000 rrrltl a
<br />n6monrht entl5 years.) OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />COMMENTS AND FJ(PLANATION OF ANY VIOLATIONS (Rele2nce al/attachments oars)
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<br />EPA Form 3320-T (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) PAGE OF
<br />n~nj t/an.~rll7-1521 ~
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