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PERMITTEE NAMEJADDRESS Undude Faciliry NamdLocation /Dif/ermq <br />NAME .}. .- <br />ADDRESS ~ A :: `. }, ' J •'~ F_" D T F"! <br />P.ll. E1g = ~' <br />C? 4Jc C'O y1p'S <br />FACILITY <br />LOCATION <br />aTTh: ?. :UTr- -.T .r. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ FDmI ApprOVed. <br />DISCHARGE MONITORING REPORT (OMR~ OMB No. 2040-0004 <br />(21bJ (+F 9) •• T q ~ n Approval expires OS-31-88 <br />PERMIT NUMBER DISCHARGE NUMBER :• _ r , ,. ~ . „ ~ I, , <br />MONITORING PERIOD " ~ % r, e "- ~' '' ' ~ '% T 1. ! • e r ^ c -~ a v <br />YEAR MO DAY YEAR MO DAY <br />FROM 99 C6 71 TO "' ^r. Tn ;~ ~ .. .... ..rn A~~,-r I ( •yl.,. <br />rza2+/ rz2 2J1 I24~25) R6DJ (28-19) l~a+1 , NO7E: Read Instructions before plating this form. <br /> l3 Card Ony) pUANTITY OR LOADING. "~ (4 Ce)d Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4653) 54-87J 38-45) 46-53 54.8+ FJ( OF TYPE <br />(32.30 AVERAGE MAXIMUM UNMYS MINIMUM AVERAGE MAXIMUM UNITS aval.rsrs <br /> re2m> (B4-se) 69-70 <br />~.)~JD=., -"T~;. SAMPLE ,....,~s~ ~:c-~: rt+~7<rtnr ( Tnl <br />i;I3slihV''" MEASUREMENT <br />fn.7,y 1 ~ n PERMIT ,a4elpar0 MkaaRna r. .. ;. <br />' -,~~IqM 0P1`1'~!#AL ( Tr4LT .RAP <br />i:Ft'LUR'%T ;R7"~ Vr.1."'r REQUIREMENT ~~n ;'~ i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT " <br />_ <br /> REQUIREMENT " <br />,. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - -,"„ s' a <br />P ' '-. <br /> "REQUIREMENT - ~" ; <br />' - , .;y <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />Y <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />" <br />" <br /> ;REQUIREMENT "" ~ ~ ~ ` <br />' <br />" <br />W'* "a• <br /> SAMPLE <br /> MEASUREMENT <br /> ' PERMIT. " ~ ~? - <br /> REQUIREMENT " ~ t ~.. ". " <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br /> <br />~ . , <br />"- , <br />= " <br /> REQUIREMENT ~ - - - - ~ „ ~ - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF L <br />AM FAMILIAR WITH THE INFORM AW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN <br />AND BASED ON MY TELEPHONE DATE <br /> ; `~ <br />Kichard M{ll$ INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, ~ <br />/ ' <br /> <br />Environmental Mana <br />er ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITT <br />NG FALSE INFORMATION <br />ING TH <br />INCLU ~ <br />Y'{ ~ l ~~ ` <br />970-870-2712 <br />7 <br />28 <br />99 <br />g I <br />, <br />D <br />E <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE to U.S.C. 4 1001 AND 33 U.S.C. -SIGNATURE OF PRINCIPAL E%ECUTIVE <br />TYPED OR PRINTED ~rrwm(im~o me0nf a+b eCNe9n 6~marrth5 erM 5~ fines up b 510,000 Md a <br />wi yeere.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />~c"'L:'P rL.-. •'?f.fC` !. T!'7." ~~1'!.°;? F~~ >LOY4, ~UIi P. ~~srT;~ vVF. r..- .-r. ~.'Ir -'~ t'r c~c °°_i`IT~Fr~.•T ~~ (err r <br />:: ({ci .l'.SL GIfAP SC'''t,T AA'RLt iIS GL,~DT pvn 7C I)T ~: ql- cu^op r^, nva-~prJ rn~ n!T ~nR~v •;t MnT T•' i^R f`. -T~ ~~1 <br />r rti^ nr~r Nc <br />e <br />EPA Form 33261 (OS-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAV NOT BE USED.) PAGE OF <br />~n~3?/9nng12-?52? 1 <br />