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PERMITTE IE/ADDRES$pnclude Facility Namr/localian ifDi$erenq <br />NAME ~ I; <br />I l ~^^ik rnp^, t •Rrr~.• <br />ADDRESSr.A ,_ ~T,!- ^~.,PL~,T' <br />'.rr ~r•~v .,~ <br />r?AT1. CO R1~24 <br />FACILITY <br />{I LOCATION ,~,,.~' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (IJPDESJ FDPn Approved. <br />DISCHAR GE MONITORING REPORT (OMR;) r OMB No. 2040-0004 <br />r1r- s ' ~~ Approval expires OS31-98 <br />PERMIT NUMBER DISCHARGE NUMBEfl r - ~~ r •~ r, T ~ ~ ~• . <br />MONITORING PERIOD - ~" ' ~ ` R-~ ~ ~'~ '~ ° r ~' ~ ~ "~ ~-~ <br />YEAR MO DAY YEAR MO DAY <br />FROM Q ') f: :! 1 TO l'T !l c , n ,.+- a .. ^. ,-,. r. , .. : c I ~ I ~.: :. <br />1 az.zal rzazs) tzrrv) rze-zs) (soal) ~ NOTE: Read Instructions before plating this form. <br />PARAMETER (3 Card Ony) QUANTITY OR LOAD ~ (1 Card Onry) QUANTITY OR CONCENTRATION NO. FREOUEN SAMPLE <br /> (46-53) 54-6T) (3845) 46-63 (51-67 EX OF TYPE I <br />(32,37) AVERAGE MAXIMUM S MINIMUM AVERAGE MAXIMUM UNITS <br />Rp~TI ANALYSIS <br />61-661 <br />69-70 <br />SOLTUS, 'CD; A1. SAMPLE •Y;r;:rr ^: r. rnr: <br />C Y; r•. "'"+"'. ^ r ' ~ T <br />U I'i S I:r L Y% ~ MEASUREMENT <br />" <br />7R2 <br />~5 1 lI U PERMIT '3kAYQRR pplp4tad-. <br />~~r~ ,?pbb 8$PffT#''I': Q ~Y~le~.~, TRlT ?R1~19 <br />F f F' L U S ii T i, a ^ - ~ V n T ~~ ~ REQUIREMENT <br />.. f. ~. -. , . <br />: (3'R'P ~ Apra <br />~ P M f( <br />" 7 T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , 2*;k_ <br />'~ ~ty, :+' f-,- , <br /> REQUIREMENT - ~ - - I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ft r~` ~;;{ '.=s +> ~~ ~ :. <br /> AEOUIREMENT .., <br />,: r %~` ~~ <br /> ~ _ <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT j - <br />~ <br /> REQUIREMENT . t ~ <br />` _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ..~... e°.p? <br /> REQUIREMENT - ~~, <br /> SAMPLE <br /> MEASUREMENT <br /> -"PERMIT- - - ~' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT.. - ~ - _ ' ' <br /> REQUIREMENT ~ - - -- - _ <br />~' <br /> - , <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF l <br />AM FAMILIAR WITH THE INFORM AW THAT I HAVE PERSONALLY E%ANIINED AND <br />ATION SUBMITTED HEREIN <br />AND BA <br />D ON M TELEPHONE DATE <br /> <br />Richard Mills <br />INQUIRY OF THOSE INDIVIDUAL : <br />SE <br />Y <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING _ <br /> <br />Environmental Manar~er THE INFORMATION, I BELIEVE <br />PENALTIES FORCSUBMITTING THE SUBMITTED INFORMATION IS TRUE, <br />FAISERNFORMATMONE NCLUDINGICTH j , ~ /' <br />"~~` ~`>~" ~'" "' <br />97~-(I7~-27IZ <br />7 <br />28 <br />99 <br /> POSSIBILITY OF FINE AND IMPRI E <br />SONMENT. SEE 1a U.S.C. 6 7001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 4 1319. (Fena/rias umYer these smtures may inc/utle lines up ro 510.000 entl ar <br /> <br />TYPED OR PRINTED <br />merimum lmpnsanmenrolbenvaenamonllu entls years.) OFFICER OR AUTHORIZED AGENT <br />CDDE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />GOMMtN I5 ANU F>(PLANA 1ION OF ANY VIOLATIONS {Re/erence all attachments here) <br />i^'T'.'Lf:A6Li': °'1I.~.~ Li"'iT L"1IV:;R f"1 IIUYr,~f14C ^'If'iT'r` '.Yq - T,~,7~ n(' fUr c9^ :r':1.~~5s'mcRrT4~ r'.rr <br />'.: k:',69~ ;kAP TA'"FL=' Ab1iLY~Ic nf•",U?FF'1 I° VTFI°LE :rpr. c•rl tCrrnPq cnr.^n, ~^T'+f..7 au9T )•Ir *~cTP9CTT^`i ~-T <br />'r <br />PA Form 3320-1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WFIICH MAY NOT BE USED.) PAGE OF <br />