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PEHMITTEE NAME/ADORE55 V•~rA,Nfmo,p ,v.,.N, r.,r.nr.., nu~trnwe, <br />NAME T1~ApPER ry7!tTMr.f I~tC. <br />ADDRESS TRAPPP.R RIME <br />P.O, H01( 1y7 <br />Ct+Ai(: CD 91625 <br />FACILITY <br />LOCATION <br />A7'SM: W. 60RDDR PETERS, RAF,S/GEM IICR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATON SYSTEM INPDESI <br />DISCHARGE MONITORING REPORT IOMRI <br />!I-r61 r7-I91 <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO_ DAY f~YEAR1 ~MO~~ DAY <br />FROM~~~ TO 1 "" l u~ l Zn <br />(20-1 F} 11?-13/ 114151 (16.171 !28.291 1363!1 <br />Form Approved. <br />T !< 7 R OMB No. 2040-0004 <br />Approval expires OS-31-98 <br />v - 1'T ?T Ai. x7ca- <br />=.^b*• kF,T TESTI~16 F~(OR 009A <br />aaa rD iPf^CiiRR~1~ lNS1R+ aa# <br />NOTE: Reed inetriEClione a a pletinp thin form. <br />PARAMETER ~ !3 Grd onlq QUANTITY OR LOADING N Grd onryl QUANTITY OR CONCENTRATION - - ~ NO. FReouENeY SAMPLE <br /> (46531 /54611 /38A51 (16531 15~-611 Gf <br />131-371 El( <br />~ <br />ANALrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~ nr1-ss !64681 169-701 <br />LC50 STATttE ORH.P. ACr SAMPLE alp4ao# a##aa# <br />-" axL##a- a##wg*. ,t '77) <br />CERIODAlrHgl- MEASUREMENT <br />TA93li 1 0 0 PERMIT a#vtLaa aR+C Ota# # j(yQ. ¢ ~Q~ :. : '::aIQ~;.>Ofit~¢'.' <br />~•r- <br />~~~ <br />~~ <br />hFt'LQEtl'[ GRDSS PALO REQUIREMENT #ta <br />LCS;1 STATRI? 96HR AC SAMPLE aa0a#a aia a ~ a #an 04444'- ( ; 3) <br />PII'1£PHALE` MEASUREMENT ~~ <br />7 ANbC 1 D U PERMIT #a'##a# ## ##a 4R C#4 a4#t+4i`-.: c,'~= ..~: <br />'_ <br />i ~.1iLY ~l~119 <br />EFf'LUEdT G30$S --L'11 REQUIREMENT ~,.;~~ . . <br />. <br />. <br />. <br />~ <br /> SAMPI.J_ <br />~ <br /> MEASUREMENT ~ y. <br /> PHTMI7 <br />~ ~lr = . . <br />' - ~EOf,IIIIEMEhI'f -,. <br />. <br />r,~r <br /> SAMPLE <br /> MEA:>UREMENT ~ "-! <br /> <br /> PERMIT <br />~ <br />~ <br />`.''s~:`.l; ~~~ ~~ <br />~~ <br /> REOIJIREMENT ~ ~- <br /> SAMPLE <br />( MEASUREMENT <br /> <br /> ^ <br /> <br />~ <br />' ¢ <br />, <br /> REQUIREMENT - ; <br />' SAMPL <br />' MEA:iUREMfiNT ~ - <br /> .PERMIT ..; ~ _ .. .. <br /> 'REQUIREMENT <br /> SAMPLE <br />~ <br /> MEASUREMENT - <br /> PERMIT .. . <br /> REQUIREMENT ~ - ~ ~ ~ - <br />~ <br />NAME/TTTLE PRINCIPAL EXECUTNE OFFICER I CERTFV UNDER PENALTY Of L <br />AM FAMILIAR WITH THE INFOR AW THAT I HAVE PERSO <br />MATION SUBMITTED N NALLY ExAMINED AND <br />ERDN <br />AND BASED O TELEPHONE DATE <br /> ; <br />N <br />MY INOUIM OF T <br />E <br />D <br /> <br />W. Gordon PeLele HOS <br />INOIN <br />VALS IMMEDIATELY RESPONSIBLE FOR <br />IEVE <br />TRUE <br />NACCI111ATE ANDACIOMRETE <br />t <br />MS <br />ME TNI <br />TOTM <br />A <br />~~ ~ <br />970-824440 <br />99 <br />07 <br />14 <br />[/Gonaral Ma <br />a !I <br />P <br />ld . <br />. <br />A <br />AW <br />A <br />H <br />E <br />RE ME <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFOIIMATION, INCLUDING <br />r <br />rae <br />an <br />S THE POS51&LITY OF RNE AND IMWUSONMENT <br />SEE IB U <br />S <br />C <br />1 1001 AND 33 <br /> . <br />. <br />. <br />. <br />U <br />S <br />C 8N3NAT11RE OF PRINCM' <br />L EX <br /> . <br />. <br />. f t 31 B. lArrei. Mwr rhrr mnm. mFy NeANE Ahr w ro S 10,000 A <br />ECUTNE <br />TYPED OR PRINTED .+san..:I.nl inrlAe++wrr Mfwwrn FmmN. Anl6ywt/ OFFlCrEB~~R AUTHORIZED AGENT W <br />E NUMBER YEAR MO DAV <br /> . O <br />....~.~~.~~I. I ~ ..I....,.. ~ ............... ..... .............., rr..,...,... .,r .rr.~.,..,...r~ 11.1.1 • <br />SF.E I.A.1F PP 7-Q, FOF q{'TAILS ')F °F.ST PRO~EDORS. REPDRT LC~~ <br />- STATTCrT'!.t.^'1TK* F~'"TMATP. vujCM Ig <br />I.i3THAL T!1 SDR OF T°ST JR:AVISriSF AND AT*8Ctl ACUTE TdYICI'.'T tF~+! R`PnP,p RRP~ ~~ rierq, rnT+ItPr; nr• }LL <br />A Form 3320-1 (08• Previous a rtiona may a use ( 0 A T BE .) w , - ' <br />a t <br />