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PERMIITEE NAME/ADDRESS pwrL4 irdlryNw//amI« IJDIyh.«n <br />NAME ~ ~. ,S _, 1. N ~. i.' 5 .. (. l "~ r ~~ i t <br />ADDRESS (1 h, h n :. r; <br />khi~l.F CO 411,33 <br />FAaI rrv <br />LOCATION I{~;' ~~!i i..) „it• S~~ <br />NATIONAL POLLUTMT DISCHMGE ELIMINATON SYSTEM l/VPDE$l <br />DISCHARGE MONITORING REPORT IDMRI <br />11-161 17-I9 <br />~_~. ~ 00221 C0~ F <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM '/ J ~ ~ TO _ <br />1a6~11 m-731 Ins-~51 IY6I71 /78-191 /363// <br />Fonn Approved. <br />-~ - r, r . ~^ ~ (,C3MB:Noa2040-0004 <br />. f . ~ ~ ~ ~ ~ Approvelletcpirg9 0531-98 <br />.~ <br />c F ' t 1. L <br />NT.'! r <br />l <br />>~~~ NC WISE NA't~':: ~--~ , <br />NOSE: Reed ImtrucUoro be1a~ completing this tam. <br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING (4 Grd Ontyl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> 146531 15461/ /38-451 146531 154-611 EX TYPE <br />131-371 MALry3 <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !s1-sal I646S1 I6&701 <br />~UL1 vJ+ ^:In <br />' SAMPLE -. ~ ':~OOAO~ <br />L f I <br />3 <br />L' (S ~ ( :) <br />b <br />L I ~:, II L <br />V t .. MEASUREMENT /~ /3V ~j,,,- <br />IG.~~ 1 U i1 PERMIT •:~':;:: ::: r:r,::.e: ~ ::.:;' s'rfo+a+P:~a LF7ICAAL ,,; T:-; *: •, .TO;Y 'R4r <br />t-F r L U E ,! : C n 0 5 5 7 F. L C, REQUIREMENT <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 /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ . --~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF l <br />AM FAMILIM IMTH THE INFO AW THAT I HAVE PERSONALLY E%AMINEO MD <br />RMADON SUBMITTED HEREIN <br />MD BASED ON TELEPHONE DATE <br /> ; <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOfl <br /> OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />INCLUDING <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br /> , <br />THE POSSIBILITY OF NNE MD IMPRISONMENT. SEE to U.S.C. 1 1001 MD S] SIGNATURE <br />F PRIN AL EXECUTNE <br /> u.3.C.7 tats, rPrlYS•uK+rer+«mturo+m+y hrAe+6+++y+ro tr0,000 O AREA <br /> <br />TYPED OR PRINTED <br />+ndrmuirwnirrAASr.nNlr OrerM«n anivlrA+r106 y+rsl <br />OFFICER OR Alit RL2ED AGENT <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/erence a//ertschmenrs here/ <br />:;;., „I^'.II r+: LL :'1Vr~~ F3.1 -,FTTL..A:?LL ~.,,I1~ Lit: 1'- n"?LIFO =CF C=1CtF+?'irL F' _/:" 'YF..- <br />• Y ~ C <br />~...: LEnDL:. -~~7 L::`-+ L: °.I~ n'.:Y D EUr ~1~Jf i'F~ir? ?d~C Tr' :'l r:S~ °7 _.i TCT °C F';_, !: CF ^i:0:?c I`~ T. A.. ~. ~~IL ~, <br />.. r.: e'i F-`.rF f. h.l_ T:'i=. .-ViT~.lPif: :-.-._ T. a_1 .. <br />EPA Fam 3320.1 (08.95) Previous editions mey be used. •IREPLACES EPA FORM T-40 WHICX MAY NOT BE USED.) U U C ~ 7 / +7 ] U 3 1 - 1 S 13 PAGE 1 OF <br />