Laserfiche WebLink
RfRMITTEE NAME/ADDRESS p.d~bs:myNmri«ula 1/D~...v/ NATIONAL POLLUTMT DISCXMOE ELMINATONSYSTFM /INPDESI Form Approvsd- <br />NAME DISCHARGE MONRORINO REPORT,° OMRI o. 04 <br />SLrMECI CD9L CONP1ti!tT !~-1w 7,7 YS/ ( <br />TO THIBk~; <br />~~g <br />7-s8 <br />ADDrrESS pBAY£H D <br />L <br />I <br />~ <br />SU6R <br />Yy) <br />PERMIT NUMBER ~ <br />EA <br />H-TUBY " <br />" <br />I OE NUMB <br />CO e1639 :Y <br />- - PI N,L <br />* <br />FACILITV~ MONITORI G OD M I Y OR <br />.LOCATION YE R MO DAV ~~ ~ YEAR MO DAY ~~ <br />YATLEY <br />CO 8163) FROM Ol S1 :~ 99 03 3 oaa MO DISCY4! L 'tea <br />~ <br />~ <br />hM f <br />T <br />orm. <br />,Tdlh <br />MtlnO t <br />i <br />TYl u. iiUO H`•DYN. 6E11ERAL KA/~GE@ /~ +l77-731171-751 :•+ I16I71 Ids-1sl !3431/ NOTE: Rudlntruetlanb.for <br />PARAMETER 13 fird Onhl QUANTITY OR LOA , G. !4 Onhl QUANTETV OR CONCENTRATION Np, FREDLENCr SAMPLE <br />l37-371 146531 15e-67/ ~' 'R 3b-I51 146 I51-611 '" ~EX OF TYPE <br /> AVERAGE MAXIMUM " UNITS ~ INIMUM AVERAGE MAXIMUM UNITS <br />fF7.671 MAirss <br />(54-5gJ <br />ffi9-701 <br />OIL lYD ssellse SAMPLE a4SLtaa ~ ~~,"" II#a0/k~ -F#~kII#a R'A O>m IIla <br />T I S U! L MEASUREMENT I $. <br />B4U66 1 U U '-: PERMLT.",;>'. <br />. <br />REQUIREMENT' .'. <br />'~*~!`1fT'Y:.''i: <br />~ <br />~:~":•.: '. ..~.: <br />.~d$.~' : <br />~ <br />C _ <br />C,,- <br />.~..e ............: .. <br />IAA; <br />, .. <br />~. <br />glpip>QNOIAi .. <br />. <br />..~:' .. ': <br />~-~ ~r+kf0!!b4Q <br />, <br /> <br />OIII4 <br />3M,. ~(II:i <br />~~~ <br />, <br /><.C a:: F.:... <br />~~i~ <br />..:.:.. .:.:.:.: <br />{~"~~'>«. <br />EPFLUdYT t+R055 ~ LO ; <br />, "~ _:~ . ~( ,t <br />. , , <br />.: ;,, <br /> .. <br />... <br />, <br />. ` ,~. <br /> SAMPLE ' <br /> MEASUREMENT <br />•; <br /> .:~'; PERMIT.. .. :~ ~'"'.:i"'~<€ ~... :" ;.x .:xs r...,?::: ~: :: <br /> _..., <br />:.-d>. <br />... ..... .. <br />p~ <br /> <br />.: <br />............ <br /> <br />:. .. <br />.. <br /> <br />..... ., <br />......:...:.. <br /> <br />- .. <br />....... :..... <br />" SAMPLE <br /> MEASUREMENT <br /> :' :PERMIT '.. s~ss~+r;ti;,x':> 1:,:",~,: .:,.;:.:.:" _' <br /> .. <br />... . , ,,,, <br />: <br />: <br />. <br />: <br />ir`e';'+" <br /> .. .. . :: <br />: <br />..::: <br />~:.:~, :<.:.:. <br /> SAMPLE .t., ,~ <br /> MEASUREMENT ', . <br /> •.. <br />' <br />' REQUIREMENT <br />...: <br />. ....., .:z,...,, <br />~. .. <br />... ...; r::::i:a u.,. ,: <br />wr. ...:. ' <br />:i4.::: .. :.'::.~'..~...: .~'. ~ ~;.;•;.;' <br /> <br />:'~..~ ~ '^';:;': ",.: ~:...,:. <br /> <br /> <br />i".i:i.'.::::::::': ,:. ~:<f<.'. ~' <br />!.' <br /> <br />'..r:.'::: <br /> SAMPLE <br />" MEASUREMENT <br /> :~.: PERMIT.': ~:' "`s;,:':'~:=::"..:-::' :"" " " ~ ' .:..' " " " .::~:: ~""~::::':":::: ~~:::,:.::: s;,rF<;;; :!;.::.::..:k'J:::: :~:.':'.;'~;:;: ,:: <br /> 'ffEQUIRENIf;f1S". ',.. .:.:::::..: .. .:.:'. :: " "' "::.:. ~~:.:. s. ~:::,, .::;:;z::;.::::: <br />......: :..::: <br />`:"'::'::. "::.: q3~.:'?": <br /> <br />~.. :::s',.::. Yi,:A: ~:::":':r'::::;:::~..': <br /> SAMPLE <br /> MEASUREMENT <br /> :r:::"PERMIT;.:.,. .r " ":: :.'~'^'':~? <br />,. <br />i:'..::7 ~"': ''.. .. ~..:...:::~: ~' <br /> 'REQUIREMENT: ~ ~ :..:,..::"' II...:>':.i. .... :. .. .. .... <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. <br />.," <br />...:.,; .. .:, .::;~:g "::':1:....::: .... <br />' . <br /> . <br />. <br />'REQUIREMENT: .......::.. :..:............ .. :.. <br />' <br /> <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I tFAnFr UNDER PENALTr of LAW THAr I HAVE PERSO <br />AM FAMIUM WITH THE INFORMATION S <br />BMITTED H NAUr ExAMw <br />EREIN <br />MD BA ED MD <br />SED <br />\ TELEPHONE DATE <br /> ; <br />U ON / <br /> MY INOUIRV OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIB LE FOR <br /> OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMA TION IS <br /> TRUE, ACCUIVITE MO COMPLETE. 1 AM AWME THAT THE RE ME ' <br /> SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INC LUDING _ f <br /> , <br />THE POSSIBILITY OF RNE <br />I <br />P <br />1 <br />~ ~ ~~ <br /> WSONMENT. SEE <br />MD <br />M <br />B U.S.C. E 1001 MD 33 BIONATURE OF PRINgPAI EXECUTIVE <br /> u.S.c. 1 131Y. fPnlMd.• IM~r e1~a mwro..I.r SxA.t. n.• w ro trocav <br />' AREA <br />TYPED OR PRINTED .rw nnrxhx.n irrPVl <br />onwrf o/WtwwnemmdrsW BYwA/ OFFlCER OR AUTHSRIZED AOENT ~pE NUMBER "YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS IRe/erence e/! ettechmenm here) 1 ' <br />1"~5 8 IdUH LI11IT5 aI1L 0e YLIYED AMO SETTLEAc~LE SOLIDS LIRIT APPLICD POA C=LOTR,2tlN8 eBLCf! tfEMT= ?SS <br />IEDII LIRITS YAZ4HD [DN >lO.TAe2Mi! P&BCIP eveYr SUDJLCS TO BOtDBM OP PpOOP ZM' L i.l. OIL ~,6a>at58-SEE <br />I w w <br />PA Form 3 O-1 1 - 1 - reviow mono mey a use JREPLACES EPA FORM T40 WHICX MAY NOT I3E USED.) PAGE OF <br />OOD58~/9B091a-09Iy 2 <br />. - - ~ <br />