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PERMITTEE NAME/ADDRESS l7 '''-ir(BryN•Wfurra.IlD1O •~0 NATIONAL POLLUTMT DI9CHMOE ELIMINATON 9Y9TEM /INPOES) Form Approved.. <br />NAME S.EMBL'K~ CDAL COtlPAMI ~ ~ DISCHARGE MONITORING REPORT lDA1Rl '2 <br />~.:1 ~•. 2-, 51 17-19 oISCtlA>scc Ta TRI9i aP~;~~~ -. . <br />ADDRESS fidAYBR D ~ ~ (St19R MY) pprov a Is 1-98 <br />HACDEN CO E1639 '. PERMIT NUMBER y.. a yENUMBDI p TI MAL <br />MONITORING'~~ tiINOR <br />FACILITY ~'~ <br />LOCATION YEAq> MO DAY ~ EAR MO DAY ### <br />tlAYOiM CO 81630 FROM TO T ### Mo DISCHARGE I~1 <br />A T? M i G. BUD D R 0 Y q~ 6 EN E d A L H A M AG E R !7. ' -731 11r-751 176171 17e-2s1 I3a371 NOTE: Read Imtructlar before ompl•tinp thb form. <br />PARAMETER 13 Grd Onlyl QUANTITY OR LO ~ p Grd On1Y1 ¢UANTITY OR CONCENTRATION NO- FREQUENCY SAMPLE <br />M6531 /54-e1/ ~ !3B-I51 !06531 15I-511 OF <br />l31-371 ~ EX MN.Y919 TYPE <br />AVERAGE MAXIMUM MINIMUM AVERAGE MAXIMUM UNITS (s7ea, /BI-881 /6570/ <br />PH SAMPLE ###7r4# C-.`•C?O% #0#34k ~ ~2~ <br />,. <br />MEASUREMENT ~. <br />,. , .,:., <br />UUKUU S I U PERMIT • rq:Qfk 49r# 4;Axl4tf# ##V •..>a'~s.:::r.`:::: ~IOI LirQi#...4:~{j:.,.:;.?: ?.'.' " ~ ~~:.:; .'~~~'~ <br />?.. <br />SPFLUhM} GROSS -ALU .REQUIREMENT ~ LR4## - ; . ~• <br />f'LON~ III CO~DOIT OA SAMPLE ~ (1 - ~g#I# ~ ~ #'.k##40 414###d <br />7HHU TREATR BM} PLAN MEASUREMENT ~' - <br />SUUSU 1 I U 'PERMIT,.:. ,:, <br />~.. <br />tFPLUBNT GEflgS rALU :REQUIREMENT:..,IDDA ATG OAI 'T'!1 .:HCD ." `~~~e-, i .. ;*. r:: l4C0 <br />OIL AMD GASASt SAMPLE CYF#rAae ( 9K) ##*r4Tl ,,1 rsoso# tra#### <br />VISUAL MEASUREMENT '°' <br />,. -. .. <br />,. F,y,~~~ <br />~:::.. .. .. :;:.. s: :... <br />B4UOb I I O PERMIT: #IRSOtCP R$~~R.~ BS=I #~>R14/L. is ;~;; 4A~# ei:`!. •RJFJ:(:": i~d~Z <br />E~t'LI1t:NT GR09S IALO RE¢uIREMENTr. ,.. IN32 F3LX MO'0 ~':~ :: '~` <br />SAMPLE <br />MEASUREMENT ~ - <br />~.. <br />~.RE¢UIFifMENT ~. ~ ~. ~.:.~:~~: .:...:.:::..: :. ..:.: ..:.. . <br />:,<~ !<~. <br />SAMPLE <br />MEASUREMENT <br />r;:; ~.,.PERMI .. ... .... . <br />.. .. ... <br />~~EQUIREMENT .. : .. .: .... ~ . . <br />8 <br />.......... . <br />SAMPLE <br />MEASUREMENT <br />.. :fiEQUI.REMENT~:. ~. .~ .. .. ~ :.:: ~ .. .. .... .. <br /> <br /> ~(iEQUIREMENT~' ~~~::~ ~::: .. :.. ~ ... <br /> <br />~ <br />... <br />. .... <br /> PENALTY OF LwW TNAT I NAVE rETISONALIY E%AMI <br />NAMErt1TLE PRINCIPAL EXECUTNE OFFICER I cERnFr uMDER <br />EREIN <br />MD B NED AND <br />A9ED ON TELEPHONE DATE <br /> <br />' r ~ <br /> <br />{ <br />~ <br />\ w. ~. ~ti ~" ~ <br />` : <br />AM FAMILIM WITH THE INFORMATION 9UBMITTED N <br />MY INQUIRY OF TM09E INDIVIDUALS IMMEDIATELY RE9PONSIB <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORM <br />LE FOR <br />ATION 19 <br /> <br />I <br />(J`'/ <br />0 <br />1 I <br />I I <br />y' <br />r <br />~ <br />, TRUE. ACCUMTE MD COMPLETE. 1 AM AWME THAT THE <br />ORMATION <br />IN RE ME <br />CLWING /' +--~ <br />~ - r~~~p ~ <br />~ O <br />11 O <br /> 1 <br />~ ~ <br />Rl •..1 `1' vJ v~ ~ 1 <br />\ <br />~~• , <br />BIGNIFICMT PENN.TIE9 fOR SUBMITTING FN.9E INF <br />THE P0951BIUTY OF HNE MD IMPW90NMENT. SEE 1B U.9.C. ! 1001 MD 33 <br />RE <br />f <br />dPAL EXE <br />/TIVE ~ 7 3 + <br />I 1 <br /> 444 <br />I <br />V <br />TYPED~dR PRINTm U.9.C. 1 1310. (MWFY• udr N.w sYdb. wry ichri. elrF W m i r0,000 <br />rr ar nruim.n irMricmwlt or Mnr••~EmanTa rM6yral BIONATU <br />O <br />OFFlCERO IN <br />CI <br />IfINORQED AOENE <br />ODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lR•ference ell sf(echments here! <br />T55 E I1tOtl LIRI?S PILL B6 NAI-EO AMD S8}TLEAFI6E SOLI05 LI!!IT APPLIED FOR G=I~YRe24HR P9EtIP E1EMT= tS5 E <br />1RUM LIlfYTS RASYLD laf: ?1DlReTM1tlR ,pABCIP E-EMT SOBJ6C} t0 BDRDL• OF PIIOOP IM I.A•T• OtZ S GxEiSE-SJ'2 <br />r t n n r <br />' <br />EPA Form 3320-1 108-951 Previous, edibone may a used. (REPLACES EPA FORM T40 W}IICH_MAV NOT BE USED.L PAGE <br />~ <br />00067~/9f 0410-0123 ' , : OF <br />I <br />. _ .. ._,_ ~. . .. <br />