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PERMITTEE NAME/ADDRESS (/nclude Facilirv Name/LOCOIIen /Di~e~enq <br />NAME SEMdCA CCAL CCeFIhi <br />ADDRESSDRIYtiH U <br />HAYDeaI <br />co 6I6~r <br />NATIONAL <br />FACILITY <br />LoCATIOt~AYUEN CO 81630 <br />FROM <br />wT'fN: G. HUD 6HOYN• 6EkW@AL dt-~lGER <br />(zan) <br />ITANT DISCHARGE ELIMINATION 5 M (NPDES) FOfm ApprOVed. <br />A~ GE MONITORING REPORT,. ~a1 . I k C h OMB No. 2040-0004 <br />Approval expires 05-31-98 i <br />(SUfrP. AY) a <br />NUMBER DLSCHARGENUMBEfl } ~ PIr~~. [IGUTT <br />MONITORI}YG PERIOD CISC a_#,,~~~•. T,C TElE/SAGE CFEEF 1; <br />10 DAY YEAR MO DAY -/~' <br />' UU ~ ~~~ [ISCNA6G;f 1~xq~ <br />:-z31 rz4as lzssn 'rze~zv/ !30311 NOTE: Read Instructions befor completing this form. <br />PARAMETER (3 Card Onry) _Q)1gNTITY OR LOADING ~~ <br />~ dOnry) QUANTITY OR CONCENTRATION O. FREOUENC SAMPLE <br /> (4653):` ~ ~ (54-61) <br />~ (38-45) ' (46-53J (54-67) EX OF TYPE <br />(3237) AVERAGE <br /> <br />• ,~` MAXIMUM <br /> <br />~ U~~ ~ MINIMUM ~ AVERAGE MAXIMUM '(SiNITS. <br /> <br />(ezc3l <br />ANALYS/S <br />(B4~ssl <br /> <br />(6970 <br />IL ANG GNSA9k SAMPLE -''""'f~~ ( 4 90O 9 .p ~9 .. <br />V ISU I,L ~ MEASUREMENT <br /> <br />tl4U66 1 0~~ 1 =P~FMrn' <br />kr ~nxaa>a ~~ ~ FE=1 ~ <br />' ~ •^ >o a [ ~ 0>D r. <br />~ •.~ ~' <br />~ <br />EPPLUF.N'f GA05~9~ -ALU , <br />J91~~t~GN7 ; <br />~~~ ~C _ ~ <br />r <br />'', <br />. <br />~' I ~ ~~ ; ~ <br />~ ~ <br />~ 'A<t ~~~ . <br />~ <br /> fC .; <br />~ .~; .~ <br /> SAMPLE - <br />~ <br /> MEASUREMENT ^"~~ <br /> a.. <br /> ~, r `. <br /> rRl:'QUIREMGAkT ' q.~ ~ < 5 <br /> t I <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> .t ; <br /> SAMPLE <br /> <br />MEASUREMENT _ <br />' <br /> ,z c` <br />~ ' <br /> OUIFiEhI~NT I. .vf• <br />,`'.v~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> g1~(llf)EMENT ;LT <br /> <br />~ <br />.x <br /> <br />k; . <br /> SAMPLE <br /> MEASUREMENT <br /> ,; . ,L?69~f1f ~~ <br /> ~Ef~UI~QMENT "~~ , .~~ <br /> i <br /> SAMPLE <br /> MEASUREMENT ' <br /> <br />' ~ <br />~ <br /> QUI, f3 <br />~.~ F! rriENT~ <br />, * ~ ~~a, <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER (.CERTIFY UNDER PENAL '. FL <br />AM FAMILIAR W <br />TH T AW THAT 1 HAVE PERSONALLY E%AMINED AND ^ TELEPHONE DATE <br /> I <br />HE FORMATION SUBMITTED HEREIN; AND B45ED ON MV <br />INQUIRY OF THOSE INDMDUALS~IMMEOfATELY RESPONSIBLE FOR OBTAINING ~ <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE ~ <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br /> PENALTIES FOR SUBMIT7ING~ FALSE INFORMATION <br />INCLUDING THE <br /> <br />. <br />POSSIBILITY OF FI <br />E OD <br /> N <br />AND IMPRISONMEM. SEE 18 U.S.C. § 1001 ANO 33 U.S.C. SIGNATURE OF INCIPAL E%ECUTIVE <br /> uds /loss up to Et0,o00 entl or <br />max <br />m m <br />n <br />~ <br />~ <br />TYPED OR PRINTED i <br />im <br />n'sOnme <br />ol5ensse <br />B mOnrns end S <br />p ~'~) OFFICER O IJTHORIZED AGENT AREA <br />c D <br />NUMBER. <br />YEAR <br />MO <br />DA <br />wmmerv I ~ ,Rrvu eArIArvA I wrv VH ArvY wULA nUNS (Hererence ell attachments here) <br />T55 L INUN LICIT9 YILI HE YAIYEL AND SETTLP.AHLE S,ilI05 LII".IT APFLIEC FCF <=lOYA,i4NA FBE[Ip EIEE1; 7'_5c <br />IkUN LIAIT5 rA1YED FC6 ~IOYkr24Nit PRECIP EYeNT SUEJECT TC &UEOEN GF FFCCF IN i.A.i. Gl[ 6 6BlA.E-S!F <br />j w T n TGS ~^YTP^SlYrt=Si~~~ ~~ Q . <br />EPA~Form 33261 (08.95) Previous etlifions may not be used. (REPLACES EPA FOpM T:pp WkiICH MAY NOT BE USED.) 00100/ 99 0 8 17 - ] 6 S 3 ~ . ~ ~. PAGE 1 OF <br />