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PERMITTEE NAME/ADDRESS /lndude Facdm•Name/Locanon iJD~erenp
<br />NAME SENF.CA CGAL CGNFAN2
<br />ADDRESSp H A y E k D
<br />HA)tDEtl CO 81139
<br />FACILJTY
<br />LOCATIOI~AtDE$ CC b1830
<br />ATT4: („ EUD E'ROtlN. GENERAL !'!AY.AGEh
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM1 (NPDES) Form ApprOVed.
<br />? DISCHARIGE MONITORING REPORT (DMR59) h I tlQ h OMB No. 2040-0004
<br />Approval expires 05-31-98
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<br />PERMIT NUMBER "tS~sGHARGE NuMeER E - • : p ! L . AC U,'[ T
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<br /> (3 Card Ony) QUANTITY OR LOADING Only) QUANTITY OR CONCENTRAT NO. FREOUENC SAMPLE
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<br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHON E DATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY
<br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY 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 SUBMITRNG FALSE INFORMATION. INCLUDING THE / I O 0
<br /> POSSIBILITY OF FINE AND IMPRISONMEM SEE le U.S.C. 4 1001 AND 37 U.S.C. SIGNATURE OF PIINCIPAL EXECUTIVE V
<br />
<br />TYPED OR PRINTED § 1319. (Perretties~~under these sMlutes mey include lures up 1p Sf0,000 end w
<br />maximum impdsmr7ren! I•belueen6monMS end Syt9ers.) OFFICER OR AUTHORIZED AGENT
<br />ODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIULAI IONS (HarerenCe all a1raC0men(S here/
<br />TSS E I60N LItlITS YI1[ UE iiAIYE:D AND SETTLEAiiLE SCLIDS LIeIT AFIYLLEL FCit <=10'fA,74FF FFECIF EYEFTp TSS G
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<br />EPA Form 3320-1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) [1 C rl 5 7 / 00 C f 9 7 -1 F 6 i PAGE 1 OF
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