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PERMITTEE NAME/ADDRESS Qndude Faailiry Name/Camrion ijD~erenq <br />NAME S%NF:CA CCA.L CGI!FANT <br />ADDRESSD 8 A'r F. F: D <br />ItATDEB CU 61639 <br />FACILITY <br />LOCATION A Y C t y CC 816 30 <br />A T~PN: G. HUD &ftOGN. GENERAL PIANAG EA <br />POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approvetl. <br />DISCNARGE MONITORING REPORT (OMR~ OMB NG. 2040-0004 <br />rz-rs/ nr- s/ r; I HC A A?proval expires OS-31-98 <br />C' 0 (~UHR E~) <br />PERMIT ~ DISCHARGE NUMBER t' - f I F E l F ' T <br />MONITO 'RIOD DISC :.F F(E TC TF1E/CF! CHEEK <br />~~ YEAR MO D YEAR MO DAY <br />FROM U V 70 ~ 1 U +' ^ is F (: C I ~ C Fl.b I16 E +,y,,; t, L C,'i <br />2n !zz z3l r (zs-zrl (zb~1e) ~ (3a3n NOTE: Read Instructions before completing this form. <br />NATIONAL <br /> (3 Card Onry) QUANTITY OR L • (t Certl On/y1 OUA'NTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (48-53) (54-61 ~ (38-45) (48-53) (54-61) EX OF TYPE <br />' (32J7) AVERAGE MAXIMUM S MINIMUM AVERAGE MAXIMUM UNITS <br />I6z~691 ANALYSIS <br />(64-681 <br />69-70 <br />v ARD EAS SAMPLE ) `~}'• 0 0 <br />D ~1 I1 <br /> ~ V Vrls <br />YISUAL MEASUREMENT <br />H4U6t4 1 0 1 ~P6RMIT ~ "':° [S=1 4 , <br />_ <br />. a+cA ; .~ . kI, ~ <br /> <br />LFFLUEN2 GROSS YALUE <br />~~IE;~UiPE<MENT <br />t,t" <br />~ <br />lC=O <br />•i~~'•' ¢ <br />x <br />=~ <br />C>DO9 1 <br />~6~R . <br />~ ~ - <br /> SAMPLE <br />~~ <br /> MEASUREMENT <br /> <br />~ <br />l <br />I <br />" / ~, <br /> .~. T.. .\ 3~ .. <br />j:. ' <br />T. <br /> SAMPLE <br /> MEASUREMENT ~ , <br /> <br /> .,, u tE,r I. <br /> SAMPLE <br /> MEASUREMENT <br /> T <br />I <br /> N <br />t)I M e, <br /> SAMPLE <br /> MEASUREMENT <br /> ,.~ ~ <br />.i^`~ <br />~ ~ ,~~ <br />' ~ _.Trr ~ ~ ~~ <br />f <br />5 ~~ <br /> p <br />GQU~E'NT ;tT <br />e .;.~~ T <br />y , r .. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> g_." <br />q <br /> y <br />~. <br />~~inFF%(EI~T <br />~ <br />.x lac.-z ~ <br />.i <br />f <br /> SAMPLE <br /> MEASUREMENT <br /> " PERgMIT- ?% > '~~ "e" <br /> ~~4U[RGMEN~= r <br />~ y <br />~' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENgL7V OF LAW THAT (HAVE PERSONALLY E%AMINED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORM ATION SUBMITTED HEREIN; AND BASED ON MY ~ ' <br /> INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br /> ACCURATE AND COMPLETJ= I AM AWARE THAT THERE ARE SIGNIFICANT <br />INCLUDING THE <br />T(ING FALSE INFORMATION <br />PENALTIES <br />FOR SUB D 0, ~~ <br /> , <br />. <br />MI <br />POSSIBILNY OF FINE ANDRMPRISONMENT. SEE 1B U.S C. 4 10D1 AND 33 U.S.O SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br /> 000 and or <br />include Imes up ro 510 <br />rerul <br />ma <br />4 1319 <br />P <br />lri <br />db% If AREA ~ <br /> , <br />e; un <br />rese s <br />as <br />y <br />. I <br />ene <br />tl S OFFICER OR AUTHDRIZED AGENT <br />O <br />E NUMBER YEAR MO DAY <br />TYPED OR PRINTED Years.) <br />maximum impnsonmen(o(belween8monlhs an D <br />COMMENTS AND EXPLANATION OF ANY vW W I IUrvJ (nererence allatracpmenrs nere/ <br />T55 E IRON LIRIYS Ylll 81; YAIYED AiT~'r-'SE1tLEABLt' S,CLIDS lIEI1 OFFLIFL' FCF <=lUYA,i~IEF ft/1~1]) EYEA7; 1`_5 6 <br />1P.UN LIFiITS JAIIEU EGF )lUlR,248R PRCCIP EIENT SUEJFCT TU EUFCEN OF FRCCF I+i L A.~. U11 4 ~iIRA`-E-'_EE <br />~~~~~~ me w~u~reTrr cac T N,I c - <br />EPA~Form3320.1(OS-45) Previous editions iney,Tlotbe Psepl ~~ (RERCAdES'EVA'FQRM 7-40 WHICH MAY NOT BE USED.) p{4AK1'I OC C197~~.4~` ~ PAGE T OF <br />NUMBER <br /> <br />