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PERMITTEE NAME/ADDRE$$ (/ndude Facility Name/Cocvnon IfDl~rrenr) <br />NAME SENE:CA CCAL CGCEAt=Y <br />ADDRESSD 8 A ii E R D <br />HAYDEN CO E1639 <br />FACILITY , <br />LOCATIO nAYL:. '- 81630 <br />A1'Y6: :!UJ baUwh, GENSRJ NAGEH <br /> Form Approved.~!'?~'~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />' DISCHARGE MONITORING REPORT (DMR; QMB NO. 2040-0004 <br />r2 s) m• e) RI lip A Approval expires OS-31-98 <br />~- cs c$u x x.E) <br />NUMBER ..~ DISCHARGENUMBER E ~,:, ~)( FGOTT <br /> T F I <br />h 1 C F E E$ <br />~ <br /> E/ L <br />6 G E l U <br />~ <br />Q' <br /> O ~ MONITORI RIOD ,. <br />IM YEAR. MO D EAU MO D'v ~~ ~ tic 1 9Ct <br />It:;CNA ECF ~ <br />(zaztr rsz.z~l r <br />RssD (~e~~9) (so st) NOTE: ~_ <br />Read Instructions before completing this form. <br /> ~ (3 Cerd OnryJ QUANTITY OR LOADING •'artl OnryJ QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53)' (54-67) (3BA5J' (4653) (54-61) EX OF TYPE <br />(32.77) ~ AVERAGE MAXIMUM UNITS MINIMUM '-, AVERAGE <br />* MAXIMU UNITS <br />rezuv ANALYSIS <br />(sa-saJ <br />s9a0 <br />G i L A N G G R A S L <br />V I S U A L SAMPLE <br />MEASUREMENT .>p0>QOIP4 -, <br />- ; '` <br />U ~ y4) :: i~O,y LCO t <br /> <br />~ /g <br />(/ <br />' Q~ <br />U l S <br />U4U46 1 U 3. PERMITm ~ ° >,LI +0gA09sl oc fiY. <br />• i/ I I5 ,a <br />EFFLUENT Gb05~ YALU ,I3F11~ME4BT ~ StKi ~rx'i~ , <br /> SAMPLE <br /> MEASUREMENT <br /> - . <br /> it• ~„ <br />T lid <br /> SAMPLE ~ -,~'.~ <br /> MEASUREMEN ~ •' <br /> 3?ERMIT <br />' <br />~ ~ 'U - <br />~ <br />~~ <br />`~ -. <br /> R~,~UIPEMENT ~.c. .~. <br />. ~*,~ <br /> SAMPLE <br /> MEASUREMENT c^ ;; ~~. <br /> <br /> ~EEifiUS'' <br />~ <br /> ~A~aUIREMENT rrr - <br /> SAMPLE - <br /> MEASUREMENT <br /> <br />e <br />' PERMIT - -~1 4 - <br />I - - <br />s~,: - <br /> E4uIg6hltrNT ~:~ ~ ~.i <br /> . <br /> SAMPLE <br /> MEASUREMENT - ' ` ~~%~ <br /> <br /> ~/,~ p{. +f3 _ e 4. , <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ' <br />•~ <br /> J$'CI'(JIREMEN~' ~, .- - ' <br />r ev.'~' ~ ~ - <br /> - : ~ <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM fAMILIAA WITH THE INFORM LAW,THAT I <br />HAVE PERSO <br />A <br />I <br />N <br />UBMITTED HERE NALLY FJ(AMINED AND <br />AND BASED ON MY <br />IN TELEPHONE DATE <br /> INOUIRY~OF THOSE INDIVIDUAL ; <br />T <br />O <br />S <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATION IS TRUE, <br /> ACCURATE AND COMPLETE. <br />PE <br />A <br />T <br />E I AM AWARE THAT THERE ARE SIGNIFICANT <br />DING THE <br />E <br />FOR <br />T <br />ON <br />INCL '~ ` <br /> <br />N <br />L <br />I <br />S FOR SUBMITTING FALS <br />IN <br />MA <br />I <br />. <br />U <br />POSSIBILITY OF FINE AND IMPRISONMENT SEE is U.S.C. § toot AND a3 U.s C. <br /> <br />SIGNATURE OF PRINCIP EXECUTIVE <br />U ~~ O~ <br /> <br />TYPED OR PRINTED g t3te. (Penetties under these statures may inclutle hoes up ro St0,000 entl or <br />maximum ~mpnsonmenl of beMSen6mpnlhs end5years.) OFFICER OR AUTHOR ED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />TS:; L 1ROH LIHITS YILI 8E YAIYED AND SETTLEA6IE 9CII05 LINT AFFLLEC FCL• <=10Y9,s"4Lb F6ECIF EYE11T; 7`S G <br />LNON LIflITS YAIY6D FGF ~lUYH,14HH PkECIe EYEa:T 9UEJECT TC EURDEN GF FbCGF Iy I.A.T. CII E 6FEA.9E-.SEE <br />T u b n +~e rnx T~6AIRr_ei:E t e+ E' <br />EPA~FOrm 3320.1 (0893) P,[evidus edjtions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) n n R S O ~ p p A A - -y ~ ~ A L ~ ~ PAGE ~ OF <br />