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PERMITTEE NAME/ADDRESS (!nclude Facilip' Name.4ocarion ifO~eren p <br />NAME SEhP,CA CCAL CCf!FAtrY <br />ADDRESSD H A Y E k U <br />HAYDE~ CO 81639 <br />FACILITY <br />LOCATION~AYDEN CO 81630 <br />FROM <br />A?Tn: G. NUU t3H011A, GFhEkAL ltAIiAGER <br />n .Li <br />IAL POLLUTANT DISCHAgGE EUMINATIQkSYSTEM (NPDEB) Form Approve( ~ ' <br />DISCHARIGE MONITORING REPORT j0(MR~BJ Y I N C A OMB ND. 2040-0004 <br />.0 G D( • 1 Q Q li (S U B H A Y) Approval expires OS-31-98 <br />PERMIT NUMBER ~'~ }DIGCHARGE NUMBER F- F I M l l E O U T S <br />MONITORING PE a• aC 11= AFT IFSTI AG fCE (IEe <br />EAR MO DAY ~~' YEA MO DAY <br />1 , ~~ ~ ~ ,-~ do [I~CHAi6E ~--~ :oa <br />o vl rzz~z3l iz~zs ~ tzs~zn aa~zel 130-30 NO~i@,IrRead Instructions bef a Gdfnpletinq this Corm. <br /> (3 Card Ony) QUANTITY OR LOADING;. OnyJ QUANTITY OR CONCENTRATION NC3U FREOUENC SAMPLE <br />PARAMETER (46-53) (59-61J (38-45) (46-53) (5461) ~}C - OF TYPE <br />(32-37) AVERAGE ~ MAXIMUM ITS. MINIMUM AVERAGE MAXIMUM UNITS <br />(62~GT1 ANALVSIs <br />(6468) <br />69-70 <br />U ~ E HR SAMPLE ~ ```~-~ r'Y't •~".• <br />( ~ <br />CERIGUAPhh1A MEASUREMENT <br /> <br />TAt~3r: 1 U U PEf~1M1~ <br />=. xma , 0 FL- L1 'PA <br />EFFLUenT GROSS YALUE . <br />NEOUIR~NIEN'!` ~~ _ m <br />~-.°a~~Y~, x+6wT ~~ <br />YALf ~ <br />: CEF'! <br /> ._ ."-~". , <br /> SAMPLE <br /> MEASUREMENT •- <br /> ~~ ~ ' <br /> e <br />-A~9 <br />~~ - <br />~ ~ ~ <br />" - <br /> . . Hj , i .. <br /> SAMPLE <br /> MEASUREMENT <br /> '~- A~RMIT~ ~ <br />~ ~. <br />- <br />~ <br />~ <br />~ - ~~ ` <br />~~ . <br /> .)3E <br />UIf(EMENT - <br />. <br />s~ <br /> SAMPLE <br /> MEASUREMENT <br /> " '~PDRMIT - ~t ~,~~ -: - - - <br /> ,r <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERNnI~' - . > :I~ <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br />.. ~. ~{~~~ ~ ~ " <br /> fui~ <br />"gEQUIRE r-c <br />Y p'F ., <br />S` <br />' <br />j r. " <br /> , .t Y. { <br />y <br /> SAMPLE <br /> MEASUREMENT <br /> }~ ~5~i~~pc <br />~ <br />Rk --~ <br /> <br />~ <br />. <br /> ,~Q.G <br />G~CMCN~ : <br />" ' l'~ . <br />' <br />~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY ENAMINED AND <br />IN <br />AND B <br />SED O TELEPHONE DATE <br /> ; <br />A <br />N MY <br />INQUIRY OF THOSE INDNIDUALS 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 SUBMITTING FALSE INFORMATION <br />INCLUDING THE a 0 - <br /> <br />, <br />POSSIBILITY OF FINE AND IMPRISONMEM. SEE 1B U.S.C. 5 1001 AND 33 U.S.C. <br /> <br />SIGNATURE OF PRINC~I AL EXECUTIVE L <br />O <br />TYPED OR PRINTED manmum~~sonmenr of heMee ~S mon(hs rentl5utle lines up ro 410,000 entl or <br />p" YeersJ OFFICER OR AUT RIZED AGENT ' P <br />" <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> oD <br />wmmerv I s nlvu txrlarvn I luN Ur ArvY v1ULA I lurvs (Frererence au adacnmenrs Rere) r <br />:i°t PAH2 I. A.4 FCN. CETAILS OF TEST PROCEDURE. AEfCAT LCiiEST DILUTIC6 (X FFFLUEl1) YkICF IS LEIHAI TC SU:: <br />CF ThST UHGAkI5H5 ~LCSU) AND ATTACH ACUTE TCYICITI IyST kEFCRT FCftF TC DI'IF. <br />EPA Form 332o-1 (08-95) Previous edjti0ns may~not be used. ~ (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) GQ3B 8~ 99 C E Z ~ -16 S 3 ~ PAGE. ~ OF <br />