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FFRMITTEE NAME/ADDRES51/~oV+..ur,ep. A..... 1...:.ua..ae~n••.•~I• <br />H41AE 2RAPPeR nSNINr-,E I>:C. <br />ADDRESS TRdPPER FIST <br />P.O. BD]( I `11 <br />CRAIG CI) R1E,25 <br />fACILITY <br />LOCATION <br />AT1'Fi: 4. GORDJ4 PF:TE85. PH~3t~EH ttG9 <br /> <br />L <br />~~ <br />NATIONAL POLLUTANT OISLHAROE ELIMINATON SYSTEM INPOES/ <br />DISCHARGE MlN11TORINO REPORT /OMRI <br />/1161 !17-191 <br />~~ <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />VEAA - MO DAY YEAR MO DAV <br />FROM TO -~~b 3 <br />llal~ll l72-131 r11-1s1 11s-1n 119-1st r3a3I1 <br />Fonn Approved. - ' <br />r r W ^ u OMB No. 2040-0004 <br />(5119 R !! RI Approve) e,cplree 05-37-98 <br />F - ~ipAL 1!~FI° <br />~'~CRRRG~' r7 ;RG° CyRfER <br />PO/.r 117 DT~Cf!OR~L {Y ( #bn <br />NOTE: Rsed imtructipu belor pletinp this form. <br />rARANiEiER l36rd On/y) QUANTITY OR LOADING is Gre Onlyl QUANTITY OR CONCENTRATION ~ NO. FxEGUENCr SAMPLE <br /> /CG53/ (54-61/ /.i9J5i i4653I ~54-sIl OF <br />l31-371 EX <br />ANALYSTS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ls1~6]1 lSL6'91 !63701 <br />IL ANQ 6$-'A SF SAMPLE 4A R34A ( y4) R##Rq{c ####gItr R##6 Rs? <br />Y I S Q A L ME A`.:UREMENT <br />8+1066 1 . 0 ~ PERMIT R#attas RLPOHT CS=i +«##»< ArR'.: '> ..AA+[i~r±Didr'.. 4~? <br />'ra~r <br />.~~aii. <br />P.FFLULhT I:R9$$ YpI,O REQ111REMENT IYST K A - r0## ;. <br />' SAMPLE <br />-. MEASUREMENT <br /> PERMIT C /~ <br /> REQUIREMENT <br />- <br />_- ~J l <br /> SAMPLE <br /> MEASUREMENT <br /> f ERMIT ~ "~• <br />I(r. <br /> REQUIREMENT - Hij~j. <br /> <br /> SAMPLE <br /> MEA'UREMENT <br />h.' <br /> PERMIT - _ .. ,. F:'r;, f.::.:; ~~'~ ~:: " <br />; <br /> REQUIREMENT .. .. ._,:,1.; .:.;; :;. _. <br /> <br /> SAMPLE <br />( <br />~ MEASUREMENT t <br />~~ PERMIT - - ~ ~ . <br /> R6QUIREMENT ~ ~ ~ - ~~•~~;T- ~.~~ ~~~~ <br />.. , <br /> SAMPLE.- . <br /> MEA:>URF.MENT .r ~ ~ ~' <br /> PERMIT ~ - ~ - ~ ~ <br />...r ;: <br />.:. :. :. , <br />- _ <br />..., <br />- <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT ~ ~ ~ ~ ~ ~~ <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ~ FT~ <br />~D~tN <br />HE <br />i <br />T <br />S <br />Y <br />Itis <br />µ TELEPHONE DATE <br /> i <br />T <br />INFORMATION <br />SUBMITfED <br />HE11E1N <br />o <br />~ <br />o . <br />. MY INQUIRY OF TNOSE INgNDUAl9 IMMEDIATELY RESPONSIBLE FOq <br />OBTAINING lHE INFORMIATON, I BELIEVE THE SUBMITTED INFORMATON 19 ~F' <br />G <br />li. Ggrdon Patsrs TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT TNERE ARE <br />SIGNIRCANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />970-824-4401 <br />9 <br />07 <br />4 <br /> , <br />THE POSSIeIDTY OF RNE AND IMPRISONMENT. SEE le U.S.C. E 1001 AND ]] <br />f <br />310 <br />C <br />rM <br />, <br />00 SIGNATURE Of M1INCMAL EXECUTIVE <br />"I TYPED.OR PRAVTED . <br />U.S. <br />. <br />1 <br />WS. MIMr P <br />.aO mumv mry NeA.d. M. y b F IO,0 <br />Wor~rw:.wn~.w;or.+redan.wN,smwssrrsrw.l OFFlCER OR AUTHORRED AOENf CODE NUMBER VFAR MO DAV <br />I':+~ - M TS AND EXPLANATION OF ANY VIOLATIONS /Re/arence e!l ettechmsnn hers/ <br />F 5'~.TOTAL IP.pfI LI!TT; PILL HE JiATYEDe J1ND 5[T2'LE1166~ gOLTDS LIRIT ><PPLTPP QpR <-1`1TH,.'34P p4BC7p 'YR11T- <br />S$L BII$DE11 D! PROOF RPaOIREf1EaT5 tItIDLR I. A. 3. PDS 1!0!IIT'1RING - Y.P. i. nTL ~ ^RFR:,? - ^FF j.P.l.(n1. <br />an n.~ Eiv4 AC.1 iQ YTf_liDli el lilSMt.Y_eV Rns L`Y e.ne t'~r• esYrM e~~..n~~n <br />(171 7S~r1: n/l? 1-] !~T i1 <br />Z <br />