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PERMITTEE NAMEIADDRE55O,rbm FsNiry N„/Larulm lJD16+.,v)
<br />"AF"B rs(APrea nrer~ee zrlc.
<br />ADDRESS TNA PP E't P.INP.
<br />P.O. EjDY 181
<br />CF,A FG
<br />CO 81625
<br />FAal.rrv
<br />LOCATION
<br />ATTti: ir, G1aD0A PfTF.AS. PRBS/Gt^ CG8
<br />NATIONAL POLLUTANT g5CHM0E ELIMINATON SYSrEM //NPDESI
<br />DISCHARGE MONITORING REPORT IDMRI
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<br />r PERMIT NVMBER. gscHAAGE NUMBER
<br />MONi~ORING PE rOD
<br />YEAR MO OAY ~ .YEAR MO DAY
<br />FROM TO -
<br />I24?71 I?1-131 /?s- 51 !15.77/ !?8-?91 !.7491/
<br />Form Approved.
<br />N I %~R OMB No, 2040-0004
<br />{ 5 U fl R fi U} Approval e><piree OS-31-98
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<br /> 146- 31 /5461 !38151 !4653 !5461
<br />EX D
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<br />16r-6g1 169-701
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<br />NAME7TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTr OF LAW THAT 1 HAVE PERSONALLY EXAMINED MID TELEPHONE DATE
<br /> AM FAMIUM WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON
<br /> Mr INQUIRY OF THOSE N1gNDUALS IMMEDIATELY RESPONSIBLE FOIL
<br />
<br />GOIdOII Pet:~ss OBTNFIING THE INFORMATIgI, I BELIEVE THE SUBMITTED INFORMATION IS
<br />TRUE, ACCURATE AND COMPLETE. I AM AWME TNAT THERE NIE
<br />T PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING
<br />S
<br />NIFIC
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<br />'
<br />70-824-4401 9
<br />1
<br />reeidant/General MBna e; IG
<br />,
<br />AN
<br />THE POSSIBILITY OFHNE AND IMPNSONMENT. SEE 18 U.S.C. 4 1001 AND 93
<br />SIGNATURE OF PRINCWAL EXECUTNE
<br />
<br />TYPED Ott PRINTED u.S.C. f I G1o. lhlWei+ uMV e1,r moms m+y incNS, r , Iq m S1D,gf0
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<br />OFFICER OR AUTHORIZED AGENT AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANV ~'IOlAT10N5 IRelerence ell attachments here/
<br />1'SS E rf)TAL IRON l.i-!I?5 Y[LL HP YAI4FDF AFiD ~FTrLEANLe SOLITIs LIl1IT APf'L7F!1 °~~ r_itITR,?II'+R PR'?CIR °~F'NT-
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<br />rPA Fmm ~32D~T 10 -951 Previous ed~Eion: may be uce i P - ~ O T HI MA N USED.1 O r.l, T ! J ,1 ~ ^ 11 - `_ I PAGE 1 OF Z
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