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?inMIYrEE NANE/ADDRESS ptiir4 Fsdlry N~dLecMlm IJDI~ rwl) <br />NAME LOHENCITO CGAL COMPANY, LLC <br />ADDRESS LOf(ENCITD CANYON NINE <br />1311 BEHTYODD DRIVE <br />EVA:iSYILL*r IH 47711 <br />FACILITY <br />LocAnoNygSTON CO 31091 <br />ATTh: A.L. PERkY, MANAGER <br />NATIONAL POLLUTANT OISCHA110E EUMINAnON eF 3YErw IiirVCsr <br />DISCHARGE MONRORINO REPORT lOMR1 <br />1-I6 l17-I91 <br />4 <br />PERMIT NUMBER DISCHMOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 1 TO 1 i ~ 1 <br />!16111 l71-131 11~-151 !1B-I71 118-191 !3631/ <br />Form Approved. <br />(SUeR iE; TE,,TINGA~~r~ie~o531-98 <br />F - PHIAL 11 <br />"INCF <br />"# NO DISCHARGE "` <br />YNOTE: Read Matructloru bafo7i eomplstlnp this form. <br />PARAMETER !3 Grd Onryl QUANTITY OR LOADING /I Ord On/vl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> l~6-53 !54611 l38J5 f~663 !5461) OF <br />I31-37/ E% ANALysB TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS r61aa1 !64681 /69-701 <br />LCSO STATHE 4UHk pCl SAMPLE #;;### ##4### Lt#### #Lb4=F# ( 23) <br />C. F:RIODAPHH jA MEASUREMENT <br />TAn38 1 0 0 PERMIT ###### #t71;><41ptII a## iOD.GQ41 #4t+p#o acl~### Ei3- ?AL! 'REH <br />r;FFLUBNT GROSS VALU REQUIREMENT 9~a F <br />L.C~U STATkE 96HR AC SAMPLE tr####17 O#a### #t#a#r, #a#### ( 23) <br />r'IMEPHALtS MEASUREMENT <br />iA:IbC 1 0 0 .PERMIT ~~#ID6P?p+4 ~.: .~~.IROA.t'ROIIR~.. 4##. 1,4D..Q~QDx ~~ ###0>p#_ ~.~'~~#IR.4~#?R~:~. $R~ <br /> <br />,iFFLUENT GROSS YALU REQUIREMENT. <br />aaa0 <br />M 1 TJ <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> :...~PERMIT~.;.~~ ~~: <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~: <br /> REgUIREMENT~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME?NTLE PRINCIP E%ECUTNE OFFICER I CERTIFY UNDER PENN.TY OF lAW THAT I HAVE PERSONALLY E%AMINED AND <br />AM FAMIUM WITH THE INFORMATION SUBMITTED HEREIN: NID BASED ON <br />/ I TELEPHONE DATE <br />~j~ul' ~r'~`/nw <br />/~f l~ VL ~/~ MY INQUIRY OF THOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING 7HE INFORMATION. I BEl1EVE THE SUBMITTED INFORMATON IS / <br /> TRUE, ACCINVITE AND COMPIFTE. I AM AWARE THAT THERE ARE <br /> <br />SIONIFICIWT PENALTES FOR SUBMITTING FALSE INFORMATION <br />INLLUOINO ~ <br /> , <br />THE POSSIBILITY OF FINE AND IMPNSONMENT <br />SEE to U <br />S <br />C <br />1 1001 AND 7] ~/ <br /> . <br />. <br />. <br />. <br />U <br />S <br />1 IJIa <br />A <br />W <br />1 <br />L <br />C [iIONATVRE Of P111NCIPAE EXECUTNE <br /> <br />TYPED OR PRINTED . <br />. <br />. l <br />V <br />r/ uuYr <br />. <br />0 <br />Mw mlMa nrF MAW Fnr. Ip ro i IO,Opp <br />.ndwmuhwn inpasmlwre/bMrn 6nlurtM rN 6TVa/ <br />OFFlCER OR AUTNORIZEO AOEN7 <br />CODE <br />NUMBER <br />YEAR <br />MO <br />Dqy <br />COMMENTS ANO E%PLANAIION uh ANT VIVLAIIVNS lMB7MIDCI N/If7xD/nents DNB/ <br />SEE PART I.A.4 FOR DETAILS OF TEST PROCEDURE. REPCRT LOMEST CIIUTIC! (; EFFLUENT) 4HICH IS LETHAL TO SUS <br />~F TEST OAGANIS[75 (LCSO) AND ATTACH ACUTE TOYICITY TEST RF.PCFT FCFh 7C D"R. CCFIES OF ALL INFORMATION <br />in_:m uc Ccvw~ mn voF <br />EPA Form 3320.1 109.95E Previous editions may be used. /REPLACES EPA FORM Td0 WHICH MAY NOT 8E USED.) 0 0 09 R / 9 7 1111-175 la PAGE lOF <br /> <br />