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<br />PERMITTEE NAME/ADDRESS 01rYLFxYiryNwr/Lxmlm d01Ce.ti)
<br />NAME CY'~ .:_ 'r,' ~. ~• - - - .. ..
<br />ADDRESS ~'I•~ r-r' 1 F 7"; •; ,~,I •.. .-f ._71„.-..
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<br />PACUm
<br />LOCATION
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<br />NATIONAL POLLV[ANT OISCNMGE ELIMINATON SYSTEM /NPOESI
<br />DISCNARGE MONITORING REPORT IDMRI
<br />I-761 /17-I91
<br />~D0077hY rl?7 +
<br />PERMIT NUMBER DISCHMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ) 1; r - TO o.. fl ~ ..
<br />1(0711 I?2-231 111-Y51 126(71 !IB-191 !30.311
<br />Form Approved.
<br />•~ r • - ., h v ^ •. •^ ~OMB.No: 2040-0004 ~ ..
<br />! ~ : ~ . D , 4,;1 Approval expires 05-31-98
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<br />PARAMETER !3 Grd OnlPl QUANTTY OR LOADING 11 Grd OnlYl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE
<br /> !46531 15461 l3B-451 !46531 154-611 EX GF TYPE
<br />132-37I MALVSIs
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 163-a]! !54581 !5&701
<br />_J iiitlCY[V:"" SAMPLE .kbRS•~ R;+C:*#~ #^v+:•:.• ( 11)
<br /> MEASUREMENT
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<br />C'PRU "'~I `: ~IT.°`" ='.a`IT MEASUREMENT
<br />;OJLO _ D - PERMIT v^*'7?P )P4IORAL ><4:-=lL=;< ,.4fS4t'~k ::fi i;;~i„# t r...
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW TNAT I NAVE pEgSONALLY EXAMINED MD
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN
<br />MD BASED ON TELEPHONE DATE
<br />
<br />Richard PJlllls ;
<br />MY INQUIRY OF THOSE INDINDUILL9 IMMEDIATELY REBPONABLE FOR
<br />OBTNNING THE INFORMATON
<br />I BELIEVE THE SUBMITTED INFORMATION IS ~~
<br />
<br />Environmental ~~ianzs~er
<br />,
<br />9GNIFICANT PENALT/1E5 FOq S BMITTINO FALSE NFORMATON INCLUDNG ~L+
<br />~
<br />970)870-2712
<br />10
<br />15
<br />98
<br /> THE POSSIBILITY OF flNE AND IMPI1150NMFNT. SEE 1B U.S.C. F 1001 AND 57 SIGNATURE OF MIINCIPAL EXECUTIVE
<br />
<br />TYPED OR PRINTED U.S.C. E 1]te. IMrNY. ,.wr NAr moms m•Y hcN.W lx.rA .p ro t IO,IX10
<br />.nd ar muirweieMvnenr AlMlwwn anondn rNeYAVa!
<br />OFFICER OR AUTHORIZED AGENT AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAV
<br />a.ummcrY I a nnu CArL.n•nn I rvrr urTnn r Yw~n I Ivrva rnerarence an ermcnttmsnrs oars/ T
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<br />EPq Form 3320.1 108-951 'Pravloue edlDOne may be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.1 ,I ~ ~ rl : / 1 D ~ U ~ 7, I ,t ~ ^ PAGE t OF
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