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_, <br />PERMITTEE NAME/ADDRESS pM,4 FrWryNrWLrr+m UD~.rw) <br />NAME t. ~/t/r(VS ti11'ir'C (. L)rtr'uk AT 1L,i+ <br />ADDRESS N (J NU.t O~ <br />:\ fTRAlti CU dibZo <br />~` <br />FA0ILITY L:Yi'r:L,S tMPjRE. CUkNUKATIUN <br />LOCATION t, h p j v LU t11 b 2$ <br />alit` t<IiLNAtL u. LULILI,NF uENER~I MGit <br />NATIONAL POLLUTANT DIECNMOE ELIMINATON 8Y8TEM NPDESI Form Approved. <br />DISCHARGE MONITORING REPORT DA~RI Mg~p q~ <br />?451 17-19 ~~,Jrv ~y Gh-;ln 0 0 OOQ4 <br />ti T Approve expires ~K=31-98 <br />;;, .; r: Nw L~40 <br />PERMIT NUMBER dSCHMOENUMEER ~ - r 1 NAL <br />MONITO. ING PE IOD M l NLIK <br />YEAR MO DAY YEAR MO DAY <br />FROM ~. ~~s ~.~ ~~###;- O~piSCHAkGE ~Ftra <br />110-7 /) /IL13I f11.2 I76-I71 /IB-19I I30-31/ NO`A~Ad Imtruct{oro M w~ eomphTlny thk form. <br />PARAMETER 13 ~Qrd Onlyl QUANTITY OR 40ADING rd Onlyl ~ nUANTITY OR CONCEN TION NO, FREOUEHCr SAMPLE <br />l32-371 /4653 151-51 l38-I5I /46-53 5461 EX DF TYPE <br /> <br />AVERAGE MAXIMUM UNITS <br />MINIMUM . AVERAGE MAXIMUM UNITS <br />rc~eal MALV519 <br />15~-ss) <br />Iss70l <br />Ji.LliiSE ft,TAL SAMPLE p####,p ###### ##yo(~ 19 <br />J 1~ J u L V c U MEASUREMENT <br />ICGYS 1 U O '~.:•~PEAMYT~ ~:' #~4~+Y~44: ~ ~ :.~.z:'!-#~.~:~:~ #tir ~:'K'~.#...~II~x.;;' `':~;~~R~~Pt74St~ U~7I~~hAG ~~`~~~ ~ ~i..1~=.:: `.:~i#i:.: <br />tFcLUt,df hKii55 VALU ,REQUIREMENT. .. ~,+., #### ~ ~ <br />:«~ ,. :~ <br />M <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br />~ ~~~ <br /> REQUIREMENT' ~ ~ ~ ~ ~' ~~~ <br /> SAMPLE <br /> MEASUREMENT <br /> :..~. PERMIT :. ~ <br />~ .:~ ~~ ., .. <br />.. '^: '.t:y::~~~:: ~r. ? <br />~ <br />~ <br />~ <br />: <br /> REQUIREMENT: . .. ~ .. <br />. <br />~.-?;~.,..';.. .:::.. , . . <br /> a;. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~; .; .>:.: ~ <br />` .. <br /> HEhUIREMENT. ~ , <br />~: ~.;T:.::.. .. <br /> SAMPLE <br /> MEASUREMENT <br /> ;::.PERMIT.;. ,. <br />.. ~ <br />: .;.:... .... <br />~,:.t:;.. .: ..... <br />.... <br />~ ,. .. .., <br />.,::.: <br /> REQU.IREMEKT <br />.:. ~ .: :. ~ ~ :...:: ~. ~. <br />.. .:..~. ~.~ <br /> SAMPLE <br /> MEASUREMENT <br /> .~: PERMIT' <br /> REQUIREMENT: ~ ~ ~~` ~ . " <br /> <br />. <br /> <br />.t <br />: .: <br />.:: ~.: <br />~. <br /> <br />. <br />' .. <br /> .. . ..: .y <br />.:.. :. .: . ; :.. .. <br /> SAMPLE <br /> MEASUREMENT <br /> •:... <br />~ ~ <br /> ~REQUIREM.EI~kF.' : ~:::~ . .. .: ::... ... .: <br />: <br />~ <br />~ ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I OERTIFY UNDER PENALTY OF LAW TNAF I NAVE PERSONALLY ExAMIN <br />AM FAMIUM YATH THE INFORMATION SUEMITTED HEREIN <br />MD EA FD MD <br />SED OM TELEPHONE DATE <br /> <br /> <br />I:ichard :~".ills ; <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY REEPON4E <br />OETAININO THE INFORMATION, 1 EEl1EVE THE eUEMITTED INFORMA <br />LE FOR <br />TION 18 . <br />_ <br /> <br />En <br />nt <br />i <br />l M TRUE, ACCUIIATE MD CO,MRETE. 1 AM AWME THAT TNE <br />INC <br />510NIFICMT PENALTIES FOR SUEMITTNO fuSE INFORMATION RE ME <br />LUDING <br />970) 870-2712 <br />Z <br />i7 <br />98 <br />ronrle <br />v <br />a <br />anager , <br /> THE POeEIEILITY OF RNE AND IMPIIIeONMENT. EFE 1E U.E.C. 1 1001 AND 7] ~IONATURE OF PRINCIPAL EXECUTRVE <br /> °i"' <br />e9 <br />d <br />vS <br />. <br />l~ e <br />.~ <br />~ <br />F <br />w`~ <br />~ <br />~ <br />~ ~ P 710' A A <br />TYPED OR PRINTED . <br />d <br />m <br />h. <br />n <br />is <br />M.. <br />s <br />rai <br />rre <br />y..r. <br />ia <br />i OFFlCER oR AUTHOR¢ED AOEM <br />CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/erence el! etrsehmenre here) <br />JtITLEAUL~ SJL11~S Llr~[i >'+HlvcU ruK lUY~FZ4Hn P.lEC[p L~L;;i-StE 1.%+.~, r~ lv. FUri KE,.d1~~IMENiS. uiL c. <br />„kcASE L,kAo SAMPLr: ANALYo1J Kc~.lUjrctU IF VIS1L1Lb 1HEE~ f5 uEfSEKVLLi. 9r:7ttLY SAMYLI,ti;', liYSfRlIL7IUN5'I.(..c.F <br />v <br />EPA Form 3320.1 108-961 Previous editions mey be used. IREPLACEB EPA FORM T40 WHICN MAY NOT BE USED.1 O A2 3 S / 961 ~ L)1-1311 PAGE lOF <br />