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PERMITTEE NAME/ADDRESS (ImY4. s~wy8a./rama,dm~r...,,q <br />NAME ;~^.!i~::A ~Oni. C+7"PA!rY <br />ADDRESS fl R 1 a [, k U <br />HAYi1:;:7 CO 81639 <br />FACIIITV <br />LOCATION fl A Y D Z B C O :~ 1'. J O FROM <br />ATTN: G. bUD I•.POi,'N, GEaEI~AL "`AtiA:,~.F <br />LUTANT DISCNMOE ELIMINATION SYSTEM lNPDESI Form Approved. , <br />NAR6 E MONITORING REPORT fDM9~ C N A C N T C ~ 1~ 1' :• 1~ T_ I~MB No~040~ 0004<.~ i <br />., Approval expires•0 -3 <br />~D~zl ceu x ~sueF r.•) 1~.T4~ <br />IIT NUMBER DISCNMGE NUMBER i - F I ~ ~ :, <br />' ° MtRC~ <br />MONITORING PERIOD <br />MO DAY YEAR MO DAV <br />v u To •e r _~ s° MO DI9CNr1RGE ~ _1 :p Y,:~, <br />va.asl fa4-aF;l nsan 1113-1sl r3a311 NOTE: Ree~.{gbtoictlorn betore~completinp this lorm. <br />PARAMETER !3 Grd ontyl QUANTITY OR LO I4 Ord On1Fl QUANTITY OR CONCENTRA NQ. FREOUENCV SAMPLE <br />31 <br />37 <br />~ (46-531 !56611 138-461 /4653 B71 EX OF TYPE <br />1 <br />- <br />/ <br />AVERAGE <br />MAXIMUM <br />" IT <br />~%}-~'911NIMUM <br />AVERAGE <br />MAXIMUM ~ <br />UNITS <br />fsls,T/ MALYSIS <br />/56681 <br />l6&701 <br />%:EF'FiC'f STAThE 7DAY SAMPLE :~::xarCR ct::z.-; ~~~ O;Oppq e.*o+ra ~ 23) <br />C fl i{ C L.'ri I li li A P H t• I A MEASUREMENT ~ O <br />~ U <br />TCP3u :, 1 ~7 PERMIT ^[:+x#~s# ' : .t%Txua## Cca• ]~, 3 ~~>"d;lgl.`:` uast:a~: lEk- TRL! ;RAB <br />StE CUi!t:LhTS RELOY R.EnUIREMENT <br /> <br />. <br /> <br />. r,., <br />~-_•~ <br />~+~ value <br /> <br />~ <br />crl.r <br />:. F:FF ECr _irATfiE 7DA! SAMPLE ~:: a,:`Y~ :C?4#4 •~Y. <br />Ott,} v4r ( ')) U ~ <br />, I I <br />CHii PIf7 Lk'bAL1:5 MEASUREMENT ~ 0o v ~` <br />V <br />VV <br />G b <br />ICYbC :i 1 D PERMIT;.:: .. : #4r4.C+ #Q#IR+}rF #IC# I2. 3 4r?afA~>; ADL.OiI#?C~. ~F.Y- T$L! ;RA5 <br />Stt CGtNtMTS 9cL•7~ REQUIREMENT; ~:'~:::~ t: ::+?: +7ti YAIUE ~ CF.GT <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT. <br />~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENUTY <br />OF l <br />AM FAMIUM WITN THE INFOR AW THAT I HAVE PERSONALLY EXAMINED MD <br />MATION SUBMITTED HEREIN <br />MD BASED ON ~ TELEPHONE DATE <br /> : <br />MY INOLXRY OF TNOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR <br /> OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATON IS <br /> TRUE. ACCUMTE MD COM0.ETE. I AM AWME THAT THERE ME <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING (T <br />X <br /> , <br />THE POSSIBIUTV OF RNE AND IMPRISONMENT. SEE 18 U.S.C. F 1001 MD 37 BIONATURE OF P11 CIPAL EXECUTNE ~ <br />V <br /> U.S.C.F 1Jte. fMWeY.,nNr ,Ma mvhs ,r~F 4cpd~rn.a ,grol10,000 AREA <br />TYPED OR PRINTED mlwmunlu,r4w/aunwre of e.,w~n smwrA. r,a6 yrra/ OFFICER ORA NORIZED AOEMT CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rslerenee e//attachments here) <br />EPA Form 3320.1 108-951 Previous editions may be used. (REPLACES EPA FORM TAO WHICH MAY NOT BE USED.) 0 ~ 0 U 4 / 9 7 ] O 31-1$1 3 PAGE ]OF <br />