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CCMPp-rY <br />ADDRESS URA.iA D <br />HAYDc"K CO tl1639 <br />FACarrv <br />LocAnoNrlAYUEN C0 81630 <br />ATTN: G. tlUG CiP.OwN, GENI:kAL ;tANA:,EA <br />NATIONAL POLLUTMT DISCHMOE DIMINATION SYSTEM (1VPOE$I <br />DISCHARGE MONITORING REPORT IOMRI <br />2- f 61 I7-191 <br />CO UU [Zl Q, A <br />PERMIT NUMBER DISCNMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEA MO DAY <br />FROM y ti ~ TO '- .u <br />126211 122-131 12d-T51 !26271 128-291 !36311 <br />Form Approved. <br />' i. h A f' ~ .I i)~ n A JGMB Noa20~i6,f-0004 a V <br />(~ L `c F D b') APProvell ~p~r~a~05-31-p8 <br />9 - PIAAL <br />"INCfi > <br />ri4fi dG DISCHARGE ~__~ #?~~ <br />NOTE: Reed imtruotioru belwe completing this Corm. <br />PARAMETER !3 Grd OnlYl QUANTITY OR LOADING /I Grd OnIYI QUANTITY OR CON T/CATION ND, FREOUENCV SAMPLE <br /> /16531 !5481 !38151 !4653) 154-5/ DF <br />132-371 EX <br />MALY515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 163~69J 164881 169-701 <br />„ SAMPLE 44#x## #:: r..A# <br />~ <br />~ +1{'. r7 r,.?: <br />vl <br />~ 3 IZ <br />( ' <br />V ( <br />~1 <br />~ <br /> MEASUREMENT - A . . <br />.~, <br />.r <br />ODUUO 1 G 0 PERMIT Lt41A'iIOIR >%rY4CIq# ~ :C%` (,S 4CCGri>~ 9,G EEFLY [NSI°' <br />iFfLUENT ~d055 YALU. REQUIREMENT G;:{::% "tI-R~lfQ~:. CAkIMUM ,iC <br />SOLI US, TOTAL SAMPLE <br />MEASUREMENT ##7?F;'k ##r,#;, ;k ;.riggqq <br />l ~ ~ <br />~' <br />~ <br />( 1', (~ <br />v <br />~/ <br />J <br />C <br />SUSPEAUEU 1 <br />J 3 yr <br />GUS3G 1 U D PERMIT urk:pv# ##k#ri# r,:.~: C#fi0riq" :39 7C NC F'/ ,I:A° <br />t:FFLUEtiT c;kOSS VA LU. .REQUIREMENT ;: 3Q6A AVG CATiY kX ^!~-/L <br />J yn".'^H <br />:iU .,d FLE <br />F SAMPLE <br />MEASUREMENT .C: {: C:r;: ;:?^ri ?v;a ^{Lriri I <br />~ D <br />` <br />< p <br />~ ; <br />( ~~) <br />U <br />1 ( <br />( <br /> e M 3 p ,wb <br />OOSvS 1 U 0 PERMIT 4a#;:4' ####{:r, . t::5:: COfifi{>C A}:FCR4 P.LFGHT :11CE/ ;HAN <br />~FiLUt;hT GAD55 YALU REQUIREMENT #{?:3 30sb' avG DA:7iY !•X ML/L M'~NTk <br />k0.', i). SAMPLE r::. ~:. ##?'#F~5 ;. r, •,:r{{ ( 1`~) <br />'/ <br />(p, Fri MEASUREMENT Q• ~l (.,~ Q•~(J Q 30 <br />UlU4S 1 Q U 'PERMIT #fi. o%wfi `v$:kOp~ .••:r: ~.:}^ fi:5ri T.S <br />- 7.e'Q ' ' )FCE/ ;kAi~ <br />LFFLUi:NT GR085 YALUF REQUIREMENT =.+);~' 3Q>;A AYG >MAILY t1X 7C/L nOSTff <br />i) ~ NU i,A F: SAMPLE ':u a% RL`• #' ;:#^.-t: ..v:>{~{ {{Ofi?~7 ( 1~~ <br /> MEASUREMENT v <br /> <br />03~GL 1 U G PERMIT. ri# Itrf - arf>r :;.;::x :~»fi#riq A:f{gri>F 1 ~ OvTIv ;AAN <br />tFFL'JEtiT GROSS YALU- REQUIREMENT .. ,- IbS'1 !'AX MS/L GLA2 <br />t L. N F N L . <br />T }i <br />?U Tkh: <br />~ <br />Y <br />E <br />N <br />T P SAMPLE <br />MEASUREMENT ~S /1r 5 <br />7 <br />Cr <br />~• <br />~ I LI ~ ( 03) CYifi{{i {-{, ri:.fi?~ -. :::5 :}•. <br />D I/ .1^ C <br />1 (A <br />: <br />p <br />j <br />. <br />N <br />Lp j <br />(~. ~ J <br />SOU~U 1 0 U PERMIT :REPORT REPORT ~: rir{ari riomaa# ~ri{;:{<s ~ ' •, EEKLY ' RSTAr. <br />tcFLUENT (.kUSS VA LUE .REQUIREMENT 3oDA AYG QAILY ttX %CD Y <br /> <br />JJL ~• 'U <br />GiSSOLYEL <br />SAMPLE <br />MEASUREMENT <br />,-. , <br />O####I~ <br />.-.4 <br />S' <br />~ QQ//,' <br />~~ Vv <br />( <br />1~ <br />D <br />O <br /> <br />yr. <br />b <br /> <br />76195 1 G U PERMIT T •• •ria CPT ICIiAL AFFGAT TRLY 1dAU <br />tFFLUiNT G}ID.iS YALU REQUIREMENT ?'{;# x,628 AVG CA.IIY I". 7I MC,/L <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERnFV UNDER PENALTY of uw TRAT I NAVE PERSONALLr ExAMweD MD <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN <br />MD BASED ON ~ TELEPHONE DATE <br /> <br />a <br />~PLA L. <br />~PS <br />S ; <br />MV INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR <br />I BELIEVE THE SUBMITTED INFORMATION IS <br />OBTAINING THE INFORMAnON <br />.. <br />~ <br />I , <br />TRUE <br />ACCURATE AND COMPLETE <br />I AM AWME THAT THERE ME <br />/1 ``~I <br /> <br />((~~ , <br />. <br />SIGNINCMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING 1 ~~.~~ _ <br />V <br />l ~ ~/ <br /> <br />U ,Y L~1 I O ( ~ , <br />THE POSSIBILITY OF RNE MD IMPNSONMENT. SEE 1B U.S.C. f 1001 MO 77 <br />BIO <br />PRI P ~~ ~~ Q V o <br /> <br /> <br />TYPED OR INTER <br />U.S.C. 1 1 G t a. IF\rWOiA MrWr eNr AsrrmA /IIFY MrCpn1A FMa rq ro f 10,000 <br />.nsx.na.:nun iruvbs++wrr e/hrwAVramanNS An06Fwa/ NATURE OF <br />AL EXECUTNE <br />OFFICER ORA HORI2ED AGENT <br />AREA <br />CODE <br /> <br />NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS IRa/rrence sll elfsehmants here/ <br />TSS v iNGN LIMITS VIih r1~ GAlVEU E SETTL'r:nFLE t~OLICti LI1:11 AFFL]EC FCF C=1nYF,24r!5 PIiF.CIP EYENT; T`-%:, <br />i[tGA & -i:-TTL~'A3LE SGLID:i L1NIT5 HAIYED FOA >lUYH,24Hk FnE::IF FYFN9 ~UFJF.CT ?C 36HCEN OF PROOF IN I. A.. 2. <br />OIL L GIiFp°.G - ?i?F T.Y..1-r'. TfIS M:1N T'P l1R TNG T-A.1. <br />EPA Form 3320-1 108-951 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 0 0 G 1 ~ / 9 7 ] () 31-1513 PAGE lOF <br />