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PERMD'fEE NAME/ADDRESS (Include Faciliry Nmnr/Locatlon ifDi$erenQ <br />NAME MINi+,C~ IY^. <br />ADDRESSNUk"fR THC~MPSO"1 CREEK BINF.S <br />27ti3 C014PA.i5 DRIY~;~ SUITE 101 <br />!:R-Un In rr•n.rnu <br />NATONAL POLLUTANT DISCHARGE EUMINATON SYSTEM (NPDES) <br />DISCNA6 GE MONITORING REPORT (DMR~a! w <br />(" S':~q <br />PERMIT NUMBER DISCHARGE NUMBER c -I FE piL <br />Li <br />Form Approved. <br />OMB No. 2040-0004 ' <br />Approval expires OS31-98 <br />nlr;, t; <br />FACILITY - - `-'-''`--'" ~v na ~v0 MON ITORING PERIOD PO$ !t l'AI IiC 511 `; (`max <<'U[ Pr)ND <br />LOCATION, YEAR MO DA <br />t_ARdUe'DA[ <br />1' Y YEAR MO DAY ,.~ . <br />• <br />CO 81523 FROM r:99 0 0 <br />ATT;I: J <br />' r0 49 03 4 pI^•CN~i'r";c (~( A>•:Lt <br />- <br />t <br />. ii. :;I lvF <br />+~ CONSDLTINO tt'.NG• x za Q2-z3 <br />) (ra e <br />CDm <br />ing this form. <br />ze„ (xe-xr) (ze-xel (3W t) '- O ~Aead Instructions befor pla <br />PARAMETER (3 Card Ony) QUANTITY OR LO G 4~Certl Ony) QUANTITY OR CONCE ~ TION N0. FREOUENC SAMPLE <br />(4B-53) (5061) <br />(32-37J 'S (38-15) (46-53) (54-61) EX OF TYPE <br />AVERAGE MAXIMUM IZ MINIMUM AVERAGE MAXIMUM UNITS ~'U-~1S <br />rezrs> sa-68 69-70 <br />P R SAMPLE .. i.'t (t r ~4:tr :t l,: __ <br />~ ~ - <br />~ 1? <br /> MEASUREMENT <br />0DJ0G I D 0 a',`~ k~{idl~„~. - <br />" ~ :,ll#404IIt ~, c^; ~4w>ar "' <br />~ ' <br />EFFLUENT GROSS V.iLO AHEM .T = <br />L <br />y #t,e4 _r <br />1 <br />SULIDS, S3TTL°A"LF. SAMPLE '(`~#~-+~ R4400t y ( <br />25) <br /> MEASUREMENT <br />D D 54 5 1 0 „ . " r QO yR~l4r~ .:; ### qj ~ ~ . . ~ ,,.:.. . <br />E:f'FLUENT GRO_ `~ VhLl;r. REOU, n ~ <br />~ n=~'re ':-, + 6>t,t4 ' , <br />OIL ANG ::R£A5°, SAMPLE rt#[:-:~,° :`444#~~ 4#0344 , <br />04404': M T <br />( T9) <br />FRE°JN t:kPk-c;4AY v):'T' MEASUREMENT <br />oosse 1 n D <br />." PERMIT'-`= ^ .. <br />'~ <br />ytd#~~IiF"~ <br />;ty; <br />QT .. <br />## , <br />F.PFLUENT ;FOSS YALIl AEOUIREMENT ., .:?~ <br />_ A <br />Y "~~ ~ - <br /> .,, <br />„ <br />- #, <br />4 <br />; ~ <br />PLJri~ IN CONDUIT' pii SAMPLE O ~ <br />I (~3p `.3fi0 <br />~ "-.".tr .::0#444 <br />TNRU ThEATP°riT PLA NT MEASUREMENT V 1'R <br />SUU50 1 0 0 '`- ;2ERMlF~` ~~~ ~" <br />~ _ <br />1kA4#~ m Mkti# ~#- <br />EFFLUENT GRO55 vALI'F flEf~UIREM~N7 p~,~ , <br />~ ,~~„ ~=~ . <br />•~. <br /> <br />~- ~ fifi>`4 <br />SULIOS, T:1TAL <br />' SAMPLE !''3G4 444p4~^. t. t,-A:~ :y <br />' ( 19) <br />DISSOLVL <br />~ MEASUREMENT <br />7ozy5 I o D ~ ~~3~t)~ ~ <br />~ ~ ~ <br />' <br />' #4s. rte"' ~ xa~ ~; <br />EfFLUEAIT ::ROSS YP <br />L(IF FiE 111FlEM);NT ;: - ; <br />' ~ = <br />^ + ~ '`' '< <br />. ; A, <br />•4 <br />4 . <br />. __ .: .r •,t <br />-; :h; <br />^p <br />IL AHD t;7PASF. SAMPLE 4!44{=fi ( nry) ~',~+: A:~+ 40:kL`#4 :f #i: t)#r, <br />V I~ U A C MEASUREMENT <br /> <br />bRDoo 1 D D " <br />Q,~~RMIT <br />` <br />"~ _ ~ <br />`~ <br />~~'a. <br />£S-1 <br />~IFi>t~!4~ <br /> <br />60# <br /> <br />4t.~ '^ <br /> <br />]]~~ <br />LFFLU£.kT GROSS VA6rJ O~QUIREAd <br />~ ~. ;" <br />`~ _ <br />. ( :G <br /> SAMPLE <br /> MEASUREMENT <br /> f(iMIT `" <br />FiE tIIpEM NI ~ ~. ~.~. <br />°~'-~ , <br />° <br />r ~ <br />~ ' ~~ T °~ < <br />~* ~ ~ <br />^, <br />., <br />~ a:' <br /> t . e <br />NAME/TITLE PRINCIPAL E%ECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I NAVE PERSO NALLY E%AMIN ED AND TELEPHONE DATE <br /> AM FAMILIAR WDH THE INFORMATION SUBMITTED HERE IN; AND BASED ON MY <br /> <br />(~ <br />L INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON <br />THE INFORMATI <br />N SIBLE FOR OBTNNING <br />- vC y O <br />, I BEDEVE THE SUBMITTED INF <br />ACCURATE AND COMPLETE. I AM AWARE THAT THE <br />PENALTIES FOR SUBMITTING FALSE INFORMATIO ORMATION IS TRUE, <br />RE ARE SIGNIFlCANT <br />N <br />INCLUDING THE <br />_ <br />TLjSI <br />POSSIBILfTV OF FINE AND IMPRISONMENT. SEE 18 U.S.C , <br />.4 1001 AND 33 U.S.C. <br />SIGNATURE OF PRINCIPAL EXECUTIVE --/r~~ <br />IT) ,/ <br />4 UI <br /> utle lines up ro 310,000 erM ar <br />m <br />mP <br />n <br />~ <br />e . <br />TYPED OR PRINTED eximu <br />m <br />nsonm M of beAtee <br />e m <br />onlla entl e <br />p YeeraJ OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />'-.••••• •~•-.-~.-~•~~..+~.....+..~.~.....~v~w lneivi onco ai e~mcnruunm nare/ <br />~F.^?Lf_A9Lt: SOLLDS LTI"IP GILL dE YAIYED FO?t >10-lR, 24-RR a^^91'CIn ~VRYT-S?~ T.a~?e,pG 7Y. FOR FFQUT?SCENTS. <br />fRT!;LY SAyPLLXG INST5UCTI0315-LC.9, Pv IL• 30 DAY AYC I5 4T~`t°'iT M7NTHIf AYo DtlRINC PERIOD REPOETP_D. <br />EPA Form 33241 (0&95) Previous editions may not 6e used. ~ (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />OOQ10/990211-1033 1 <br />