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PERMITTEE NAMEIADDRESS OwrV6 F.nxyN~/Geeulm UDd1.rp <br />NAME TRAPPt:R `IPIt:r, 7r C, <br />ADDRESS tnAPPf?H 'T*F <br />~.o. Rox I~~ <br />C +' 4 . G "') 91 I, 1. b <br />FACILITY <br />LOGTION <br />.I... .17 fi. GDPa~a' n!: •r c,; ~~ pRc .:/G`'4 h~~R <br />PARAMETER !3 and Onlyl <br />/1653 <br />l3I-371 <br />AVERAGE <br />:Lq nnu ,r •~~~n .r. <br />I .UAL <br />%.FF'LUF" T GR'155 Y'~ 1,'~ <br />IEQUIREMENI~~I. ~~. .... <br />NATIONAL POLLUTMT gSCNMOE EUMINARON SYSTEM /NPDESI Fonn Approved. `, . ~I; <br />DISCHARGE MONITORINGflEPORT IOMRI y r y rl o OMB No. 2040-0004 ~~ <br />11-f51 17-f91 <br />CDQD3 I S qD5 A (°174 '14) APProvele><Pires053 B' I <br />PERMIT NUMBER g6CHMOE NUMBER c _ sr ~•g?. ~l~D P,~A T; <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAY ~~Y /~/c',' A <br />FROM TO - NOTE: Rud InstrueUons bstor +i eompletin0 this form. ;~, <br />1747/1 l17-731 I7I-251 11617/ 118-I91 !34311 <br />TY OR LOADING 14 Grd Onlyl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE '5.~; <br />15L811 lag-r51 /46531 I51-611 _ 'cX OF Tr'P`c 1 I <br />MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsasall rsas8l I 189-701 ~1'1~ <br /> <br />~:~..PERNIIT~ ~ ~~ <br />HEQUIREMENT~: <br />-'-~PERMIt.: '~ <br />iEOVIRENIENT~~. <br />SAMPLE ~- <br />1EASUREMENT <br />PERMIT. <br />iEOUIREMENT.. <br />E5=1 ''.~°A~'R?~:!~~±SG~.::':.,.~.~#~;~~.Al~'.'..~ ~ ~~~~R.;!k~'s..fi13~IR;`{{`~.,~-:~ .~~,~~: <br />r <br /><~ <br />v~ <br />` ~, Y <br />~~ <br />I. <br />~:~; <br /><.::.::...:^ 7j <br />~: y.:J:. ~~'~ <br />d' ,<: w <br />:~1 <br /> SAMPLE • `~,~ <br /> MEASUREMENT ~ig <br /> <br /> ~.' <br />~ ... .....:... .. ~~ i. <br /> ~:AEOUIREMENT :: :..... ...: :.. ~::....:: ...: <br />:~.... .. .. , <br />-i <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERT <br />AM FA IFY UNDER PENALTY OF <br />MILIM WITH THE INFO LAW THAT I HAVE PERSONALLY EXAMINED MD <br />RMARON 6lMMITTED HEREIN; AND BASED ON <br />/ <br />/1 TELEPHONE DATE <br />~~ <br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON61gLE FOR ' <br />~ <br />~_'- <br />~/ G <br /> <br />W. Gordon Peters OBTNNINQ THE INFOMIARON, 1 •F11EVE THE SUBMR7ED INFORMATON IS <br />INCLUOMG <br />T~6 FOR 6UBM11TIN° FAL6E INFGIMATON <br />~QNIFICIVlT1 PENN n/ <br />970-824-4401 <br />99 <br />1t) <br />2] <br />Preslden.t /GelLeral_ Manager , <br />. <br />THE POSSIBILITY OF RNE MD IMPNSONMENT. SEE to U.g.C. 1 1001 MD 33 SIONATlA1E OF PIIINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED U.S.C. ! 1318. !{V WOYF udr e4rr .uluwa nrF Mx.'hdF rn.. Iq ro i IO,QO° <br />wwm..rre.n hadanwNOrbwran enNnMr nde YFAraI <br />OFRCER OR AUTHORQED AOENT <br />Ac,OpE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rs/ersncs ell str~chmsnts hers! ~ ' <br />.Y~ <br />Tcrl ?^5• l=l:^ <br />IBS LT~T* eyoi <br />3 rAI95D <br />SIt <br />)Bi~ Doc,'iP "Y~NT- <br />IwIT~ ';ILf <br />AN1 4c:°L RA~iF <br />I <br />55 E <br />L ff;U ( <br />OT <br />. <br />. <br />F <br />r <br />. <br />. <br />. <br />, <br />; <br />. <br />T <br />A <br />-`..°. UURDc4+ •1c n...I•/c RF:~7L3F"9°:~TS 1!V~~'R I. A. 3. DES7fiTPF.f. "UST '^.IRL' ALT, pO49'1V~:•L" KF'AStI~.F'r ~1~ ~-;ry/.•~r OH <br />ACCOR^'R" ~'T" °£`~" 5"' PRACTT"=S - SEE. I,.4.'i. TDS I!OMiTrI'#IY~-I. A. 1. CTTACN Sap^ FL~~'i nA*e *.~ ~~q_ <br />EPA Form 3320-T 108-96) Previous editions may be used. (REPLACES EPA FORM T<O WHICH MAY NOT BE USED.1 n Q ~ 7 S ! 9 7 t! 7 ~ ] -1 i 3 ° PAGE ~OF <br />~- <br />