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PERMfiTEE NAME/ADDRESS peeY6irWry Na+dlaanaw IJDI)FrwO <br />NAME $BtlECA CDAL COifPAilY <br />ADDRESS DRl1i ER D <br />HIYDiiY CO 8163y <br />FACILffV <br />LocAnoNtlAYDEtl •CO 8I63D <br />/TTN: G. BUD BROYY, GENERAL 11A?IAi,ER <br /> . <br />NATIONAL PoLLUTANT DIBCNMOE ELIMINATON SYSTEM /NPOESf FOnn AppFOVBd. <br />~ <br />DISCHARGE MONITORING REPORT IDMR) SdD <br />POND DSCHG TOMB~IJoe 3040-OOOw4x~ ~ <br /> l1-161 17-191 . <br />O q1: <br /> CDUDOOZ21 010 8 (5088 YY) S31-9 <br />ApprorBy~~i~rte~ 8:~,F <br /> PERMIT NUMBER .o1scHMDE NUMBER P - F I R A L ~ ~ ~~' <br /> 1INOR ~~ <br /> MONITORING PERIOD <br /> "YEARt c'MO DA ~~ YEAR <br />Y~ MO DAY <br />FROM ~ iLF <br />~~ ° <br />~ ~ , <br />~;".~ TO 7D iL .li %+r fiD DISCRARGE ~_-) +~~ <br /> - " <br />n2''9 iM1Pi»:1 ~t <br />niJf r ' <br />51 ..... /969]1 <br />/9A-991 <br />/90-J 11 NOTE: Raed Irutruetlon baton Dom latin thiB fwm. <br />P 9 <br />' <br />PARAMETER !3 Grd Onlvl QUANTITY OR LOADINdt: <br />yy,,~~ (I:0.rd Only! OUANTITY OR CONCENTRATION <br />~ NO. FAEOUENCY SAMPLE <br /> , <br />146531 154611 '~:Ei IJB-0.5 1465) 16461 <br />~ <br />EX OF <br />TYPE <br />BI-371 AVERAGE MAXIMUM UFIITS¢ MINIMUM AVERAGE MAXIMUM UNITS !es-esl MALYSIB <br />!64681 l69-701 <br />U1L AYU GREASC SAMPLE ###R## ( 94~ #$+-g#s 't$#### r'#~^'#;%` (1 ~[~ <br />VISUAL MEASUREMENT v 1 l ~S <br />U4D66 1 D 0 PERMIT <br />r- <br />~'~."-'s`r'r ~.1'.P{;1az:Y 'Y ES=1 <br />.;;- <br />+• •~%r'+ al;,YlrxYrr:;y: C%~+`-fist=Z .t## i ::'r.KLY ~I: I <br />~ Ik.T. <br /> <br />EPPLUEtlT GRDSS YALU <br />REQUIREMENT :... <br />LYS`Y .~!'A"T,. <br />110=D <br />- <br />##`•M <br /> SAMPLE ~ ,.. <br /> MEASUREMENT '~ - <br /> PERMIT ~ <br />~.~ <br />~~.. .. .. <br />~ ... :.:~ ; <br />~~ <br />~ <br />_ " ~ <br /> . <br />. <br />:REQUIREMENT ... ~ .. <br />.. ... ~ : <br />.. .. <br /> SAMPLE ~ ~ ,- <br /> MEASUREMENT ~" <br /> ...PERMIT ~. <br />: <br />. ... ~ <br />~ <br />~ <br />~ ~~~ <br />~ <br />~ <br />~ ... <br /> REQUIREMENT . .. <br />.. <br />.~ : . <br />.. <br />~. <br />. <br />~.:: <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ .PERMIT. ... ~ ..:. ..... <br />~ <br />~ ~ <br />. . <br />' <br /> REQUIREMENT ~ "~ "~ ~ ~~ ."~~" ~ .:~ .: ~. .. .... <br />... .. :.. r: <br />,... <br />~ .:' . <br />~ <br />.. <br />... .. .. <br />: <br /> SAMPLE <br /> MEASUREMENT - <br /> ".~ PERMIT .~ ..~ .. ~.. ~. .. , <br />. <br />~: <br /> :REQUIREMENT. . ~ .: :.". ~ .. ~ ... .. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : : ~ .:.. : :.. ~ .:. : <br /> <br />.. ~,,:.. <br />~ <br />~ <br />:, <br />. <br />: <br />~ <br /> <br />~ <br /> REQUIREMENT <br /> <br />.: .. ~ ....: ~. .. ....... <br /> <br />.. ... .....i.;' <br /> <br />Y..-. . <br />.: <br />:.. <br />., . <br />4:' ., <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ": .. . ... <br />~ ~~ <br />' ... <br /> REQUIREMENT' ~.:. ~ ~ <br />" .: ~ <br />. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERT IFY UNDER PENALTY OF LAW THAT 1 HAVE PEASONALLr EkAMI NED MD TELEPHONE DATE <br /> AM fAMILIM VATH THE INFO <br />MY INOUIM OF THDBE IN <br />OBTNNINO THE INFORMATION RMATION SUBMITTED HEREIN; MD BASED OM <br />DIVIDUALS IMMEDIATELY RESPONSIBLE FOq <br />, 1 BELIEVE THE BUBMITTED INFORMATION IS <br /> TRUE. ACCUMTE MD COM <br />SIONIFICMT PENALTIES FOR RETE. 1 AM AWARE THAT THERE ME <br />9UBMIT71N0 FALSE INFORMATION <br />INCLUOINO '/ <br />~"1 <br />` ~ <br />~~ <br /> THE POSSIBILITY OF NNE MD , <br />IMPN90NMENT. SEE 18 U.S.C. 1 1001 MD 77 7 1 <br /> U.B.C. 1 1718. fPrlYb~ Isar uwaF NAma my itcAre~ nrr. Ro ro ! 10,000 BIONATURE OF PIIINCIPAL EXECUTIVE AREA NUMBER E <br />R O DAY <br />TYPED OR PRINTED ,M wmuNRnr MnprlsArnrn olMMwlemmNa,rMef,r.l OFFICER OR AUTIIORD:ED AGENT CODE Y <br />A M <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IONS lMeferenC~ e// stteenmenfs neiel <br />T55 G IRON LIMITS YiLL HE YAI9ED 1tlD SEYTLEABLE SOLIDS LIRIL,~PLIED POR C=10lR,24HR PRF.CIP P,YEtlT; iS$ E <br />1d0Y LItlZTS-YAIffBD-PGA >10YR,24HR.PdECIP E7 ENT SOdJECT ,~,fI~RbEIT OP PROOP IN I. A, 2. OIL 6k GREASE-SEE <br />mey be used. (REPLACES EPA.FORM.T~O'WHICH.MAY.NOT BE USED.1 00096I9H 0914-Q92~ ~ ~ PAGE Z°F <br />