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PERMITTEE NAME/ADDRESS (lndude Facilirv Name/Lxmion iJD~erenr)
<br />NAME
<br />THAk'PEn tl1Hli\C, 14C..
<br />ADDRESST R A P P E R r I .. F.
<br />P.o. aoa la/
<br />FACILITY C ;t A i G
<br />LOCATION
<br />CC E1i.25
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<br />NATIONAL POLLUTANT DISCHARGE EUMINATIONSYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONfTORING REPORT (OMR; OMB NO. 2040-0004
<br />rz-'6) rn- vl f! I N C F Approval expires 05-3t-98
<br />PERMIT NUMBER DISCHARGE NUMBER (S U N F N (, )
<br />F - FIIIi rcrAT
<br />MONITORING PERIOD FCNC Is TC EAT EC2YAFI CLLCE
<br />YEAR MO DAY YEAR MO DAY
<br />FROM OC C1 U To UG C 3 -#~ NG LISCHA6GE ~( tat
<br />(zosr) (zaz9) (z4-zs) lzsw/ (ze-z01 (3o9r) NOTE: Read Instructions befo ljt'LQ'pleting this form.
<br /> (3 Certl Ony) QUANTITY OR LOADING l4 Cerd Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (4653) (54-6/) (3845) (46-53) (5d~67) E% OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />(62G3) ANALYSIS
<br />(64-68)
<br />69-70
<br />r .''. SAMPLE +'r L~?~.^,- 4LL4## #ii4#Q
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<br /> MEASUREMENT .
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<br /> MEASUREMENT
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<br /> MEASUREMENT
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<br />r'. :tU THE AT KENT PLAAT MEASUREMENT
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<br />LISSOLYED MEASUREMENT
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<br />Y 15 U A L MEASUREMENT
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<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY EXAMINED AND
<br />TELEPHONE
<br />ATION SUBMITTED HEREIN; AND aASEb ON MV DATE
<br /> INQUIRY OF THOSE INDIVIDUAL
<br />I 6ELIEV
<br />THE INFORMATION S IMMEDIATELY R€SPOH~1131E FOq OggTNNING
<br />E THE SUBMI EO INF RMATION I$ TRUUE, ~
<br />~ ~~~
<br />l
<br />
<br />W. Gordon Peters ,
<br />ACCURATE AND COMPLETE.
<br />I AM AWARE THAT THERE ARE SIGNIFICANT
<br />D - /
<br />w'! 970-824-440L 00 0 2
<br />
<br />President/General Mane er PENALTIES FOR SUBMITTIN
<br />POSSIBILITY OF FINE AND IMPR G FALSE INFORMATION, INCLU
<br />ING THE
<br />ISONMENT. SEE IB U.S.C.410o1 AN033 U.S.C.
<br />SIGNATURE OF PRINCIPAL EITECUTIVE
<br />
<br />TYPED OR PRINTED 5 1919. (Penelees under these sretures may include lines up fo 570,000 end or
<br />.maximum rmpnsonmenl olbeMeen 6nronths end5yeers.) OFFICER OR AUTHORIZED AGENT A
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachments here)
<br />;tT'tLEAcLE SOLIDS L1N1T [TAT bE 11AIVED FOR >10lR,24ER PHECIF EVERT - SEE ALTERNATE LIYITATICAS Ct,CFF
<br />i•A.1.G, AND ALSC ECbCES OP PRCCF REQU1hElIENTS UNCER I.A.3. CIL E GkEASF - SEE l.E.l.~C). TC_
<br />E r •1 08.95) Pr vTous'editio m be us (R A H T 00039/OCG111-1Ei4 PAGE 1 OF
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