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PERMITTEE NAME/ADDRESS 6Mi4 fwmry NwJlxwa dO~i.w9
<br />NAME I(c 5 C r: n L r_ r~ >. 1 a\ w
<br />ADDRESS KtFr. LOA i!+~`?'
<br />$1'ti1,1B'IA"' ;P~ ? ~:';~ CO HLu71
<br />FACILITY
<br />LOCATION
<br />A'T'fN: GE•1ni.;. V, P.1 TTf;,~Od, "TINE: t!GR.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM l/VPDE$l Form Approved.
<br />DISCHARGE MONITORING REPORT IOMR) e ~ T O No 204Q-0004
<br />!s-rsl n-l3~ !CZ PCNC ,0 ~LLI,1'~rBi.,•.LL. ..•
<br />COG950C36 ~ (SUPA IY) ApprovaiLP~S~8105-31-98
<br />PERMIT NUMBER DISCHMGE NUMBER F- F I 1 A L
<br />MONITORING PERIOD M I N C E
<br />YEAR MO DAY YEAR MO DAV
<br />FROM UV U TO _ ~ a-a R^ CI SC'NA9GE ~ x ~ ~^-`'
<br />Izazll 22-z31 Izaz5l Iz6-DI !z6-z91 I3a3ll ,NOTE: Rsed Imwetlorw bsfon compbtinp thb lorm.
<br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING l16rd Onlyl QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE
<br /> 146-531 15x611 I3B-r51 146-631 15x51 DF
<br />131-371 , E%
<br />ANALrsls TYPE
<br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS lez-691 /64661 169701
<br />Yi1 SAMPLE CCO$;:. Cy+.';rvq ,,:aaa; { 12)
<br /> MEASUREMENT
<br />UO4U0 1 i' U '..PERMIT.. " #tr~fiatG L•C~s¢fs;? '; LL;:
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<br />b~~y >R-0a+p3~ g,(7. 6QkLY fNSFTU
<br />Lr'r'LUI:NT ::kr)SS VALU REQUIREMENT..
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<br />-LIDS, 3E~TLL:A5LE SAMPLE 4t<at+?4al 'k9a<COC AteaAa aa04a: { 25)
<br /> MEASUREMENT
<br />~US4S 1 U A i;:::::PERMIT:'.: . ;':.r,->r#::~. , : :..ac~4R>a#. 4aa+ Ir•iQ4tDII .: .. +OgaA04 CAS I INC~:/ JRA%
<br />~FF'LUENT GN03$ YALO :REQUIREMENT OCCd
<br />~ LAITY !kX ML/L 'Sr38TH
<br />L A G ASE SAMPLE #r/#R,^r`* (c:t;:q.rg 4aat~aa acar,{.d ( 19)
<br /> MEASUREMENT
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<br />~~jf~ PERMIT ~'~ar~J~RI;r.~. Y#+zt+~d Oar:r v>fa:~9ri >raCAfl# )C 4 `OVTI!t :$A1;
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<br />r TUN, IM fSNDUIT OR SAMPLE ( nj) a:7n; 3: r,ra~r: ;: ~;x;: ~: ,~
<br />rrI,LJ TKEATMENT F'LAMI MEASUREMENT
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<br />~ fiaar5aa aaa>3ar~ caaxli:~ : .: r:{: ENCF/ ;N5TAli
<br />c.F'FLUL'N'i .~JSS VALUE PEqup(iEMErrr
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<br />.iULI DS, (I~: l:L SAMPLE a:~-. .'8 ktr;: r,: ;::} a~:ac,{ i:Ot;l" ( 19)
<br />LI:iSJLY z., MEASUREMENT
<br />7U1y5 1 0 U ;:.;'.PERMIT:::: fr~k>att?F?%. ' .. +<v#v><rA9 oaf "'•4>?4D ~aaaa~ tfE~ORS " T!?LY ~gA6
<br />sPFLJE~+T ~NOSS YALUE :REnu1REN1E@IT
<br />~.. aao# LAIN P1Y SG/L
<br />J :LnU ~ E:ASE SAMPLE Oi 4C;:tl { 94) A30aaa aeac:.: is ':S': ;a: ;:
<br />Y I ~'~~ A L MEASUREMENT
<br />'t4J,:o 1 U 0 PERMIT..-. C:`r~'7a17~ iiEPOf(S~ ! E°=1 ••'~'a~aa yaa.aaS *aa;:<Ir,: : ~.;:Yf;: 1 'Yt.F/ 'I3UAL
<br />;.P: LDEGI' CROSS YAL!)F REQUIREMENT IwST MA%. NC=O Yfoc•;: .?
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<br /> SAMPLE
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<br /> PERMIT
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />AM FAMILIAR WITN TXE INFORMATION SUBMITTED HEREIN
<br />AND BASED ON TELEPHONE DATE
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<br />TRUE, ACCURATE AND COM0.ETE. I AM AWAAE THAT THERE AflE
<br />910NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING
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<br />THE POSSIBILITY OF RNE AND IMHYSONMENT
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<br />EpA'Fwm 3320.7 (08.951 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 C 0 ~ I ,j / 9 ~ (% 2 ? - l 2.'. ~ PAGE iOF
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