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PERMITTEE NAME/ADDRESS lIrliLirlllryNsW1«,nm dDlp...,p
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<br />ADDRESS 7'AIPPER MIFi£
<br />P.O, 90[ 1137
<br />CKAI:, .:0 8I5I6
<br />FACILITY
<br />LOCATION
<br />6TTK: K, COK,7~K V£TP.RS, PRF.S/CF.N lICR
<br />NATIONAL POLLU/ANT g5CHA110E ELMINATOM 9YeTEM /NPDESI
<br />DISCHARGE MONITORING REPORT IOMR/
<br />IT-161 17-79
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<br />PERMIT NUMBER DISCHAIIOEMWBER
<br />MONITQRING PERIOD
<br />YEAR MO DAY EAR MO DAY
<br />FROM ~ TO FJ 3
<br />I14T71 l1T-131 111-T51 126-T71 !T9-T91 !36311
<br />Forrn Approved.
<br />!1 T n p R OMB No. 2040-0004
<br />(411ER .NN) Approval expires 05-37-98
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<br /> !1653/ 151-571 138-151 11853 15/-51 OF
<br />137-371 EX ANAtrtas TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rfT-aJl 151-591 I5A701
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW TNATI NAVE PERSONALLY E%AMINED AND TELEPHONE -DATE
<br /> AM FAMILIAR NATN THE INfORMATION SUBMITTED HEREIN; AND BASED ON
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />1F. Gordon Pecare ~Rl1E, tIlACCURATEFNIDA COMPLETE~~E T~SUW~EED~~T TNEFEO ARE ~C ~t~-'-~ - 970-824-4401 99 44 34
<br /> SIGNIFICANT PENALTIES FOP SUBMITTING FALSE INFORMATION
<br />INCLUDING
<br />?seaident JGaneral Manager ,
<br />THE POSSIBILITY OF FINE AND IMPRVSONMENT. SEE t8 U.S.C. 5 1001 AND 3]
<br />SIGNATURE
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