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PERMITTEE NAME/ADDRESS /lntludE <br />Facili{r A'ame/Location If dilfoenll <br />NAME_~1.S:S:- _.. ., U_.- -..•v cR'L, sl^-- <br />ADDRE55'l`~J.._~l'~.5.~_'~T_ ______-_._-_ <br />FACILITY ________________ __ <br />LOCATION __ __ ______ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) I J l~ . <br />DISCHARGE MONITORING REPORT DMR I` I ~ ~ ' I <br />(1-161 (17-19J ) .`.~\0 a!. ~~ y'~ Iv.. <br />~CG5GJ2oG .. ,; P. (SUi:n 56) FP.S^T4F!!roved. <br />PERMIT NUMBER DIECMAIIGE NVM~ I L - ~ C T ~. A L OMB No. 2040.0004 <br />MONITORING PERIOD SETTL POiyG ^?Pr4'L'1~32'rLb~?~-~ <br />YEAR MO DAY YEAR MO DAY ~ . <br />FROM Dj ~~ L:{ To ti3 i.. ~ •':- NG DISLRAT.iGE 1_I~^ .`'. <br />Haan Iaavl raeasl mean nuaBl /vanl YNOTE: Read instructions before comol nD this form. <br /> (3 Grd Only) QUANTITY OR LOADING (q Grd Only) ~ DUALITY OR CONCENTRATION <br />PARAMETER /qb-53) (J4-61) (38-q5) (q6-SJ) (Sq-el) ~ ~ - O~ "~ g"n~,~EE <br />(37 X11 ~ ~1Y <br /> AVERAGE MAXIMUM UNRS MINIMUM AVERAGE MAXIMUM UNITS (8)6l) /da~8) (6¢701 <br />-.. 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'~ <br />e" <br />;- ~ <br />1 <br />a JT <br />.i: t ~'S <br />w <br />. <br /> REQUIREMENT C <br />'p!y':'Y F <br />. F <br />~ x <br />~ i~~-aY-rY t <br />°: <br />;'~ ~ is Y, <br />1 <br />',~ s <br /> .. .. . <br />.. ~ <br />~ <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER .I CERTFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%wMINED <br />' . <br />r TELEPHONE D A T E <br /> AND wM FAMINR WIiT1 THE INFIXtMATA <br />1N SUBMRTED HEREW: AND EA.ED / <br />/ <br />/ <br /> ON MY INOURY OF THOSE NpVIX1Al5 IMMEpATELY RE" NSIBLE FOR // <br />/ <br /> <br /> <br /> <br />ichard L <br />Tibbits <br /> <br />OBTPIIVING THE INFCRMAT0l1 1 BELJEVE THE BUBMRTED INFORMATION I$ r <br />(J <br />/ <br />'}`v <br />_ <br />. TRUE ACCURATE IJJD CCMPLEIE I NA AWARE THAT T}ERE ARE <br />9GNIFIGNT PENALTIES FCR <br />UBMnTNG FALSE INFORMATI <br />pNG G//Z <br />/ <br />Su ervisor ON, iNCLU <br />S <br />THE POSSIBILITY OF FINE AND MPR150NMENT. SEE IB US.C f 1001 AND <br />33 US <br />C f 1318 <br />(P <br />t <br />d <br />l <br />i <br />i <br />l <br />d <br />li SIGNATURE OF PRINCIPAL EXECUTIVE 303 882-7232 94 01 12 <br /> <br />TYPED OR PRINTED . <br />. <br />anLt <br />msa l <br />aN <br />O may <br />n[ <br />a urMer <br />u <br />e <br />nes uD N <br />J/OP00 an0 or maxsmum impriWnmens M Dcnvnn 6 mpnNS and S yurE) <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />OMMENT AND EXPLANATION OF ANT VIOLATIONS (Xtferen[e all altaChmCnIS hC«) <br />:I;. i; GFi1.FE--S=_° FOCT_ril;iic. I/, Fi~E i5. <br />'rn 3920-1 (RBY. 9-06) P(BVIDlIS ediliOnS mdy bC usCd. (REPLACES EPA FORM T-a0 WHICH MAY NOT BE USED.1 PAGE OF <br />