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PERMITTEE NAME/ADDRESS(lnolude Fanlirv Namr/Lomrion iJD$erenrl NATIONAL <br />NAME SChECI CC1L CCCFIINY I <br />ADDRESSpR1fEEA 0 <br />kAYDEN <br />CO U16J9' . ~ PERMIT NUMBER <br />FACILITY <br />LOCATIONJAYDEN CO B16~0 <br />ATTY: (:. BOU P.AOSiN, GENERAL NAN1c:FY <br />FROM <br />ELIMINATION SYSTEM (NPDES) <br />NG REPORT (DMR; <br />(11 91 <br />~p.Si.'- C ] y ~ <br />DISCHARGE NUMBER <br />VG PERIOD I <br />TO <br />Form Approved,.l, ~!~' ;!t <br />OMB No 2040.0004 <br />!4I b 0 N Approval expires 0537-98 <br />(5oea <br />eb) <br />.. <br />F FI;~~,'L TiCUY4 <br />qi~ l.;40 SIDE CFEE11 <br />this form <br />letin <br />beforH com <br />ti <br />d I <br />T <br />' <br />nstruc <br />ons <br />E: Rea <br />O . <br />g <br />p <br /> (3 Card Ony) QUANTITY OR LOADIN (<Card Only) QUANTITY OR CONCENTRATION ~ <br />= NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54s0 ~ (38d5J (a6-53 .- (5a <br />6f1 EX of TYPE <br />(32-37) <br />AVERAGE <br />MAXIMUM ~ ' ~~r <br />°<UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM.'iG,~ <br />UNITS <br />(s3~631 ANALYSIS <br />(64-68) <br />(69.70 <br />JIL ANU (:AEAS! SAMPLE 'Ta°^^°a ( 94) ,svsaaa F94aa9 alit! <br />~• <br />VISUAL MEASUREMENT <br />B40b6 1 0 U .'PERMIT 3'aaaT-'~' )7kFCk2 Y E5=1 * i+ri'~1~4~,7~' >~ <br />' 1hf~.;#t~ ll~i' ' 1,T~8'~L <br />EFPLUE:NT Gk055 Y/LUE REQUIREMENT IN <br />$I tIA'7 '( <br />a0 v- <br />V' - .a aaall <br /> . r , <br />, ..., ,_. <br /> SAMPLE .,,,, y , <br /> MEASUREMENT <br /> ' PERMIT-. <br />REQUIREMENT <br />- <br />- t <br />„, -" ~:„;. ,fir ~`° <br />.f,'s~r' "~ <br />~~~_r~, :. ~ ~,y4 <br />T r <br /> SAMPLE <br /> MEASUREMENT ' <br /> -PERMIT • ~ ~~~"~~ <br />~''~ <br />a ~- ~ + rt. <br />"' <br />" <br /> REQUIREMENT ~ ~~}~ ~ zF 3~,,:~. <br /> SAMPLE " !';r <br /> <br />MEASUREMENT r-- <br />' ~; _,~'. <br /> <br />.PERMIT , <br />~~ <br />:F+ <br />'.r-` <br />~ <br />~ <br />i <br />~I ~*~'~~.. .. <br />~ •' <br /> REQUIREMENT - . ~i <br />~ <br />t <br />. <br />IUa~ ~ ° >z:',:, -~ - .,•~aa <br /> SAMPLE _ <br />' MEASUREMENT - '+°" <br /> "PERMIT. iF; ., <br />~ ~ <br />t ,. <br /> REQUIREMENT ~ °"'i t„'' <br />~'~ "~ ^ <br />`„4 <br /> SAMPLE ' <br /> MEASUREMENT <br /> ~-; PERMIT'. ~ - <br />,~ " r , <br /> REQUIREMENT - - , ti ~"- ~r -+` <br /> SAMPLE <br /> MEASUREMENT <br /> <br />~ <br />"-..PERMIT'.- - ~ x <br />:<.: <br />ry <br />REQUIREMENT ~- '- ~ ~ _ ~ _ <br />d~s~' ~,-R • <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND TELEPHONE DATE <br />AM FAMIUAA WITH THE INFORMATION SUBMITTED HEREIN', AND 8ASE0 ON MY <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOP OBTAINING 1~ <br />0 U ~ L / 0~ <br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. / ~ ` / <br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT ! ~~ <br />PENALTIES FOR SUBMRTING FALSE INFORMATION, INCLUDING THE <br />POBSIBILITV OF FINE AND IMPRISONMEr1f. SEE IB U.S.C. 4 1001 AND 33 U.S.C. ;u GNATURE OF PRINCIPAL E%ECUTIVE <br />' <br /> 5 13te. )Penalties under these srerures may inclutle lines up to St0,000 entl a OFFICER OR AUTHORIZED AGENT <br />CRO <br />NUMBER <br />YEAR <br />M <br />DAY <br />TYPED OR PRINTED merimum rmpnsonmant of 6eMeen6monlhs entl5ysars) E <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachments hen=) <br />TS:: b IAQh LIMITS till] 9L MAIYhG E SETTLEA6IE SCL]CS LICIT iFFLIEC FCF. <=l0Yfi,14Efi FNFCIF EYE17: 755 L' <br />IkOY LIEIITS YAIYED FCF ~LUYk,2>sHA PH£CIP EVENT SUEJFCT TC NUhDtd GF FbCCF IY I.A.i. CII E GEEI,EE - SEE <br />T {i ~ A TTC ^ bTT Ll ( t i <br />EPASFDrm 3320-1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />