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PERMITTEE NAME/ADDRESS pndude Facilirv NameJLOmrian iJDigerenq <br />NAME S£YF.CA CCAL CCCFAhY <br />ADDRESSp Rd y SR <br />kAYDBN <br />CO t11639~ . <br />FACILITY <br />LOCATION(AYD$d ~ ~ CG 81630 <br />ATTN: G. $UD $HOiR, &i`MSRAL NAdAGEN <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR; <br />(1~tbl l11. 9) <br />cG000U21 .~i~ A 3 A <br />PERMIT NUMBER ' w¢i DISCHARGE NUMBER <br />FROM <br />(40'21):_ ~. (22-401 (4i 45J ~ (26 4JJ (48-29) (30 71) <br />MONITORING1PEFilOD <br />YEAR <br />V.Y MO <br />V1 DAYt~,'~`VEAR <br />V~ Tp U6 MO <br />V.7 DAY <br />J1 <br />Form Approved.' ~ K' <br />III-CR OMB No. 2040-0004 r <br />Approval expires OS-31.98 <br />{SUER M-) <br />f - PIAl1 ACUt2 <br />cI~CH4ECF TC SICE CiEEII <br />fififi d0 []_CNAE6E ~ +n'1 <br />NOTE: Read Instructions befo].e completing this form. <br /> (3 Certl Only) QUANTITY OR LOADING~~" (4 Ca/1Y Ony) ~'tOUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />'PARAMETER (4653) (Sd67) ,~~' ._p (38-45) (4B-53) (54-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM 'UNNTS MINIMUM ~ AVERAGE MAXIMUM UNITS <br />I64S3) 'WALrsls <br />(64-68) <br />69-70 <br />U1L AND (adEAJL' SAMPLE ~LSPGts ( qli) AXtp44~~. t0 ti0~90 i7 tOCRtfi <br />Y I S U A L MEASUREMENT <br /> <br />H4066 1 0 0 FEPMIT - ~`~~~ ~'~` " FS=1 # <br />k <br />) ~ <br />kt ~ 9 s K~t C -CE/ IISUAL <br />EFFLUt:NT GROSS YALUE :FiEOUIREMEN7 ` <br />~ <br />_: <br />"' b m <br />" <br /> , <br /> SAMPLE <br />MEASUREMENT ~ "'' <br />;~` <br /> -PERMIT - -~ : ,. - ~ ss~;~ r...ts ,F ~, ,.I <br />t e <br />- ~ ~; , <br />s <br />- <br />' <br /> REQUIREMENT- -~ - - ~ <br />z - + -~. <br />. <br /> ~ - N <br /> SAMPLE <br /> MEASUREMENT <br /> P •.. PERMIT - a--r4 ~)~, es~ ~pr ~ ~ - _ <br /> REQUIREMENT - ,. 4 ~. fi <br />"' ~ " <br /> I~4.'b+f ,. 3,.L dti <br />" <br /> SAMPLE <br />::,~ <br /> MEASUREMENT <br /> <br /><PERMIT <br />REQ <br />I <br />EMENT <br />- <br />,- <br />- <br />~ <br />^"",~ ,' <br />ax i },y r:.:: }T a <br />r <br />~ <br />'e <br />"'-- .~ ` <br />..- <br /> , <br />U <br />R ~, t <br />t ,+'a k> <br /> <br />'" SAMPLE <br /> MEASUREMENT <br /> '.` .PERMIT>- ~ _" ~ ~ <br />" ~#" <br />"t jrr x ,~ ~ t <br />, <br />- <br />{ ~ ' <br />."• . <br />~ <br /> 1REQUIfiEMENT ~', <br />. ~ <br />~LI~:: )#~.;;': ,, . <br /> <br /> SAMPLE - <br /> MEASUREMENT <br /> 'PERMIT ~ - j t. ~ ;r~ s'~3s <br />~ <br />~~ ~" <br />l ~ ._ <br /> REQUIREMENT ~' - .n1L~~ r <br />'kv°~ <br />k.- t <br /> - ;7 , _. <br />> ~. ~, <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ~'~ PERMIT . - <br />~ <br />- - ` of ~r ~ <br />"~ --.~ ~" . r <br /> REQUIREMENT: - - - '4'i " <br />,~, <br />`,,., >rroY <~.%:' ~" ~ (f.4~' _ - <br />NAMERITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN <br />AND BASED ON MY <br />' TELEPHONE DATE <br /> ; <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. <br />~ <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING THE , •s ` <br /> . <br />POSSIBILITY OF FINE AND IMPRISONMEM SEE to U.S.C. § 1001 AND 33 U.S.C <br />SIGNATURE OF PRINCIPAL E%ECUTIVE r ((,/Y`/, <br /> § 13t9. (Penattres antler these statutes may inclutle Imes up to 510,000 antl or r~p <br />O <br />U <br /> <br />TYPED OR PRINTED <br />maximum imprisonment of belween6months entl5yaers.J FFICER OR.A <br />TH <br />IZED AGENT <br />T" <br />ODE <br />NUMBER <br />YEAR <br />MO <br />DA <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) L <br />TSj b IROA LIRITS YI11 kE 1iALYEC ti SETTL£ASLF SCLlC,S LIY:IT AFFIIEC fCF <=l0YR,2tlEb,-AlC}F [IE!!; 155 E <br />IROR LItlITS dAIYEO fCE ~107A,1U86 PFirCIP EYFNt SUE.]F.CT TO BUAOEA Cf FFCCf IR I.A.sk ~;dll E [lEA_E - SEE <br />T_o.l.T. *ne rncsTr•[tur r n t • ~ ' <br />EPA Form 33241 (08-95) Previous editions may not beused (REPLACES EPA FORM T-40~ WHICH MAV NOT BE USED.) CC 151! 9g C E ~ ~' } d~ 3 ?AGE ~ OF <br />