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PERMIT7EE NAME/ADDRESS (GJr6 FrY~ryNr'f.ocaNw lJDiQGnnq <br />NAME TLAY:::. "T' I'~"•, .. -. <br />ADDRESS 'r 4 k i' }- j' ~i ~: I %. ': <br />P.U. NJ'+ i^.7 <br />Cr:AI~ <br />L'i ~y:r•.i '~ <br />FACILITY <br />LOCATION <br />;,Irv: w. ~oenc••I ~ E.r~LS, I~r..$/,r ti <br />NATIONAL POLLUTANT DISCNMOE ELIMINATON SYSTEM (A/POE$) <br />DISCHARGE MONITORING REPOfiT (OMRI <br />17-Ifl 17-191 <br />^c:0~3 5 <br />PERMIT NUMBER OISCNAROE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ TO ,. <br />126111 !1I-131 !I~-751 !I5-$71 (18-191 /363!1 <br />Forth Approved. <br />ACUTi G°T TS:;TINi;Q~R'~'pl~oa <br />($ U e R fI 4) APProvelPxpl(ei L 5-31-98 <br />P - FIrAL L <br />"INCF <br />NOTE: Reed Inetruetlaro before completing this form. <br />PARAMETER (3 Grd On(yl QUANTITY OR LOADING Is 6rd Onlyi QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> 146-531 151511 13B-151 M6-53 /5/-611 EX <br /> <br />/32-371 µKY~S TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 1Ba-BSI 15~-5g1 /5&70! <br />LCit: STAIaE i]Hy?( A(; SAMPLE ..::.t': .::::5::::; 44{1+1Yr::: 4:44;0# ( 23) <br />C c ;a I U D A f' d t. I A MEASUREMENT ~~p10 • <br />IAr,~d 1 U (1 PERMIT - :; F$::fi 4:%,=L: c: t":x: IOC. ALZpf1tF ±3t[3GY~xl: 'E'R- TRLY CRA9 <br />~_F E'LOLN I' GRJ$S VALU REQUIREMENT >!r :~=::4 ;±K.. .V J{Lti l ~~ ~ ~ ~ ~ CSNT `' <br />:.~iU ST A'I tiE ?GHN AC SAMPLE :~'`I%::::;. ;: 4rdiY: '.: •'.'L~?:`=}~; ( 23) / <br />r' 1 i~. c: t' Ei A L c 5 MEASUREMENT ~~ D, p <br />Air i,C I D 0 '~. PERMIT ~:: [:u'=<: .;:;; ;1;;: ;<;: :t ::} IUD. ':: Ot Ld~ti t.1 K+47t5'& F.c_ '' ~.:. ~.T?LY ''RJIb <br />f'E'LU:: h'f ~HOSS YALU .REQUIREMENT t::=::r -tR Yi11DF ~ ~ Ct: ~'T ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />!?; <br /> PERMIT <br />' ~ REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> : PERMIT ~ ~ ~ ,. <br /> :fEQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />~ <br /> PERMIT <br />~ ~ ~ ~ ~~ <br /> REQUIREMENT. ~ ~~ ~ - <br />NAME/TITIE PRINCIPAL EXECUTIVE OFFICER I cERnFY uNDFII PENALTr of uw THAT I NAVE PrnsoNUir ExAMINfD ANO <br />AM FMIIDAR wITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br /> MY INQUIRY Of TNOBE INDIVIDUALS IMMEDIATRY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB <br />{~. Gordon Peter6 TRUE. ACCURATE AND COMRETE. 1 AM AWME THAT THERE ME <br />SIGNIFICANT PENKTES fOR SUBMITTING FALSE INFORMATION <br />INCLUOINO .Q~/ L <br />970-824-4401 <br />98 <br />ID <br />23 <br />President 6 General Manager , <br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 1e U.B.C. E 1001 AND JS BIONATURE OF fMI1NC1-AL EXECUTNE <br /> ~ ~r N0 ro sto,D00 <br />y wM <br />~ <br />rwwmunaw <br />~ <br />~ <br />~ <br />F <br />~ <br />TYPED OR PRINTED swnrrt <br />r <br />ilm <br />ywa.l <br />n <br />tw <br />.ar <br />e <br />+ OFFICER OA AIIrNORI2ED AOERfi CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReioence d/ett~chments hero) <br />~rEr: 1.A.,;, PQ 7-9, ItC:7 DL'TAILS OF TC'.ST R~OCcLU3E• f!P.POFT LC_C - STlTISTTrAt. PCINT ESTI"'ATt' VF!ICI' :`.' <br />LtTHAL T4 50» OF TEST ~RGAAI515, AND ATTACH ACUTE. TOXICITY TEST flFFCST F(19' 7C LY,R. COFIP,S OF ALL <br />. v r. _ ^ <br />EPA Form 3320-t (08-951 Previous editions meY bs used. IREPIACEB EPA ORM -a0 WHIN AY NO BE •1 C D 0 5 ; /CRC 11 3 -1 D 5 b 1 F E <br />