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i~~PEAMITTEE NAME/ADDRESS R.~LbirWryNwdLcranw yDl~s..,tl <br />f~...(iAME ~TtiH:cJF ~I?`:.°K :]'irntiY <br />ADORESSTERHJk ~Rt:ER L]AJJUf <br />1840 HI~9YAY 133 <br />PAONIA. CO 41329 <br />FACILIT' <br />LOCATION ~ ~ ~ <br />ATTN: KZLLY PRITZLER. ]PERil~I1i5 R7R <br />NATIONAL POLLUTMT DISCNMGE ELIMINATION SYSTEM INPDE$I <br />DISCHARGE MONITORING REPORT /OMR/ <br />!I-I61 l17-191 <br />,:3ae5oe,:~ u0 A <br />;,-, PERMIT NUMBER DISCNMGE NUMBER.. <br />MO A ING PE D <br />YEAR MO DAY YEAR MO DAV~ <br />FROM ~~ L ) <br />I]69I1 OJ_Pal nom. ~ r.. 116]7/ I?6-z9/ 130-31/ <br />Form Approved. <br />U;J;; 1)U: kr J i1D T7 4 QM,&do. Ty0~4Q-QOO?4Uti <br />Approve ex I 305-31-98 <br />{~L:Ae ~c~ i~9[~~ <br />F - FINAL <br />hTN03 ' <br />Y NOTE: Rsed Irutructloro befoEe~eoll'ipletinp thN.torm. <br />PARAMETER !3 .'rd gory! QUANTITY OR LOADING Fd Onlyl QUANTITY OR CONCENTRATION NO, FREDUENCr SAMPLE <br /> /46531 I50-b'l1 138-A51 106-53 I546I1 EX ~Y 7yPE <br />l31-37I <br />AVERAGE MAXIMUM <br />MINIMUM AVERAGE MAXIMUM UNITS <br />rs1-ssl µ <br />NS <br />164661 <br />/6370/ <br />t 8E.A3E SAMPLE SRrrr ( 9Yf $h3CA3 ##R #I , .,, . <br />ISUAL MEASUREMENT <br />40bti 1 D 0 PERMIT .'4`+r 73~ 4$~!: I~~I:: .I $5=1 ~1K~` ~: 4>k3*~' ?k <br />. r.~->r+n,:t ;: ~: <br />c <br />* "(LY c,n <br />I. uAL <br />PFLULYT~~GR]SS V4LJE REDUIREMENT, ;;,::: . <br />. V <br /> SAMPLE <br />.. <br /> MEASUREMENT <br /> ~~ PERMIT ~ - <br />~ <br /> ~REQUIREMENT ...:. ;.r~ : <br /> «~T., <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ " <br /> .REQUIREMENT ~. . r..:. <br />% `~ <br /> :n.:.. <br /> SAMPLE - <br /> MEASUREMENT <br /> .~ PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ..PERMIT ~~ ~ ~ ~~~•:a~::;x;~~:: ~: ::.. .... <br /> ~~HEQUIRENIENT <br /> SAMPLE <br /> MEASUREMENT i <br /> PERMIT~~: <br /> :REQUIREMENT ~ ~' <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT <br /> ~REQUIRENIENT•~. .~ ~ ~ ~ ~ .. <br />NAMERTTLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENN.TY OF <br />MILIM WITH THE INFO LAW THAT 1 NAVE PERSONALLY FxAMI <br />RMATION SUBMITTED HEREIN <br />MD BA NED MD <br />SED ON' TELEPHONE: DATE <br /> ; <br />MY INQUIRY OF THOSE INDINDUN.S IMMEDIATELY RESPONSIBLE FOR - / <br /> OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATON IS % _ <br /> TRUE ACCURATE MD COMPLETE. I AM AWME THAT THERE ME <br />SIGNIRCMT PENALTIES FOR SUBMITTING FILLSE INFORMATION <br />INCLUDING ,[ <br />J( <br /> <br />n <br />Y.ELLV FRITZLER OPERATI0.15 MGR , <br />THE POSSIBILITY OF RNE MD IMPNSONMENT. SEE rB U.S.C. F 1001 MD 7] <br /> <br />I <br />NA/ <br />E O <br />I <br />G <br />EX <br />UTN - <br />qT <br />q <br />~ <br />Z 7 <br /> <br />TYPED OR PRINTm u.S.C, 1 1513. /lilr'Brr urWrr Mw .own. mry YsAAr Mrs Ip ro S 10,000 <br />wnmrFim.n anMowwrt alhlwrrn6moneYr.nd6 Frrnl B <br />O <br />TUR <br />N <br />PAL <br />EC <br />E <br />F/ <br />OFFICER OR AUiNORIIED AGENT AR A <br />CODE ~'NUN19ER <br />YEAR <br />MO;~ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IR37erenn sll sttechmenfs here) <br />E SETTLEABLE S]LIDS LI!!IP APPLIES ORLY TP C= LU-Y3, 24-i?2 ?Ri.:ld k.YcNT IS CLAIMi'.D. T.F CLAj?I APPd]YFD 9Y <br />YQCD, T:,S CRON l.I!1IT5 HILL N]T Eit' ArPLI%u TU RE:PiiRPY.D t2A3trddc'•ENTS'-S B I.$.lb, PG 5 l1N'b Z.H.1C, PG 6. <br />STf1k MYl TdR MAB-:PK: YT Dl au OI~F 1_1 -y.l <br />EPA Form 3320-1408-95) Previous editions may De used. (REPLACES FPA FORM T-0O WHICH MAY NOT BE UBED.( U 1 5 i / 77 Q 819-.~~~ PAGE T OF <br />' - .,~ry - <br />