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PERMITTEE NAME/ADDRESBp~6FsBrgNawJfaanm dDrpraq <br />NAME fBRriJR ~7cdi :]ypdNY <br />ADDRESS TERROR ~dcEF LOAD]UT <br />1840 NI.:tIMAY 133 <br />PAOMIA CO 81`t<28 <br />FACILITY - <br />LOCATION <br />ATTN: KELLY FRITZLBH, ~PvI;ATIJNS "!eR <br />- ~ FROM <br />NATIONAL POLLUTMT DISCNMDE ELMINATION SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT IOMRI <br />2-r5i nl-lsl GUI'~I IfT p~NG '"0 <br />~)G850C?i Uu2 A (SUf'.n ii C) <br />PERMIT NUMBER DIBCNMGE NUMBER p_ F I N A L <br />- MINOR <br />MONI TO ING PERIOD <br />YEAR MO D ~~ Y AR MO DAY` <br /> <br />Form Approved. , <br />NOM~~,o. ~04Q-Q00~4] l( r <br />Approv e I B d5-31.9$ , <br />~~ ~~ <br />'.5~1. ~•.,; YC DISC%10.((^:i (X7SX~ ;: ;; ;: <br />I2a2/1 /22-231 l14 ^d' /26-171 l7e-19/ /36311 NOTE: Rnd instructlom before completin8 this form. <br />PARAMETER !3 Grd OnIY! QUANTRY OR LOADING ~ ~ lY1 QUANTITY OR CONCENTRATION NQ- FREQUENCY SAMPLE <br /> (4fr531 (546!) '-.151 !46-53 !546/1 <br />EX OF <br />TYPE <br />132-371 AVERAGE MAXIMUM ~ ~~UNITS ~IMUM- AVERA/GE MAXIMUM UNITS ls~.eal MALVSS <br />lyy5el 15a7o1 <br />N u ASo SAMPLE .'+'-o:aY ,_,-`~~ ~~. ~(.~9u) X+kFf## 434 r.+-. . <br />I S U A L MEASUREMENT <br />I - <br />4066 1 J O PERMIT 4#~a~# $.$$E#~! S=1 <br />E r0.>Jr iCL fir; :: ' :Ork4#;. ~ C4~44t - .#:k': gcv <br />LY <br />TSUAL <br />PFLUENT Gi{]SS YAL'JE REQUIREMENT ' <br /> SAMPLE ~ ~ - ' <br /> MEASUREMENT ~ ~ '' <br /> .PERMIT •, ~ .., :~-<; :' .. <br /> ~REQUIREMEN7 ~ ~~ ~ : <br /> SAMPLE - <br /> MEASUREMENT <br /> ~~ PERMIT <br />~ ~ ~. <br /> REQUIREMENT ~ ~~ {~+~ ~ ~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~~ -~~ <br /> REQUIREMENT ~ ~ ~ - r <br /> SAMPLE <br />i <br /> MEASUREMENT <br /> ~~PER.MIT ~ - <br /> REQUIREMENT ~ .;~ : ~ .. <br /> SAMPLE <br />~ <br /> MEASUREMENT / <br /> PERMIT <br /> REQUIREMENT <br />~~~ ~ ~ ~ ~ , <br /> SAMPLE <br />: <br /> -. ~, r <br /> MEASUREMENT <br />~ <br /> ~ <br />:: <br /> PERMIT .. ~ ...::.~. <br />~ . <br />~T, ~ <br />~ : .: ` <br /> ~REQUIREMENT~ ~ ~ ~ ~ <br />~~~ ~~ "~ ~ ~` <br /> . <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIM WITH THE INFO UW TNAT I HAVE PERSONALLY E%AMI <br />RMATION SUBMITTED HEREIN; MD BA NED MD <br />SED ON TELEPHONE ~ DATE <br /> MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIB LE FOR ' <br /> OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORM ATION IS ~ - <br /> TRUE, ACCURATE MD COMPLETE. I AM AWME THAT THE <br />IN <br />SIGNIRCANT PENUiIES FOR SUBMITTING FALSf INFORMATION RE ME <br />CLUDING X <br />~ <br /> <br />KELLY FRITZLER OPERATIONS MGR , <br />THE POSSIBILITY OF RNE MDIMPRISONMENT. SEE tB U.S.C.f 1001 <br />M0~] <br />/ <br />ON <br />E OF 970 929-5851 99 + 20 <br /> <br />TYPED OR PRINTED u.s.c. f tare. lan.rd.. Mwr dNr mnn.. n..r McAW Fins l0 ro sro,DDD <br />wrrrrrimnr hpnawnAnr el brr.rrrsmmNarMbr~ral ,l~ <br />BI <br />INCMAL EXECUTIVE <br />OFFICER AITTRDRIZED ADENT <br />CODE <br />MUMMER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS lRelersnce d/ sftechmenfs here) <br />SETTLEABL_6 SOLIDS LI^fIT APPLIL'S ]NLY IP <= LO-YR, 24-9R 2RG.:IP nYEnT IS CLA?!:!:C, i'r CLAIM APPROYED :?Y <br />W,(CU, TSS i Lh]N Li".ITS E+ILL iiOT B? AP?LIh:U T) RE POR lED 'lEd SU hclr [.d..i--S 5 I.6. LAr PG 5 AND I..4. IG, i-.: Ei. <br />A, P r nl n <br />EPA Fwm 3320-1 108-951 Previous editions"may be used. (REPLACES EPA FORM T-40 WHICk1 MAY NOT EtE USED.1 <br />0154!970819 PAGE OF <br />~ <br />~ <br /> ~,.~.*~ <br />a . . <br /> .z <br />. <br />