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PERMITTEE NAME/ADDRESS pnchde Facillry NmnNG«anon JDgerenq <br />NAME .-yn.r^ ve.•r: '~r. - .. r~"^• <br />ADDRESS'% I ~I ~... 1 • 7 ° ! , ,, .I •- ~~ • ~ .; ~. ':. ~ ~.. t• c <br />910 ~aqT "r•;^r.. .-T.T^~.. <br />EFGi `:J1~^ 9J1 <br />FACILfTY <br />LOCATION <br />.:ice'.. .`i'1 '. ~.IG N• .r.T ...:e ~ L q.r•vv <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR~ <br />(2-1B1 !v- A) <br />^'T]l''715tT ~r1q <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ' ~' ~' I TO ° ~' ° ' <br />(2P21/ T12-231 (24251 (26-211 (2B-2B) !3691) <br />Form Approved , <br />„ ~ T ., .. OMB No. 2040-0004 <br />Approval expires Orr31-g8 <br />r _ c" nT P'IIITT . <br />r _ <br />~Ty^ T nt .!~ ~ T1 Cn T't rr (-~. a.•y <br />d rNOTE: Read Instructions beto w letlng this form. <br /> (3 Cent Ony) QUANTITY OR LOADING (4 CVd Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 46-53) 54-6T (38-45) (46-53) (5481) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(x269) auaLrsrs <br />6488 <br />6&70 <br />...):. ••U ~•1 SAMPLE ~ .:~r rta ~. :nn^ .. .•:r t TT) <br /> MEASUREMENT <br />lJN1,91: ~ U R -PERMIL _ ye <br />~ r•:h tk-Of`~ ;,.Ry., ~'~~'} -' 9#P ~'f.{!~'~~'.-:. N:rn~ ~ ~ - <br />°Fr'LL': "; ~o75S VFL^` - <br />- <br />RE~UI9EMENi _ <br />' s:•aa ~ >~ r.., t=-- ~; : .Ir; <br />:.T SAMPLE ':ngC3't r`xR h'`- .>: R+~^? r 1?) <br /> MEASUREMENT <br />IlU4UC 'I l <br />' ,:PERMIT'- ~Att4~# '~*" <br />.S ki- <br />» <br />X~ C;r^ ~+ t'~"~~ <br />~r <br />~ ~ ~ ~ ~ <br /> <br />.PF'LU`:A <br />1' .R9_- FA(.ll! <br />OUIREMENT <br />~r <br />e <br />.`7 <br />~ <br />~~*~ <br />t~ <br />~ y <br />~ <br />~ <br />~rl <br />r i`R <br />L <br />~ <br /> _ <br />+ <br />. # , <br />_ ..~ 'r, V SAMPLE r-Gaacc rtn+:, ~:[: ...~,,-: _,. ~ T Q) <br />°p;r'~F,!fnF,U MEASUREMENT <br />I'U`. i:7 0 D 7 PERMIT •491 R79 bl~drdRRr' C r.rt Ik#~k#OrDk <br />_ lt~P~~tT RpP{SPT 11~(F~'= k ~i <br />~~~:,' .D"r!°.NT'S 9':1.' REQUIREMENT <br />.. .rl`• . 3tlDlt !44', - <br />DiTE1' rX `:I T, - <br />rt~K'~'N ~.. <br />,;U ..105• TOT~fa SAMPLE ','r`^`r ~x 4M1 tY •. r ( T'11 <br />'''J'" ^ ~ N O': 17 MEASUREMENT <br />1i0~70 1 0 'T PERMI o=M ' RGP 9tp##~Q:i FSR OAlkR4# '~~' }h ~C',P}~-- ,.~ <br /> <br />V r L ~ C ti T r o 1 r r- r r { r• ' <br />REQUIREME' <br />M, N <br />eta-x' <br />q:#? S <br />~ ~}~~: 'trr <br />~! ~ :4 L'T T1T <br />'"! / T, <br />!1!19S"q - <br />. <br />SU1. U5, F'. 1.° i. i'!.' SAMPLE ~%'.-~^FR ^a::4 Dr ': :-?- "(. ( vc~ <br /> MEASUREMENT <br />UO`~75 0 0 '% -PERMIT. # ;r ~4#!4 - ' ~" ~ ~ R~1f(1~'C. ~a4i'6.; <br />~~ !~FC;~'~' :~~~* r <br />~?.`' COtIMt'. Tr c r[.'T 4' REQUIREMENT `~' 3 5 <br />rY;S~~rkt^~:f ~. `:''~'•t ~ <br />; <br />~ " <br />~~~~i4 ~~~ ~ <br />xk <br />~~ ' ^S! <br />/L K011 `t <br /> .r,.: <br />o. ,. <br />v , <br />. , 11 <br />..~J ,, S.Tv .~'P,~ `~ SAMPLE ar,. O;tCC ?:FCRR;' R^:~'Srtn ( 7S1 <br /> MEASUREMENT <br />OJS~iS 1 C ? PERMIT 44rirgpR¢-. - ¢0~#R~-- rt'S: i'#~~~~"r ~- ~~~FF '~;~ i~?'~" '~°: ti•_ <br />" REQUIREMENT O"'• _ ,D~}~ ,N 1T'+' tS?~I.LT X: "T,/f ?I~1('e <br />U. b . .'..^. `: . SAMPLE •^r..R,ert ttY^t,.., }!4:Y««,. ,. /. ,r~,r. ( T o) <br /> MEASUREMENT <br />f`US- ~ T 0 1 PERMIT 4Cr #si< #R##¢Ar~ q r-^r ###'#SrA - ##Rt-6r~~ '~(i ~ ? <br />~~~~~- :. <br />)~~~~~~ <br />'.Fir.7P"^ r,n'~rr y.L~.r` REQUIREMENT - - - ~ rxs~ ntix~ ~r-/r. a - T ~E <br />NAMElTITLE PRINCIPAL E7(ECUfIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO <br />AM FAMILIAR Wmi THE INFORMATION SUBMITTED HERE NALLY E%PMINED AND <br />IN; AND EASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON <br />THE INFORMATION, I BELIEVE THE SUBMITTED IN SIBLE FOR OBTAINING <br />FORMATION IS TRUE, <br />~~ <br />~~~`/i// <br />(1ICh~ rC( 1~11III5 ACCURATE AND COMPLETE <br />I AM AWARE THAT TH ERE ARE SMaNIFlCAM ~ <br />~~ <br />~ <br />f.(/~ <br /> . <br />PENALTIES FOR SUBMffTING FALSE INFORMATIO N <br />INCLUDING THE / i <br />((( <br />[ <br /> <br />l:nlYfrenrr~~ntal ~~1a~ager <br />, <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEEIBU.S.C.41001PND33U.S.C. <br />mt <br />li <br />BO <br />P <br />ttl <br />tl <br />M <br />I <br />/ <br />tl <br />b S1P <br />M <br />4 <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />970 <br />-870-2712 ~ ~~ <br /> <br />TYPED OR PRINTED es an <br />er <br />ulBS may <br />1319. ( <br />erm <br />esa s <br />nc <br />u <br />e <br />tres up <br />, <br />e e <br />a <br />mWmum lmpnsonmeMdbeAreenBmanW entl5yeers.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Aelerence ell attachments here) <br />A LI 11 `I l•i ~. TTTIr'~` i. .. .:• :I .: '? Rl.( r rT.^ (Lrl_ 1r•) 1'1 '^Y.•/ 'f T, <br />^ (c 1'•- I: ::I .. ..y.'rR <br /> <br />r!'(f "r'~' _r u] q p :r n F c pF TO n <br />c <br />IS "LEI _ T•A..• 1 ., U 31 'I K 7. PP7'lr u'^~,JT M°7 TT. <br />me rr_rr <br />e, F • <br /> <br />rn/)T •=n+.c . <br /> <br />r/ v.- <br />^ur Y C ~ rnr ~v Jcr.nr n^ • v.: +. n. .~~ -_ rn^.. r/ r <br />EPA Form 3320.1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM 7-00 WHICH MAY NOT BE USED.) . , PAGE <br />OF <br /> n r t 7 <br />T /,t ~ ^ r) T ~^, ~ ,~ rr ~ <br />