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PERMITTEE NAMEIADDRESS prYb FrWryNaWluaOm ifD~Gmul <br />NAME :. a,. ,_: ~..`d. e. ~_.. ~ V <br />ADDRESS > > A ., ;; ii C <br />6d Cd:.B .J .,; .; 11 <br />FACam <br />LOCATION ~. :. Y .: ;, CO 81630 <br />9- <br />NATIONAL POLLUTMT OISCHMOE EUMINATON SYSTEM (NPDESI Forrn Approved. .' <br />DISCHARGE MONITORING REPORT (OMRI , , QyIB o j040-0004 y <br />_ ~ . ,.. ` , , ApprovalI elcpi~ep 05-31-98 R <br />PERMIT NUMBER DISCHMOE NUMBER _ ~ ~~ i <br />~. <br />MONITORING PERIOD ' <br />YEAR MO DAY YEAR MO DAV <br />FROM TO ~ `• :i: ", :: ~(.1 :; '.. ~, I __ I .. . <br />114Z11z122-Z31 IZ4Z61 I?6271 !Ze-Z9l !3431/ NOTE: Rnd Inetruetlom bdae completing thb form. <br />PARAMETER !3 Grd Onlyl QUANTITY OR LOAD/ !4 Qrd On/yl QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE <br /> 146531 !546/1 138.451 !4653 !64-6/ EX DF <br />/31J71 <br />MAiYSs TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (s7~sJ) !6458/ (69-701 <br />,.r r':C'C ;_'n P4!: 79Ay SAMPLE ..#4 ~. .. ff 7^~ II ,, <br />~ ~:.. ~ -~ ! .: 11 `~ <br />~ ! l <br />`y <br /> <br />„ j <br />, <br />- ! ~ <br />i <br />MEASUREMENT lliV <br />~ .n, <br />i <br />~. ~~ _~ . <br />. <br />„ <br />i <br />~ <br />i,-_.1 .. .! :;:.PERMIT: ~~ '%%s ~`~~~;'=:"~ .~SO.tkfi~~:~~: L•~:. ': ~. ;: ~~+%~.: &,'.:~ <br />~ ~: ~.;=t,"I ~, _ '~1~ ::7 <br />is <br />i~ <br />~ <br />: ~ <br /> <br />. .' <br />: ; : J <br />" "~ ,. <br />. ~ <br />~R <br />EQUIREMENT. <br />~ <br />~ <br />~ ;. S . <br />~ ~ <br />~ <br />r <br />y . <br />. <br />. <br />.. <br />. <br />. <br />. <br />_ . <br />. . <br />,.. <br />. , " <br />~ <br />.. <br />.., ~ ~~' ; ~..: ~ : a r ~ ~ .~ SAMPLE :: ;~ -::.... . ,- ~ . <br /> <br />~ ,_ <br />` ` <br />~ ~ `, "' ` <br /> <br />~ ~ ~ ~ ~ ' t <br /> <br />~ ~ _, <br /> <br />/ <br />}:. <br /> <br />. <br />. _: :. ~ ~ i L ~~ MEASUREMENT ~-~~ (.l t,ti <br />t ;.:~ - U PERMIT ~~ ~~"~*S Pn Sr. .fit. ~k ~S:. _ ~ <br />i.b <br />xak~.~#M <br />r~Mr:.;.a _ <br />... <br />:'FLY <br />;~;';i8"~:".. <br />.. C .) ~ .. 'I' S r: 1. ~ a :REQUIREMENT ~ .. <br />a.I~ v,~,.:~ •, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> . PERMIT <br /> REQUIREMENT ~ ~ "" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />,~--~• <br />NAME/I1TLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF <br />MIDM V/ITH THE INFO uW THAT I NAVE PEgSONALLY EI(AMIN W MD <br />RMATION SUBMITTED NEADN; MD BASED ON ~\ ~ TELEPHONE DATE <br /> MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR `~. 1 ~~, <br />- <br /> OBTNNING THE INFORMATION, I eEUEVE THE SUBMITTED INfORMATON IS <br />TRUE <br />ACCUMTE MD COM0.ETE <br />I AM AWME THAT THERE ME , ~ ~ <br />I ~ <br />a <br />" <br />~"~-y <br /> , <br />. <br />SIGNIRCMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~y~ <br />- <br />, <br />-) ~ <br />~ IL~ <br /> , <br />THE POSSIBILITY OF FINE MD IMPRISONMENT. SEE 1B U.S.C. 1 1001 MD ]] <br />BIONATDRE OF PIIINCIPAL E%ECUTNE 1 <br /> U.S.C. f 1]13. IFlrWb. uMr swr wNros mry %KAM Nra uP ro 110,000 AREA <br />TYPED OR PRINTED wr;n..bw,.l+rp+irwn.nT eFMn.rn en.onaa rds Yrral OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refarenee e// etteehmenb here/ <br />EPA Fam 3320-T 108.96) PTeviOUe aditi0na may be uesd. (REPLACES EPA FORM T~0 WHICH MAy NOT BE USEO.1 !~ ~ ~ ~ T ~ ~ y p 91 4- 0 92 3 PAGE 1 OF <br />