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PERMITTEE NAME/ADDRESS (Include Faailiry Nama'Comripn ifO fferenO <br />NAME SI:YECA CCAL CCEFAYT <br />ADDRESSD N A Y"E R D <br />HAYDEN CO 82634 <br />FACILITY <br />LOCATIOII~A YDEN CG tl163U <br />FROM <br />ATTNS t:. BUG BAOYN. 16FNEHAL MANAGER <br />1TANT DISCHARGE ELIMINATION SYSTEM (NPDESJ Form Approved. <br />ARGE MONITORING REPORT (DMA <br />o6) rn-{s: OMB No. 2040-0004 • <br />r,i N U A <br /> <br />OG Approval expires OS-31-98 <br />fSUBA -11) <br />NUMBER DISCHARGE NUMBER F~ F I I I L A V Y I R <br />MONITORING PERIOD CI SC H A i C f T C T b I B/ f 15 tl C f E E k <br />d0 DAY . YEA MO DAY -- <br />U TO Y 7 ~fl'~ MO CI`_Ctl1FGk ~__~ ;~~ <br />". (z4151 (zfi~z7J (ze zsJ (3031) NOTE: Read Instructions before completing this form. <br /> (3 Cerc Omy) QUANTITY OR LOADI :"If ~ j<Cerd OnyJ QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-6 /) (38~45f (46-53) (54-6f/ EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />l61-631 ANALYS/S <br />(64-68) <br />69-70 <br />PH SAMPLE <br />MEASUREMENT LC#a.Y YrCaa <br />~ .Q '"~'I C <br />~ . t ~ ( 1 a ~ ' <br />3 C) ~' <br />1ti <br />OOYUU I U 1 ~ ~ I" = a :, '~~'~ ::: l1CE/ IS1T <br />EFFLDENT 6HOSS YALtl !" '"'°~*%`~~~'" ~~,' `` ~~ - '<'~~~ ~ '~ ~''~ <br />s~ <br />~3)M ' <br />SU <br />ECIIf9 <br />SDLIUS, TOTAL SAMPLE aaaaaa >aiuaaa OOOYI -- <br />' ~ <br />/ ~ ( IS) <br />~ a <br />~ (] <br />•( <br />SUSPENUEU MEASUREMENT `v. fd r, <br />DDS3G 1 0 0 ~ <br />~ :~ :aa ,,--;_ - -. rtPi •~~ <br />EFFLUENT GROSS Y-1C _ <br />~ ~: ;~~ ,`" . <br />~~ , ";,_ ~.:I ttoo ;;.. ~ <br />. <br />. '~, ~'~°`, CG/ L IStY41 <br />SOLIDS, SETTLEABLE SAMPLE aaaao~l araaaa a <br />a r" L <br />' ~ O <br />~ L <br />~ ( `~) <br />O ~ <br /> MEASUREMENT <br />~~" ' <br />• <br />~ O • (~ ~a <br />OU94~ 1 0 0 ~~~' li•. a~ _ XCO 'ra ' <br />C E <br />M 1 A8 <br />F <br />EFFLUENT Gk055 YALU ~y :. ~ ~,=;~r~>n ; stfia <br />~y t <br />- <br />`=~'_~~, C1/L !!EN1E <br />I9UU SAMPLE ACaCl90 CDOa+[ra LCA <br />r.. <br />2 <br />3 <br />O <br />~ ~ ( 15) ~ ) <br />~ <br />TUTAL &ECOY FBAHLE MEASUREMENT . - yJ • V + b <br />0U9HU 1 U U ~ - Y Xca ~ 4 <br />?tom ~~ <br />° : _ ~ a - it E/ 6AE <br />iM'FLUEAT GROSS YALUF ~`~'~ ~#' '~'~~'~ , <br />; <br />' -. ~ <br />>~1< <br />` CG/[ IECNlb <br /> ;~ . <br />UIL AND GAEA$E SAMPLE auat a ~0o>at4 n00~Yfa a~00t ( 75) <br /> <br />MEASUREMENT <br />~,~~ O <br />U.i~U[ 1 U U ~-~' 9a1>rjOOlp' Xa. .>m •a,~M _ ;. ;~; <br />.~ t'!1'[ [1I'• <br />EFFLUENT GAGSS YALU n, ~~; , ,>.x r ~i~~_ °~-'-~ R>o3o ~~ ~ r J <br />` CG/I '- 6EN1 <br />FLOP, IN CONDUIT 06 SAMPLE 1 03) +CO OC allDaa 0 1009a <br />~ ~ <br />/ <br />~ <br />T[1RU TF EATTlENT ALAN MEASUREMENT , O I 6 I • 0 6 ~ ~ <br />SOUSU 1 U 1 ~° ~ ~.- a~ssos ~~ M o>ta ~Gi4 ~'. Mb7A <br />EFFLUENT GROSS YALUF ~~" ~'~~ ~,~ ~ ~ ~.. _ ~` FGD k'~ <br />'` - <br />~ <br /> ~ -, <br />SUL2US, TOTAL SAMPLE aC4aYJri Caaa#a >4aoaols a G ~ 0 3 3~v <br />. ' 14) D I ~ <br />DIS5GLY£D MEASUREMENT A . ~7~~ <br />7U29S 1 U 0 x,~ ~~ ~K ~ ~ tAa ?Ea ss i. <br />G ``?~~ <br />~ ~'- `~} <br />~ !>f:6`: <br />EFFLUENT GAOS5 YALU ~"s'~~ <br />~* . <br />~s~~r: it#a <br />{ ' ~'G~~~` <br />' <br />2 ' <br />t, <br /> ~ <br />.r <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY"OF <br />AM FAMILIAR WITH THE INFORM tAW THAT I HAVE PERSONALLY EXAMINED AND <br />A71CJtpSUU~ BBMITIED HEREIN; AND BASED ON MV T . PHONE . DATE <br /> INQUIRY OF TNOSE INDIVIDUAL S IMMEDfA7ELV RESPONSIBLE FOP OBTAINING " <br /> THE INFORMATION, I BELIEV E THE 'SUBMITTED INFORMATION IS TRUE. <br /> ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMITTIN I AM AWARE THAT THERE ARE SIGNIFICAM <br />G FALSE INFORMATION <br />INCLUDING THE ' <br />~ <br />~ <br />'] <br /> , <br />U <br />S - <br />, <br />` " <br />" D~ ~1 <br /> POSSIBILITY OF FINE AND IMPR ISONMENT. SEE 10 U.S.C. 4 t00t AND 33 <br />. <br />.G. SIGNATURE OF PAIN PAL EXECUTIVE <br /> <br />TYPED OR PRINTED § t319 (Penetties antler these <br />maximum impnsonmenrol0efwee stem(es mey rnclutle lines up ro E1ll,OW entl or <br />n6monlhs entl5yeers.) OFFICER OR Al1T OR12AD AGENT <br />COO <br />NUMB.F.R.,; " <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachments Here) { <br />T55 LLM2T YILL HE AAIYFD"AND 56TTLEAHLE Sp1705 LIYIT APPLIED FOA <+ldt1,24HA PAECIE EYFY7'~:" S"C <br />StiTTLEAbLE SOLIDS Lll!22 YAZYED FGII >IOTR,Z4AA PBECIf EVENT SUBd[CT TG fiU1DEN OF CF.CGF II ~T. C72 E <br />c u r ~n r •.~ r _ <br />PA ForiR 33x0!( ~(OB 95) PTeyious gditipns mayno be used' -:;'a (REP. CES `EPA~OA~M T-40 W~yIC~H MYAY NOT BE USED.) ~ D D8•~~ ~9 Q ~ a ~ ~~3 ~ ,"-.: PAGE 1 OF; y <br />