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PERMITTEE NAME/ADDRESS Qnclude Facihrv Namelhocation iJDiBerenq <br />NAME <br />TkdFFik [:INIhC, INC. <br />ADDRESSf HAFFtk .'~IkE <br />Y.C. yGX ltt/ <br />FAGUTYCnAIG CG N1E26 <br />LOCATION <br />a ?'TNT r.rpnn% rP~ac< PRC~~[:S- nr`u <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR; OMD NO. 2040.0004 <br />R-1s~ (17- e) M I N C b Approval expires 05-31-9R <br />PERMIT NUMBER DISCHARGE NUMBER (~ U E n A M) c <br />F - FIAl1 d..Fal <br />MONITORING PERIOD CI °C kA EC: TC CC7C"7E CLICF <br />YEAR MO DAY YEAR MO DAY <br />FROM OC CE UI TO CC E 3C rtar; !.C iI`CFAFCE ~~ ~ t;~ <br />(z0"zr) (z2-z3) (za~zs~ (zs_zzl !ze z9! (3a3t) NOTE: Read Instructions befor c mpleting this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Cerd Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4B-53) (s4-si) (98-45) !<s-53) (Sf-6 t) EX of TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(62G]1 ANALYSIS <br />(64-68) <br />69-70 <br />F`I SAMPLE :+'Y`-}r: ;~ ~+C'.:4X~4 rtartv..: 1 ls) <br /> MEASUREMENT <br />L'NUJ 1 1 L 9EH T 0~4i4?DtY .>a,Ir4~p+PV'~ tai E.5 a+e~-;>a4a 5v5 ,E~~iY-~ -IISITL <br />EEELU~~T CkCSE YALLE A~D~ENF ;eta x2-ICU[ lcAf !G[ .C <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> - ~ ~ ~ <br /> R~(jIUIREMENT .. - .. ~ ~ <br /> SAMPLE ~ <br /> MEASUREMENT / <br /> - R}~I1T ~ - <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT L <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> - ..:JS ,11,,,,,,~',- <br />~ <br />A <br />r <br />~ ,i:: ~ a - ,,~ <br />_ r <br />. <br /> pn <br />a <br />7 r ' r <br /> SAMPLE <br /> MEASUREMENT <br /> f~ ~.', 1 <br />~ <br /> n ~p .~! <br />fIP1Y~EN! <br />'. Y y ~ <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT - <br /> REpWR~MENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERnFV UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY EXAMINED AND <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MV TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING // <br /> <br />~. Gordon Peters THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE. <br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />TI <br />MITPNG F <br />LSE INFORMATION <br />INCLUDING THE <br />F <br />R ~ L 970-824-4401 Q~ 0~ ~'_ <br />PraBident/General Manager PENAL <br />SUB <br />A <br />. <br />ES <br />O <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 10 U.SC. § 1001 ANO 33 U S.C. <br />i <br />li <br />l <br />tl <br />510 <br />000 <br />d SIGNATURE OF pRINCIPAL E%ECUTIVE <br /> <br />TYPED OR PRINTED nes up ro <br />en <br />ar <br />4 13t 9. (Penetties untler !hate stetules mey <br />nc <br />u <br />e <br />, <br />marlmum impn'srnmerrt albeMeen 6monfhs entl5ysers) OFFICER OR AUTHORIZED AGENT A <br />C <br />NUMBER <br />YEAR <br />MO <br />DAY <br />f <br />,1 <br />V.~. <br />~`1' <br />COMMENTS AND EXPLANAI ION OF ANY VwlanoNS (Hererence en atracnmenrs here/ <br />:S~ O 7G'IAL IFCN LIiITS ii1CL FF XALVEU, AAC 5ETTLFAH`_1 ~CCICL IIC/1 AFFLiIL' FCF <=1CYF,~4rF =FEC1[ EYE91- <br />.>Cc, cUL•'~c:i+ OF FBCCf Fk4UIhEhENTS CNCEk I.A.Q. FEE!'ITTEc i"L'ET TARE ALL FEF~'CiA:`Lf "Er~CFEI TL lECCCE Ek <br />E orm ~ O.7 ) r vlous i Ions may nol ~e us ' (REPUI S E /C KAY-40 ~ ICH SED. ~ - ~ J ~ ` <br />: L' <br />CCC!7~/Ci:Cl:1-iF / <br />p GE I 0 <br /> . <br /> <br />