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PERMITTEE NAME/ADDRESS (Include Fucilirc A'ume•Gncnrion i/OrBerenr) <br />NAME <br />ADDRES I'T AFF BF' Y,Ih]fJ6, INC. <br />S1kA4!'E'H f!1hE <br />P..:. ~Gk IU7 <br />FACILITY C :: A I G l (? r l t t E; <br />LOCATION <br />F ': 7-ti: :. .;UdUC6 r'c1FF_ (%:,F3/GEF !?C:R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (OMq; OMB No. 2040-0004 <br />(z-16) m- sI f' I N C n <br />Approval expires OS-31-98 <br />- ` ` (SUEF hfl) <br />PERMIT NUMBER DISCHARGE NUMBER _ F' I A A 1 E C; ,•. 1 <br />MONITORING PERIOD .AC U ~[ E I E 1 I E ~ T I E C F C F C C `_ ? <br />YEAR MO DAY YEAR MO DAY _ <br />FROM UU C4 U] TO CL Ct C r..r,~q Ri; CI:CHlE6E 11 >r*~ <br />l2o~zD Rz~z91 1z4~2s) (zs~zr) (ze-zs! l9oa0 NOTE: Read Instructions befog' c mpleting Ihis form. <br /> (3 Cerd ony) QUANTITY OR LOADING (4 Csrtl Onlyl QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4B-5a) (54-Br) (se-a5) 46-53) (54-st) EX OF TYPE <br />(52-37J AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALrslS <br /> (62.691 (64-88) 69-70 <br />CCU °;; STh;-' 4r}i i, .1CL SAMPLE e^~%'•'Y~:: ,:Gt::~:<;. i}~. ;~:.{.: pyY{;t. ( ~j) <br />C c n I C. v +: 'r t; A L A MEASUREMENT <br />4w l: L u C gEAMYt OA+IO'OQ 4+P##:p+91 # <br />- {~'. Q(` rIRCt#A A009#; -F EF- ~ >tij,,Y EF@ <br />-f'FLUcC.T I: KG _`L YALi:E AEG3rr1~Fi~MEf17 ~ :::'~~ "ISN E " <br />L;-:;G 5'I if ~M1C. 'r(.t6 >CC SAMPLE :i ~: X:q',~':: ;: t, :~;~#D tt q~ v.•'..t~+: ( .,) <br />I ri E k' l i b 1. t: 5 MEASUREMENT <br />r.i.tib(: 1 u U ~ w.~`, b. ," >Q'#gtta0 .# ~:~ ~ <br />p~ #O:G44# A>v#LRb p EF ~~ i~Lt' 6AFt <br />FF'FLCfV'I u:,GSS YPLLE HEA~I t Iti~-i ". icK•c , <br />- <br />~ ~ Y ? EA I <br /> SAMPLE <br /> MEASUREMENT <br /> ~EH IT <br /> tiBG)171 ENT _ <br /> SAMPLE / <br /> MEA <br />UREMENT <br /> S <br />~ , P. <br />` ~ , <br /> MEfFT <br />AEAIi1R } <br /> <br /> SAMPLE ~~ ,1 <br />' <br /> MEASUREME <br />NT ~. <br /> ' , <br /> '7Y. <br />r, ~k~ F'a'il r ''.f ' <br /> SAMPLE <br /> MEASUREMENT <br /> ~h ~'" ~ ~~~ kl' ,; <br /> <br />r~ <br />C <br />~ <br />a <br />h.i, <br /> f. <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br /> 9~ ~Nt <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI <br />AM FAM FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND <br />ILIAR WRH THE INFORMATION SUBMITTED HEREIN: AND BASED ON MV TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I aELIEVE THE SUBMITTED INFORMATION IB TRUE, <br />W. Gordon Peters pENALT~lES AFORC SUBMnTING AFAL EARNFORMATHONE NCLUDINGICTHE ~ <br />~ 970-824-4401 GU 07 25 <br />President/General Mara eL POSSIBILIN OF FINE AND IMPRISONMENT. SEE 13 U S.C 41001 AND 33 U.S.C. <br />3t9 <br />P <br />l <br />Ih <br />l <br />d <br />l <br />l <br />00 <br />tl <br />4 <br />E / <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED . ( <br />ene <br />has un <br />er <br />ese s <br />1 <br />9lutes mey inc <br />ude <br />ines up to <br />10, <br />0 en <br />w <br />menmum rmpnmm»ntol heAVean6maM/as antl 5yeers.J OFFICER OR AUTHORIZED AGENT AR <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> Do <br />COMMENTS ANU tXPLANAI IUN UH ANY VIULAI IUNS (HBTB2nCe a118DBCIlmentS oars) <br />SELr I.A.2, YP 7-9, fCF Gf,IAlLS CF TEST P6CCfCIIaF• FEPCh1 LC `L' - :i',d11L1I!:+i rCIF'i .-:iI':'If MtICh j5 <br />LtYdAL IG SU%: GF IE~t OFiGAtiISKS, AhD ATTACH ACU7E 9GXICITY IFSI nFl~i.'I FCh," IC CPF. CC[:F C! III <br />d o m - `~ - ) r vio edlji ey" s LA P Y BE D.) - " ` ' ` ` ' '- - P GE OF ` <br />