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PERMITTEE NAME/ADDRESS pncluJe Paahrv Name/Location i/DiQeremJ <br />NAME <br />1'h'APP6'A I"IAIhC, ]NC. <br />ADDRESSLRAPPhh LINE <br />i'.G. bGY Id/ <br />FACILIIYCHAIG CCi UlbiC <br />LOCATION <br />A TT'Nr W_ (.L/M.'1)l A LF7F FS- DkF°: /f. 4'Is !!f.R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR~ <br />(246) (Il~ 9f <br />" t <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM O C 4 G 70 E - <br />(2421) (2223) (24-25) (26211 (1e-29) p0'31J <br />Form Approved. <br />OMB No. 2040-0004 <br />r I li C F Approval expires OS-31-9R <br />(SU}:F h~) <br />F - fINfI rLr~: <br />FGNC {~ 7C Mt~7 LCi[FFL CLi(: <br />'}'~~ I~C L1GChAFCE ! ~ too <br />NOT .Read Instructions be(o plating this form. <br /> (3 Cerd Ony) QUANTITY OR LOADING (4 Cerd Only) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4653) (5461) (38-45) (46.53) (54-81) EX OF TYPE <br />(32-37J AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(6afisi ANALYSIS <br />(84-BB) <br />69-70 <br />!? SAMPLE L''~r K+'i `: ;~ C ~? O ;~ C: >r J L ~' ;- ;; <br />( 1.1 <br /> MEASUREMENT <br />ouGU 1 o C PBF§MIT ~1ry+{a+F +{satia# ~ sK:. ,5 ~atmal~ .D -5 E1ffiL 7.ITD <br />.F FLUi:~'t' GNOSS YALLE A~U18klrAENT KKr:~ kI tU!! ~ ,s <br />.:ULillS, SETTLEA9LF. SAMPLE :K;~.~•r-= =cxK=-~~ k%~.~-}~ <br />~ 1 :`) <br /> MEASUREMENT ~ ' <br />U,US 1 J C "Pita 1T ° f~IR9~PAl" 4a t~aOS IC L ,5 "C C#/ . fiAF <br />_FFLUEK",' GK055 VALLt R6Catl19 MENT dh ir'rY ' KL~=C h <br />i1L ANL V:i.'.A57L• SAMPLE ••'.+?r#x}:= ':+:'-'•'J3:E i Ti-}'?G'.' v{" %_: ( IS) <br /> MEASUREMENT <br />j,rz I u c r.ExtMq ozrs!.>a,¢a ax~>{~a~ as+. n ~z +eaa~r p <br />~~ <br />~ ~f~Ili illE <br />~kkLUF!+'C GPCSS VALGE ~~~!~~JREMENT ~ K:rt <br />+ '~ <br />L~., IS CG4ULli CF SAMPLE j~ Cj) <br />1 ++;j •• •+• ;•=:KKKx <br />r' h U T ., A T I') t i•'I E' 1 ~ 117 MEASUREMENT ~ <br />UG~U 1 U C f/~9MIT HPPQ~T ~ C6'Y t# o~ >~7~~xArt3 >{Of#+4.?~ %: #!f <br />I7' !!STAN <br />-Fk'LUEYT GNGS? VAILE 'A~pt~1fRL~tEk1T 8 ?G U fl = rCC '" asK • <br />GLIDS, TGTAL SAMPLE K=~'}K.a~ OK[=::>'~ ,1 Kt~K:;': ( IS) <br />LSSOLYED MEASUREMENT U <br />~29~ 1 U G ,z; ~' ;~?ftrrtp Kr,Y ao0C1{o FTICi!AL hEf< ~ 7 fiAE <br />}' LUEMT GBUSS YALGE ~.~. `~ ;~ 'r`k?~ '~ '' • b G 6 <br />1L AND Gbh1SE SAMPLE ~~'~~~ I ~+H) +- ~> -'• K :''%= ~>: <''+iF {r <br />I S U A L M6ASUREMENT <br />4Cbb 1 U G •'" <br />~ ' k ,#?IF~!iV:-~ F$F I E°_=1 o80q>ZA o>059~9 q%ItY(a{1M?. ;~ <br />~ i1(If ISGAL <br />FFLUENI GH059 VALDE ~ "-~'~• ~ •~ !! ~ AC=G ~ ~~ OtE ~ <br />•~ . <br /> SAMPLE <br /> MEASUREMENT <br /> ~ , <br /> R~ufiEf1T <br />REfII)I <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF UW THAT I HAVE PERSO NALLY EXAMINED AND TELEPHONE DATE <br />AM FAMILIAR WITH THE INFORM ATION SUBMITTED HERE IN; AND BASED ON MV <br />INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION, 1 BELIEV E THE SUBMITTED INFORMATION IS TRUE, ~ ~ <br /> <br />W. Gordon Peters ACCURATE AND COMPLETE. <br />PENALTIES FOfl SUBMITTIN <br />I AM AWARE THAT THERE ARE SIGNIFICANT <br />G FALSE INFORMATION <br />INCLUDING THE , <br />970-624-4401 <br />00 <br />~] <br />25 <br />President/General Mana eT POSSIBILITY OF FINE AND IMPR <br />IPenallies under these s <br />§ 131 B , <br />ISONMENT. SEE IB U.S.C.§1001 AND 33 U.S.C. <br />tables ma <br />inclutle tines u <br />ro 510 <br />000 entl <br />r GNATURE OF PRI IPAL E%ECUTIVE <br />. <br />y <br />p <br />, <br />o <br />TYPED OR PRINTED maximum impnspnment of batween6months antl5yeers.J OFFICER OR AUTHORIZED AGENT A <br />NUMBER <br />YEAR <br />MO <br />DAY <br />GOMMrN 1 a nrvu v.rLpnNl lurv ur HrvT vluu~l Iurva (narerence ea aRacnmanrs tiara) <br />;~TTLLt,ELE SOLIGS lI'1T SAY BE MAIVEG FOA >10Y6,24th H:.FCiE F4E^~I - "tF ALT(nAATE 11rI1F'(EC!` L'lLEF <br />I.A•1.:;, AI:G ALSO EUFtEY GF PROGf REQULkEME6T5 UNCfir I.i.l. GIL e ~:F.tr,F. - :Et: I.L.1.IC). .Cc <br />p orm ~ 1 (08.95) ~revi0 s etlitio m y no be use ~ (R A T H C A bT ~~~ $ ~~ - `' " ~ _ PAGE t OF 11 <br />