Laserfiche WebLink
PERMITTEE NAME/ADDRESS (/ndude FociGn~Name/Location ijDiJjrrem) <br />NAME <br />ADDRESSTnAF~FtR +"IhIhG" ]FiC• <br />tiAFk=.fi tIhE <br />L.~. bCY. 1P7 <br />FACILITY (~N.AIi, CU d1L[L <br />LOCATION <br />A'1.1'hr ~_ t_n~. r~r +; cF~TG t;~ cw cs ir. a•A nr. ti~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDEB) Form Approved. <br />DISCHARGE MONITORING REPORT (OMRI OMB No. 2040-0004 <br />tz-1s) rn-isl k I NG !+ Approval expires 05-31-98 <br />PERMI7 NUMBER DISCHARGE NUMBER F S ~ E! 7) A I f C •` : I <br />MONITORING PERIOD F C h L i t 7 C U 1 k l L 1 C t <br />YEAR MO DAY YEAR MO DAY <br />FROM CU O1 70 OC t 3C '.~~*'' HC. L1LCf:AFCk ~'~~ <br />tzo-zr) (zaz31 (z<-z5) (zssrl tzs~zsl t3a3p NOTE: Read Instructions befo~ 'pleting this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-6/) (38-45) (46-53) (54-67) EX OF TYPE <br />(3Z-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />rszc3l ANaLV51s <br />(s4-69) <br />89-70j <br />'IL AKI: Gr,r.ASt SAMPLE '+~~~+~ ( 9U) a>utOt '~~~+v ~ =)z :~++ <br />L S U A L MEASUREMENT <br />.!UUbb 1 U U 1iEgt+FFT ~-g4:04+C! '!$ttlF4:... I_=1 Og40~0 ~~O+t+60~ -"+DO.AF>cq.t1 L< --; flfil ISC~L <br />'FFLUtuT UttCS~ VALUk .R~ IiIR~MENT Y..' '' 1C=0 ~='f <br /> SAMPLE <br /> MEASUREMENT ~, <br /> <br /> <br /> <br /> SAMPLE / In <br /> MEASUREMENT u~ <br /> f3$ , MENT , ' <br /> SAMPLE 5 <br /> MEASUREMENT <br /> t <br /> ~_. ENT ' <br /> '-:i <br />- <br /> SAMPLE <br /> MEASUREMENT <br /> t , -r4 - - <br /> I i `4' '{'3 <br /> SAMPLE <br /> MEASUREMENT <br /> {('-.:•- Yi ~ ` ' t ~ 3~~1. <br />~ A "~.+. r~. i <br />~ ~.. s Yid ~ > -.S ~ r'}@ , <br /> -1 ;1" A i ~A <br />~. ail -~-~ ~)w <br /> t ~ S i} :k <br /> SAMPLE <br /> MEASUREMENT <br /> FEW~ IIT I ~ <br />' r8: , <br /> 1~~QtilR $MENT ,. <br />; <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERS <br />ATION SUBMITTED HER ONALLY E%AMINEO AND <br />EIN: AND BASED ON MV TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING <br />/~ <br />W. Gordon Peters THE INFORMATION, I BELIEV <br />ACCURATE AND COMPLETE. <br />T <br />FO <br />UBM <br />TTIN E THE SUBMITTED IN <br />I AM AWARE THAT TH <br />G FALSE <br />NFORMATI FORMATION IS TRUE, <br />ERE ARE SIGNIFICANT <br />ON <br />INCLUDING THE ~ / <br />~"~+ ~ 970-824-4401 00 07 25 <br />President/General Manager , <br />q S <br />I <br />I <br />PENAL <br />IES <br />POSSIBILITY OF FlNE AND IMPRISONMENT. SEE IB U.S.C.41001 AN033 U.S.C. <br />a00 tma a <br />t <br />E10 SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED o <br />, <br />r <br />~s up <br />mnximuml~mpdsonmenl orl belwaen BmoMhcYOndS yeers OFFICER OR AUTHORRED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . oD <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a!l attachments here) <br />x~5 6 1CfAL lAGh iI!ITS SILL dk >,A1VED~ AhL' ~ETTLEAELE SCLILS LI1!Il ALILIFL' FC4 <=1CYF,~uF6 IcfCIF k4khi- <br />Sk.E flL'ttU`Lh OF FFCGF Rf(~tiTR$hEtl15 UNDEP I.A.3. TD_° i!CFI1GhTAG - l.I..~. CII E GFE;-? - _~F I,;.,7,IC), <br />evTous eHiGbTl~rill]y RbF~i:--Used- - -- - _(REPLACESEPA FORMT4.0 WHICfiMAY NOT BEU5ED.) PAGE _ OF <br />