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PERMITTEE NAME/ADDRESS (1Mr4FrWryNwWlocrla. dONa.vl <br />NAME Ttink r~~ '~[•(;~ _• <br />ADDRESS T u F. E' t F, ~ I ~. <br />CrikI.; CO il;2b <br />FACILITY <br />LOCATION <br />C?;.: 4. GGb^iJ:• F.'.T^FF~, ,l~:t~/Gr,t! .".:%i <br />NATIONAL POLLUTMT dSCHMOE EDMINATION SYSTEM /NPDES) <br />DISCHARGE MONITORNVG REPORT IOMRI <br />7-161 17-191 <br />L^OOJ2115 Cli A <br />PERMIT NUMBER DISCNMOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM ~ ~ TO ..' ' . <br />l20-211 l12-231 121-151 /16271 128-291 /36311 <br />Fonn Approved. <br />T ^. ', C T C i E E q ;'J LC4Mg No. zo40-oooa <br />( i i F F P '~) APProvellexP~rgg~05-31-98 <br />F - FI~AI. <br />"INCF <br />NOTE: Reed Metruetldr befor eo pletin0 this form. <br />PARAMETER l3 Card OnlYl QUANTITY OR LOADING l1 Grd On/Yl QUANTITY OR CONCENTRATION <br />- NO, mEGUENCr SAMPLE <br /> 10653 !5461 138-151 11653 <br />151-6/ E OF <br />131-371 <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS X <br /> <br />ls2~eJ <br />MuYSts <br />!84881 TYPE <br /> <br />(69-701 <br />.~. l,S:. SAMPLE .'y Yi 3G? ( 94) ri9COLK ^, :: r, :~:}s Ct.:'y Y,rY,: <br />::;UAL MEASUREMENT <br />'v~Gli 1 0 0 PERMIT.... ..~~'+:rC,.t- ItEPCsRS ~ Ei=1 ~4OE7.fi?8 DrICL>k~h. ~ ~ ~4':'?}#ki. ..C;rfi <br /> <br />E"' LY <br />Gd •- <br />.yI <br />YI 1A1 <br />,rFLUF.hi GROSS 61.L(I ..REQUIREMENT .... I!/fiT.tlAX NC=O 1t,$ay# <br /> SAMPLE <br /> MEASUREMENT <br /> .~.~. P RMIT.:.::. :.i, .:: ....~.. ., ~.:., ~ .. <br /> NEQUIREMENT~ :~~~- ~ ~ ~ ~ ~~~ ~ ~~ <br /> SAMPLE <br /> MEASVREMENT <br /> z~:.::PERMIT . <br /> AEQ(IIREMENT <br />~~~~ ~ ~ ~ .. ~. <br /> SRMPLE <br /> MEASUREMENT C//J~ <br /> ... PERMIT ~ <br />~ ~ :~ <br />kS'~~~ - - ~ - <br /> AEQUIREMENT : <br />~~~ ~ _ <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMLT':~~.. ~~~ ~. . .. .. <br />~ .. ...~. .. .... :~:, <br /> REQUIREMENT: . ... ... ....:. .. ... <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> 'REQUIREM.ENT' . ~ ~ , <br />NAME/T1TLE PRINCIPAL EXECUTNE OFFICER I cERTI <br />AM FA fv UNDER PENUTY OF uw TNAT I NAVE PERSONULY E%AMINED MD <br />MILIM VATN THE EiFOAMATON SIIEMITTED HEREIN; MD EASED ON TELEPHONE DATE <br /> <br />MY INGVIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMA710N, I BELIEVE THE SUBMITTED INFORMATION IS "' <br />~~ IJ ~ `/ <br />(i /e~_ <br /> <br />44 <br /> <br />8 <br /> <br />W. Gordon Peters <br />gGNEFICMI~PENALTIIES fOR SUBMITTING FALSE IrIFORMATION <br />INCLUDdG g70-824- <br />U 9 4 28 <br />President /General Manager . <br />THE POSSIEILITY OF FNE MD IMPRISONMENT. BEE 1• U.S.C. ! 1001 MD 3] <br />E 17te <br />P <br />V <br />S <br />C <br />l <br />Y BKiNATUNE OF PIIiNCRAL EXECUTNE <br /> . ( <br />NNA <br />. <br />. <br />. <br />,. MMr Mr abNN. mrY <br />cA.1. lnrr w ro i 10,000 <br />' <br />TYPED OR PRMITED rNnnrrNe.e inp, <br />rmwrr a/errrwn s.nmeu rMS renal OFflCER OR AUTNORIIED AGENT CODE NtIMf1ER VEAR MO DAV <br />{.Vmmo.. ~ nnv cnrcnnn nvn yr n vin nvn~ In..ov.G• w. s ucnnnn.a nvra/ <br />:o~ E TOTAL IT+i>h LL`:IT~ .II LL bf. NAIV: u, Attu :iFTTLE A3LF. 3~L IL5 iit'12 AFFLIFC FCF <=lOYkr: 4tlN PF'CTF .CV::NT- <br />_:.~ BUNDE4-OF I'fiOOF_FE';U1FtE`f4.t:T~ ':vDc:N I.A.3. .DS COt+ITOFTNG - I.P.3. nIi E C:FE45~ - SF,E I.E.I. (U), <br />mey <br />OO11C/971211-:64t <br /> <br />~~; <br />