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PERMITTEE NAME/ADDRESS (lnelude Fadliry Nmnr/laadoe ybl$erm!) <br />1 NAME I;LUY .'.UUpCdIN ct<FNGY, IN~. <br />" ADDRESSD E'S E:k ADU !LIRE <br />` 36U7 :;JUNTY >iUAD 6S <br />I FACILITY RAk.,LY CO 97GJ3 <br />j LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDESJ Form APPIOVad. <br />DISCHARGE MONITORING REPORT (DMA) OMB No. 2040-0004 <br /> t!Ih.)t: <br /> (SUNK NW) <br />PERMIT NUMBER wscH ENUMBER r- F • 4 A L <br /> . <br /> M 1 RING PERIOD ~-•''•A~~" :'°FATMF,RT PLnNT <br /> Y MO DAY' ~ " ~`;= YEAR MO DAY _ <br />FROM 1 06 O1 ~ _ O1 ''"1 c• 30 ':4;: x'i _ UfiCHAt?GF. 'f^F~ <br /> <br /> <br /> <br />Rd1.AA <br />PARAMETER <br />r17D, 5-DAY <br />(1U DEG. L') <br />DJ31U :, u u <br />r!PM AEU/INFLUENT <br />°7D, S-UAY <br />(lU UES. C) <br />UJ'31J 1 J O <br />::FFLU~'hT 6RU55 YALU <br />~;iLIDS, TOTAL <br />iUSPk;NPi::~ <br />UUS3J :, U O <br />lii~w ScA/IDIFLdENT <br />SJLIDii, TOTAL <br />~5;157ENi'~EU <br />UU~3U 1 U ~' ~O <br />i.FFLUENT GR~S YALU <br />F'L'3a, IN CUBpUIT Uk <br />f~~~tU T[?EA'FM~tIT PLAN <br />S~UbU 1 0 U <br />::F~LUe~r Gkoss vALu <br /> <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. cREOUEn/c .SAMPLE. <br /> EX of TYPE <br /> AVERAGE MAXIMUM U. INIMUM AVERAGE MAXIMUM UNITS ANAtys/S <br />SAMPLE r-c a;ra;: :x •F41v 044P714 ( 1'') <br />iSUREMENT ~ 3 OC/ 7 3 Ov ~ / ~jr~j <br /> <br /> <br />... tom. ~ - <br />_ " <br />" <br />" : -_ ; . ~ <br />... <br />" m,-,.~ he <br />., -. ~. <br />SAMPLE : ~:~. <br />... <br />4 :.sr,` <br />„~ C4. <br />« 3 ( L T) <br />O / <br />/ <br />\SUREMENT G 3 ~ ~ G~ <br /> r <br />S:t <br /> ~ , <br />f.~ <br />... <br />. <br />- <br />SAMPLE ... .., r. :Ce~V M1 Yrr y,: rf d+k <br />~ <br />r ( ~) <br />1 ~ <br />r <br />~ <br />~SUREMENT ._~U <br />~ 3U~U O ~v sr4{ <br /> " ,x ;:' <br /> <br />... 5. r ._ ~. _ .t~ ~. -z .G L ~_ <br />SAMPLE ,..-.~:p; r.: :'r ;~v!: .. Ya : r.: q <br />( 1 ) <br />~ <br />\SUREMENT ~ ~~ U ~' <br /> <br />. ~9y. <br /> ~.~.~ , 17 G <br />.:, :++ <br />SAMPLE O <br />UU~ <br />~ O~ )t <br />O ( !%7} bR'f n{; ~; .:;;::: ;: ,gGrn;: ;4 ~ ~~ <br />1SUREMENT . <br />, o <br />, J <br /> i~t ~'. ~. ~~.~ <br /> <br />SAMPLE <br />,~~ ~o~..~.~r <br />SAMPLE <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFCER ICendy under penalty of law Nat thle documem end Ul ettectmeMS were TELEPHONE DATE <br />y} -i y, prepared Mtler my tlirectlon or superviyron in accordance wah a rystem tlesignetl <br />WGr N S 1 ~ / to assure that qudifietl perwnnel pn~peilygether end evaWate the Inbrmatim <br />SLL <br />',~ <br />/ ( <br />aubma[etl. Basetl on my nqulry d the pemon a pereoro who meruge Na eyatem, - <br />or Noee <br />psoru dheca <br />rea <br />Onaible br <br />Nherin <br />me 1MOrmeuon <br />the Inbrtnetion <br />~ ,' <br />g <br />g <br />, <br />I_ r i v <br />yt~, <br />p <br />y <br />P <br />l <br />l <br />l ~~ ~ <br />y Z ~ <br />eubmlmstl <br />e , to the best d my knaw <br />etlge end belief, true, accurate, eM comp <br />ete. SIGNATURE OF PRINCIPAL EXECUTIVE I . <br />7 - / O 7 . <br />s <br />TYPED OR PRINTED Lam aware Naz mere era signalcam peneltles br submining false lnbnnatlon, <br />Ircludirw Ne Possibility d fine end ImorisonmeM br knowlnP violations. OFFICER Ofl AUTHORIZED AGENT <br />[:ODE NUMBER YEAR MO DAY <br />^.OMMFNTR ANO F%PI ANATION OF ANV VIOL ATIONS /Rarwmnew a// aHachmanta haral <br />Ir~FLJ~NT SA"IPLHS RUST ."•~ ;:OLLEC"b'~, 4vr.LYZ[.[? L H.•;PO!iTFJ CONTHLY kE;AkDLES:~ ~F "~fIET.H~'R A9 EPILUENP <br />~IS:,HAHGt UCCURS. <br />EPA ForT 3320.1 (REV 3/99) Previous editions may be used. ., T I5 Ig A 4-PART FORM PAGE OF <br />~.,,,,~:-_-____LL. ~. __., 00725/00071'r-1350 1 <br />