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PERMITTEENAME/ADDRESS (IncladaFatiliryNamd[ararianifOr$erect)
<br />NAME NLUE tl]UNTAIN EVERGS, IN~,
<br />ADDRESSDE$GRADO NINE
<br />~ 36flT CDUN'TT ROAD 65
<br />FACILITY RANGLY CJ B1bYS ~`.'r;`:.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION
<br />DISCHARGE MONITORING REPORT
<br />LOCATION
<br />FROM
<br />ATTN: JEEP DU°;+L92
<br />(NPDESJ Form Approved.
<br />I N U r OMB No. 2040-0004
<br />(SUBR Na,)
<br />DUMBER F - t'IN1L ~~ ~ RbLA1
<br />55-2 SLOT. yx~RAG_. °'7 HF'J uASH
<br />DAY ~ ~.. ~ i,~, '_
<br />Read InstructionsbefOre~mpleting this form.
<br />. QUANTITY OR LOAD QUANTITY OA RATION NO. REOUENC SAMPLE
<br />PARAMETER ~ ~EX OF TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~ ~'~/s
<br />Pii SAMPLE °k •c ;x;:?,`• #:ty •~; ;t .^ ^,:ti:: ~, 12~"
<br /> MEASUREMENT -
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<br />SOLIDS, TOTAL SAMPLE "~`~``~ otaa 50 II ( 14~(
<br />SUSPENDRD MEASUREMENT
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<br />.:FFLUENL GROSS VALU AECIUIPEMEtJT ~.~ . ,
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<br />SOLIDS, SETTLE AHLii SAMPLE ~ •~ 40t rr
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<br /> MEASUREMENT „a
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<br />E F F L U E N T G R QS S VALU ii~OUfREMENt , ..
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<br />O1L E ;,ftEAS? SAMPLE , • ~ ##~R OOtYY## ( 19J
<br /> MEASUREMENT ..
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<br />::FFLUENi GROSS YALU REflUJ,REMENT ,.x:;; •~.
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<br />I3JV, TOTAL SAMPLE .. . • .. : <°r ".
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<br />(A S F X) MEASUREMENT
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<br />EFPLUENP GROSS YALU Riy'~N`f ~` ~ "Y; ,r `" ~ . ,
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<br />f'LJ:I, IN CJNDUIT Ud SAMPLE ( P:) fi:`.#.:.~r,: .:.•,: ~: r; •:k ^b:k rc C; t:
<br />T ti4U TREAT1EIiT PLAN MEASUREMENT
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<br />JIL ANU SREASE SAMPLE C:':g^.'~'•'` ( ~~:~) .'(: :..:#:: ..-. ..-'•:'•: i.:'?
<br />Y L S it A L MEASUREMENT
<br />bJJbh 1 ~ J U ~: ~ °:;;. E5=1 ~#~' "Q~+~0104'.;~ GR#
<br />i:FFLUENT GROSS YALU 1k1T~ ~ ~ f1F. p ~ll;'i ,~U.U `"' ~:_~
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Cediry under penalty of law Nm Ihis document end all attachments were
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<br />/ TELEPHONE DATE
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<br />a SIGNATURE OF PRINCIPAL EXECUTIVE 6 ~ -
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<br />.TYPED OR PRINTED I am aware that (here are signdicant penalties for Submitting tales information,
<br />inclutlin the siblli of tine antl im risonmem for knowi v,olations.
<br />OFFICER OR AUTHORIZED AGENT
<br />A NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />UUMMEN I S ANU t%YLANA I I V N Uh ANY VIULA I IUN5 (HBIeIenCe a// BttaCnment5 ne(e)
<br />r55 i; TOTAL lN7N LIMITS GILL Bc .A:VE;f`, A'iC SETTLEAPLF, 5')LlDS LIf1I": Ai?PLitD FU"r <=l0YR,2~gRP. PR£CIP EVE9T-
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<br />EPA Form 3320.1 (AEV 3/5~ -Frevy6us edtions maybe used. IS gq44PAgT FORM PAGE OF
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