Laserfiche WebLink
PERMIT TE[ NAML/AOORC51 //n((Y(f[ <br />f+nhry Same/Locaron if AI ffeU A L <br />NAME_PU Eta Ll ______________ <br />eoonnB27d SAIiYER DRIYE~SS'ii lA_-_-_ <br />___DULAt:GU ----___ CO d1301 <br />------ <br />Mclurr <br />LOCATION <br />A'fT.l: JAllti:i U HENDftICKS <br />nwnoNAL Po uurwNr DmcH+wDE FLIMmAnon 1vsTaM (.VPDESI <br />DISCHARGE MONITORING REPORT IOSfRJ <br />ar6 rzr9 F - FINAL <br />000036610 OU2Y[AuM SEDI POdD <br />PERMIT NUMBER <br />MONITORING PERIOD <br />YEAR MO OAV YEAR MO OAY <br />FROM TO LyIdQR <br />Imzu 1:.1JI /:dasl rain l~a_91 JJOJU N07E:Readi <br />12 <br />LPL'PA <br />nstructions hefore completing this form. <br /> (3 CRrd Only) OU ANTITY Ofl LOADING IJ CmA Onfyj OU ALITY Oq CONCENTRATION <br />PARAMETER (d6-33) (SL61) (JL43) (d6-SJ) (Sdfi/) NO. F UENCr <br />OF SAMPLE <br /> <br />TYPE <br />(J1-JJ) E ANAL Y515 <br /> AVERAGE MA%IMNM LIMITS MINIMUM AVERAGE MAXIMUM UNIi6 6261) (6J.A$) 164-Jtll <br />d SAMPLE YYYYYY YY YY $•~ $(=$$ik Fn <br /> MEA6UREM ENT <br />I' <br />U4UU 1 U O <br />PERMIT <br />YYYTY~P ,~L <br />#YYYYY Y <br />vYY <br />.5 y. J~A ~y <br />YY!$#~• <br />9.p <br />CEKLY <br />HAH <br />'FFllf1•:NT GfiJSS YALU[? REQUIREMENT -strt MINIHDH HA DH yU <br />OLIDJ <br />TO~r AL ^^Y$$Y$ YYYYYY $.'NPV$+`ns`r <br />P SAMPLE <br />USI'tfYDED MEASUREMENT <br />0~]J 1 U ~ PERMIT ##°#A'# ##$$$# $ Y$ ##~`$?# REP RBPOHT NCE/ RAH <br />YFLUEYT Gii055 VALUE REQUIREMENT y'~Y$n` ~ 3O AVG GAILY HY EIG/L HOHTN <br />'OL11i:i, :iET~."LcA3LE SAMPLE YYYYYY #:$+#r r##$$$ <br /> MEASUREMENT <br />)OS4~ 1 U U PHRYIT "#Y### $+$#%+ # $C ###" # PTIL)tiAL. REPORT dCE/ RAH <br />~PFLUoNT Gd055 VALUE REgUIREMENT $:'$ ~ 3ODA AYG DAILY NY HL/L HUNYN <br /> <br />11L AND VhE <br />A~? <br />YY$.".#~ <br />'rr#+'.ii~ <br />#.`'#2'T#v <br />- __ <br />. <br />. 6AMPLE <br />r1~1:Ui1 EYTR-ll K.4Y dfTR MEASUREMENT <br />'US~6 1 U 0 PERMIT ###$~## r#$# Y "$ir#'r#v P•PIONAL D EEKLY RA8 ~ <br />'F'FLUdNT G3J53 YALUi? REQUIREMENT ~ vv'* UAILY HY INST HY HG/L <br />MO tI, TOTAL ,SAMPLE "nYYYY .N~ <br />T/'r- v$ <br />V rA'VA+AA$yv <br />AS Fd) <br />~ MEAfiy1REM ENT <br />I <br />)IU4J 1 V U <br />,PHRMIT y y <br />YYYYYY y} <br />•T'PYTY$ Y <br />#$ .l~ <br />.YY~'#'~'~ p <br />R4POHT <br />NEPORT <br />NCE/ <br />RAH <br />FFLIIE:dT GROS.i YALUE REOU~ EMENT $;; 30DA AYG DAILY tlY HG/L HON4H <br />IN CONDUIT Olt <br />'LOB YYY#vv ;YvL`#::r $A'Fv'~f #'Ak <br />, SAMPLE <br />'HItU TReAT r,EaIT PLANT M£nSUAEM ENT <br />OUSG 1 0 J Pe YIT REPORT REPORT y$$### t###:3 +•:-4:s$C $#IG EEKLY NSTAd <br />FFLUt:YT GROSS VALUE REQUIREMENT IYST HY GD ###3 <br />l)LIUS, 1O E'AL SAMPLE ./. <br />YYYYYM YYYYYY YYYYYY <br />LS:iOLYED ~L~G/L) MEASUREMENT <br />02J5 1 0 U PERMIT ##;P?C#. >r$$#$$ t ;,$ C$###G ': REPORT REPORT THLY RAH <br />.E'E'LUtiNT GROSS VALUE REQUIREMENT = ~$$ D LY HY IMST HZ tlG L <br />NAME/TITLE PRINCIPAL E%EC UTIVE OFFICER I CERTFY UnDCq PENALTY OF LAW THAI I HAV[ PERSOn ALLY EAwMmCU <br />AMO AM FAMrLl1q WITH THE INIORMA iION iVBMITiED NEREIN AND BASED TELEPHONE D A T E <br /> ON MY INOVIRV OF in05[ iN[SVIDWLS IMMEDIATELY gE5PJN51BLE FOP <br /> OtliAMMG THE INFORM1ilOV r BELICVE TMC SUBMITiCD INf Oglnw llON ~ <br /> <br />15 TRUE ACCVgATE AND COMPLETC I AM wWARC YHA! THERE ARC SIG i~JJ <br />~ <br /> <br />NIFiCANI PENALTIES FOP SV EMITTING FALSE rNFORMAiION WLL VOING ~ <br /> <br />rnL P0551BaRV OF nNF ANV 1MPg150NMENT SEC IB USC 11001 wND <br />]] VSC 1 r]19 .P, no/err uMr, Ihrw rmml.. muv rrlrludr /uv. <br />!n lln //OI <br />IGNATU RE OF PRINCIPAL EXECUTIVE <br />O~ ~y~ QQ///J <br />OO ~tTJ~ <br />t7 <br />~ <br />/O <br />TYPED OF PRINTED uy <br />aM.~. ma ummr m10'L~,nn,.a^/n,manRnn,nlFr an.l i..arr' OFFICER OR AUTHORIZED AGENT AREA <br />NUMSER <br />YEAR <br />MO <br />DAY <br />1-r Ail DISCRAICt;~ OCCURS REPORT NO DISCHARGE. UIL E GREASE NOM 2 PARAH. NO SHEEN: 88066=0, 556=0, A SHEEN: <br />Zt4U6b=1, SSti=GRAB. TSS, SETT. SQL, 6 IRON NO LI8I1' PREPRINTED ON DHRS DDE TU VARIOUS PRECIP. SEE PERHIT <br />PREUIO US EDITION TO BE U6ED En µHIrM M <br />PA Form 332(1-1 (Rev. 7679) IrNT•• c~.nn .. .c -... . ., _~ . IREPL AC ES EPA FORM T- NrT nr ner,~ r <br />