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PERMITTEE NAME/ADDRESS (/nclude Faciliry Nnmr/[ocanbn i/O fferenq <br />NAME ~..(P: ~~ v,+Y7A ~r}ILSY CC.tL CGSF'. <br />ADDRESShT G°:; 1,GS1 SU!I;H, E ,.C K'1A!1 ?K <br />ylUV =ACT ryl'iFkbl CIItCLi <br />ENGLEM^OD CO iU1S`: <br />FACILITY <br />LOCATION <br />CTK: ,:Ok!!IS Y. 31;GLtY, G;.N~RAL ATNY <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPDES) Form Approved. -.~ <br />DISCHARGE MONITORING REPORT (DMR; OMB No. 2040-000~'r•~ <br />Iz tsl Il r 91 ~ A J 0 k Approval expues OS'q <br />('00077154 UO~r A (SURE :iW) <br />PERMITNUMBER DISCHARGE NUMBER v _ }•TgpL <br />MONITORING PERIOD (".I :r 6' 1, F 0 N G L' T O FO I G E L CFI. <br />YEAR MO DAY YEAR MO DAY <br />FROM t'L' V/ V1 TO uU ur 1 ##'•' NO CISCHAHGE ~ _( ### <br />(zo-zll (zazal (za-zsl R5~zr1 Ize~zsl Taaap NOTE: Read Instructions before completing This Corm. <br /> f3 CaN Only) QUANTITY OR LOADING (4 Card Only) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-61J (38-45) (46-53) (54-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />fsz gal ANALYSIS <br />(64-68) <br />&9-7D <br />L'itJN SAMPLE #7#3## ####r~'k #?###+b ( 79 <br />) <br />Q <br />3/ <br />C <br />~ <br />~ <br />~::'fAL RCCOYBRAALE MEASUREMENT Q,157 Q"~.~~ J) ] <br />IUU 1 0 0 rPEF-1MIT.- ~ IROliItrFCr $ 4E71~I! <br />A #.'+-A M~>DIQ~~'' ~s0 A$FQ~+}:' ~ F!AL''t,f p <br />iHAp . <br />- <br />~' Ur.3T GRU55 YALOE REQUIREMENT <br /> <br />,.... <br />I. tip y <br />~r r+,t <br />f^.7 ~ .~•- CO## <br /> <br />~ ~Oj)jr ~~y~} <br /> <br />.. <br />~'1~ ~r y~ <br />-~*1^~~~#e. ,~~ (wG <br />/L <br />FFONTXI' <br />~~.LVEk, POTENTI ALLT SAMPLE 4#q;;;:+t alROt.44 ')`ak A'#yt¢ ( 19 <br />) <br />~ <br />rt55'JLY L•D MEASUREMENT ~0"~~~ LQtQQ~ ~ ~ /3) <br />' Cj R~B <br />II jUt! 1 U U iL ` ER IA{'r-' 4<a~ .~ A¢x3 - - ~>R ^.-_ <br />~ <br />~ 4Lt0 q i r ;- s~, <br />"J -~ ~ ~~" F}-", ^i 'r ~~$$/ -RAPS, <br />i:FFLUF,NT CROS5 YALUE R OUIREMENJ; i ~ - - e;~ <br />.' <br />~ <br />. o#4a , <br />~`. ). '~ , +" ~ ''~"'~~G l1G/L :~'*," ~ ~f)`e, - <br />C(~PPLeA• POTENTIALLY <br />Y SAMPLE <br />ME <br />URE <br />ENT ''+"i°'''~` ~9'a~/F# rX;IR#i`O <br />~~rQ~S AA <br />~V•QQ~ { 19) <br />D <br />~~31 <br />~~~~ <br />a!:S=OL <br />ED AS <br />M <br />V <br />J LJUb 1 0 0 ~~ E <br />. <br />MIT OG+R IP4t+~ - >a ,aP n;e~ *191044Yf,; QyI L) 3 -::- ~ •~, <br />' trx 'T dHEE/I :kR$ <br />•^c•LU(;i(T GRO:iS YALUE , <br />~REQ REMENT ~' t•Rt':~# , <br />- :.. : .~(FIF1r.~~. .. ~- <br />.~~d~~~Yi:~, 'AFT= FtG/L . HONTIf <br />'.;NGANpSE, TOTAL <br />I SAMPLE <br />EM 'r""``fi'" "`#~O`'`# ##~`##~ <br />Q <br />~~'3 p <br />Q IS <br />Q { 19) <br />Q <br />~7 <br />:.COY EH A6LE., MEASUR <br />ENT r . <br />1111.1 1 0 ';V ::HERMIT AxcTaxaav 's~ma~ '~ ### ra:Y.o ~ REPORT RSF~BY Y EEKLYI 'RA8 <br />ci`FiUea:T GR{t5 Y"IUf: REQUIREMENT - ~ I.+#FSr ~ JOOA AMfr. DAIL2 bx, "G/L <br />":.O.f, LN C(T'~OUIT JF. SAMPLE y~/ <br />O <br />~{ <br />IO Il <br />~ ( 03) #4;. X:q# '•###~>:=` ::#>;+~7 ^•+` <br />`i `: nU 1'H t:ATI{~BNT PlA NT MEASUREMENT / <br />E r ~"`~T O ~/.u r/IF"I <br />rUO~U 1 ~ V :-PERMIT REPOIT` R6PAR ~~„ 'a ~>q~"' *~tP- i} >pi -. trod ~E%LY~ ;N3TA5 <br />6OFLOENT GROSS YALUE REQUIREMENT - <br />3tlUA AY6 DRIB.? ~ CGD ~ ~« '' <br />e "'''~"'~' ~°,` troo# „ <br />~- ? <br />~lL Atl9 GHGAS L• SAMPLE ~'#'~'`'`# ( 9Q) XrY/4O9o t4orfC# otrz+09r - y~ <br />Y 15 7 A L MEASUREMENT O Q ry <br />/ ry Visu~ <br />S4Jbb 1 U O PERMIT: '' -'a'~~`u~ 9. :~`'"1 E5=1 ~ •>:Ilr, '','~~~ .'~+ ~ ~~~ ,'"~=9 1;ERLY' ISUAL <br />-'Y''•-LUEhT GRO55 YALUE REOUIREMENT~ , ~ IliS! RA')C;~ NO=O ~ ;~ #+'•%' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - .. , . ~ - ~ - - ~ , - <br /> REQUIREMENT - ' <br />NAME/R7LE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY E%AMINED AND <br />ATION SUBMITTED HEREIN; AND eA6ED ON MY TELEPHONE DATE <br />Richard Mills INOUIRYOFTHOSEINDIVIDUALSIMMEDIATELYRESPONSIBLEFOROBTAINING <br />THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br /> <br />l M ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />FOR SUBMITT <br />NG FALSE INFORMATION <br />INCLUDING THE <br />LTI <br />970-870-2712 <br />ana(3er <br />Environmenta , <br />PENA <br />I <br />ES <br />M <br />NM <br />EE <br />C <br />AND <br />S <br />C /y~ ~ ~3 <br /> PRIBO <br />. § 1601 <br />. <br />POBSIBIUTY OF FINE AND I <br />EM. S <br />18 U.S. <br />33 U. <br />l SIGNATURE OF PRINCIPAL EXECUTIVE W <br /> <br />TYPED OR PRINTED utle lines up ro Ef0,660 and or <br />g t3t9. (Perre/ties untler these statutes may n~t <br />mexrmum impnsonmenr of baMeen6nromrts entl5yeers.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOlA710NS (Re/erence all attachments Here) <br />~'fERkP.'Fa LI1"!ITS FOd TSS 5 SETTL°ABI.E SOLIDS (LCC 'O') APPLY ONLY IF <- 10-Y n, 2V-NA PAECIP f.VES1' I~ <br />CLAI!"c:J. Se: e: i.A.2, PG Ili, FO.A aUA~IES 0-r' PFOOF kE~T;TIi+; M,F.NIS. OIL :; GF;EAS£--ti':5 FOOSNOTE F/, FL 2. <br />EPA Form 3320-T (D&95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NO7 BE USED.) V U U 5 (s / 0 U U u ~ 5-15 U 1 PAGE z OF <br /> <br /> <br />