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~ERMIT'fEE NAME/ADDRESS RneL,d. isWryNewdl,orclle,. I/D16irnd NAME TI~AFr%t.n MIT:^, I:IC. ADDRESS T i+.4 i t' E ~ M T +. ~: P.J. ~~'!, 157 fACILITV LOCATION ~T'1'~: d. ,OE;CD'; P?T:5P;, idFCi/L;L:N ~.;~ NATIq/K POLLUTANT dSCNMGE ELIMINATON 4YSTEM /NPDESI DISCHARGE MONITORMG REPOIET lOMRI l1-I61 I7-19/ CO 3 5 Cif p PERMIT NUMBER DISCHNiGE NUMBER MONITORING PERIOD YEAR MO DAV YEAR MO DAV FROM TO !1671) 172-13) tI~-75) 1IB17I 11B-79/ 130-311 Form Approved. CI`CHAFCF TO GPOtA.9'LBk9tl7E8°,foooa (5 U F R t• W) ADProvelle>fp~ra~06.31-98 F - FIHAC NINCF NOTE: Reed Inewctiorr before eompleFinp this lorm. PARAMETER !3 and On/y1 QUANTITY OR LOADING !t Grd Dolt! QUANTITY OR CONCENTRATION ND fRFOUENCY SAMPLE 146531 151-6J1 13B-I5l 116-53 15151! DF /37-371 Ejt ANKYSIs TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 113-6J! !6466) 169-701 I t SAMPLE ::a: fr: I;r LL#fi#~ ~ A•, MEASUREMENT ~J04UU 1 0 i1 PERMIT ~ #19;Y(iift~ .~ ~.O'frparCi:l c-z: SeS.~ ~ fi-0l;>:10.4~~ . 9.0 ~ ~ ~ ~EY:l~S.Y IMfiITt AFFLUENT .;MOSS PALL' REQUIREMEtJT~ ,.. ~ .' #-0krF ..R~.9:]iI>sti! ~ ~ ~~~ !!AX.iH1.tJM . SU .: .,J . ~ ~ A SAMPLE :~.~rl : .^.>,t QAtsOttP -0070 AOi ~ ~ 19' ~ U~ k' ~ [. L E L MEASUREMENT ~ ~JSJU 1 0 0 :AERMIT:. i :': :;; ,, Ik D•".e is :., "tw.. ~#~., ~*A4 ~. -; ~t%'4. .41Di~ ~ ~::~.. ~,3~R .: .;: r-}~: ~~ ~.' ...: ~::~ . . N~C.I F:AR c.r FLU6M1 ~fiJSS VAL'1 ,REQUIRENIIEN7. ~ -0C#-0 3GCA; AYC .~:A - Y M AG/L , YgtTH ~JLi ~. ~:. .. ,. SAMPLE +~. ~<< +; #Xt0## t~AO9vC ( 2S) MEASUREMENT 'iUS/+'i 1 0 0 PERMIT .:''vOit• #,+" +•#+: {taaKrA$ SSCXkL AlS.iORx: !tCF:/ =AAP EFFLUEtiT ~kDSS VALU :REQUIREMENT 4iz:C g G GAI:i:Y F1% riL/L flONTH n F U SAMPLE •~. .+•C4v# tA00AS ( 19) (AS F~:) MEASUREMENT ~ s~'7J,1~ /77/7 t' U1U4~ 1 0 .I PERMIT .,-... ~# +?7tt 34 -0C>< ~~ - ~fjvC~ ~ ~~ ~NCF./ ~CtAE `.I'FLUENT c;ROSS VALU REQUIREMENT >f ?t;CA AYr GAItY CCX .K=/L P10tITif •iiL Ls;: ~ SAMPLE ... ~•'~CrCIC.:: itiC:?7fi4 L~E'./Y.:; ( jq) MEASUREMENT U3Stl2 1 0 0 PERMIT ~. ##;: ~;; ~#n ~te fllfA Oor .:~~-0-0-04+f$ ~ a-091Q#5. :. ~.1~:©~: ~:~:: ~. ~ ~ - ~ORT I21 ~d~AA cFt'LUEHI GROyS VALU. REQUIREMENT ; ~ opOtr4 . ~b9T MALE M"/L r~ +ufiT a. P, I + - ,,. SAMPLE ( 03) DOLtA4tJ b!-04+TY: llhtrY70 ~n:?G TItF.A'fMEhI kLa':'. MEASUREMENT `, C'U7U 1 0 U PERMIT PEQORi AF'F'OFI'l .~ ».t+-0t8 OCt~OA'+b ~ ..~4~+d:+E-0>?#~ ¢#, ~ BF.. Y,LY !#~TAS r'F'LUEI:T i; F'.OSS V1. i.U REQUIREMENT JIJDA AVJ OAII,Y.?SX f!,D ;t`C# .~ r SAMPLE ~u w,;:::: :+ C=X~ #~ OA a>~C ( 10) . I S r~ L V E 0 MEASUREMENT iU..i'~ 1 0 G PERMIT :`°f'~• :. II >zO-'•: ~r-0-0 # ~CF YC14F.L ~ FiEFt1~2 ~TltI.Y ~:tnP :'.'FLUE?r'f GFIGSS VALU REQUIREMENT #rrt# ~ CR.~F A:qG pAIIT t1X MG/L NAME7TTrLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENKTY OF LAW THAT I NAVE PERSONKLY E%AMINED AND TELEPHONE DATE AM FAMILIM WITH TNf INFORMATION SUBMITTED HEREIN: AND eASEp ON ' MY INQUIRY OF TNOSE INDINDUKS IMMEDIATELY RESPONSIBLE FOR ~ W. Gordon Pptora OBTNNINO THE INFONAATION, I BEDEVE THE SUBMITTED INFORMATION IS ~ ~ /~ ~ 970-824-4401 98 7 27 President /t:anaral Mana er TRUE, ACCURATE AND COMPLETE. 1 AM AWARE TNAT TNERE ARE SIGNIFICANT PENKTIES fOR SIIBMITTINO FALSE INFORMATION INCLUOINO g , i P NE POSSIBILITY OF FlNE AND IM RISONMENT. SEE IB U.S.C. f 1001 AND ~7 s E iIONATIINE OF PRINCNAL EXECUTIVE u. .c. ra1o, rA.wu:. uNV uwr IRINIFA Rer hlcAdP R,.. w ro tIO,p00 TVPEO OR PRMITED .ns rc.Yw'inwn N,pioYerNOrarrwn imma...es r.ral OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANA 1ION ut qNY VIOLA 1IONS INefaence ell etteenmenra here) - - .~~ .. iu:hL Ih~~- LICI?'~ ~IL1. l; E. iAIVF,;,, AN[~ :iE'!'TLEAFLF: 30LI~5 CItlIT AFFST?C FCF <~j0Yh,24HF. PFr;CIP IVt:?- t.a uUnDE:B OP Fii00F ht:,iIhEnZNTS UN05R I. A. 3. TUS 1'OMI^.D!t1NL - ].F.?. ^,?C £ G&EASP - SEE I.t+. 1.(U). 11; :';AY AVL:RA!:F' i5 HifLpCT M(lU`rH1Y SV~DB~:L nrt•+iur_ D°~i111D--R.LLC~fITFI- EPA Form 3320-T 10a-961 Prevloue adltlone mey be used. (REPLACES EPA FORM 4o WHICH MA NOT BE VSED.1 f ~ 1 U 1 / 9 ~ ] ~ 1 ? -16 4 6 PAGE ]Of Z