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PERMITTEE NAME/ADDRESS (include Facilirv Name/LOmrion fDiJfeenq <br />NAME <br />ADDRESS H<,} rcH PIIdI NU, INC. <br />TAhEFhh E1NE <br />P.G. dGX 1tl7 <br />FACILITY C }. 6 I G C U 81 L ~.'. f: <br />LOCATION <br />ATTN: w. GGli fiCA Ff7FK~_ GAFS/GF- fCN <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />(2161 p l- 9) <br />PE MI NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 4 TO <br />(20-21) (22-2J) f24~25f (28-2r) (28-29) (3P3/) <br />Form Approved. <br />OMB No. 2040-0004 <br />L' I N C A Approval expires OS-31-96 <br />{suEA er) <br />P - F1hAI ECFrI <br />LISCNFG 'IC fLUEE GULCt <br />~ 7c EE tt I <br />y # NOTE Read InslruAcAtions 6efor rtiple~ ~ his form. <br />-._.. ... <br /> (3 Cerd OnryJ QUANTITY OR LOADING (4 Card Onry) QUANTITY OR CONCENTRATION NO. FREOVE C- SAMPLE <br />PARAMETER (4653) (54-61) (38-45) (4653 f54-61 EX QF~ TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(62-s31 NrAL~13. <br />(64. ~ <br />.(69-70 <br />IL ANI: I;N tASE SAMPLE Y%~+''m~k ( 54) +'; ~~a+ O>S~~CC 40AC 91C <br />I:i U A L MEASUREMENT <br />'4066 1 U C ",'1~ ~ ~ ~,il~.~... ;~!{~FI"w <br />•~ I`-=I ~~gl~,!{ill' - :~~~111a0~if~6+V' c ~)kXA '>o. Ci>A ~ Y ~, X~GAI <br />FPLUENI' 6HCSS YALUE UIR ENT , <br />r r" SiC=O ''6C1D <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br />- <br /> I NT . , <br />1 ~ , .4 . ~ , ~~-_ n w:, - . <br /> SAMPLE <br /> MEASUREMENT <br /> <br />d <br />~ <br />`~ M <br />I„ <br />'t~ A <br /> fiE( <br />1lI <br />B~Ip1~ , <br /> SAMPLE 11 ' ~' <br /> MEASUREMENT ~7 <br /> ' ~ <br />~ ~~ ,~ r. ,!I ~ <br />I <br />I ~ri~y <br />' <br /> Y <br /> SAMPLE <br /> MEASUREMENT <br />.. 7+ ~r;i" 3 -~ <br />' 't ~ <br />~ <br />~~ iHf+ <br />~ RFC <br />i ~' •`+ <br />~ 1 <br />~9 . <br />_ <br /> - ~ ~ <br /> .SAMPLE - . <br /> M2ASUR6IulENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />1,~. <br />b:-' <br />~ f.~e j~pp• <br />'€ Y4 ~,y, <br />~ p <br />~Yr ETA { <br />t1L 1~ <br />, <br />s <br /> p <br /> ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERS <br />ATION SUBMITTED HER ONALLY E%AMINED AND <br />EIN; AND BASED ON MY TELEPHONE DATE <br />INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />~ <br />THE INFORMATION, I BELIEV <br />W. Gordon Petete P <br />M <br />TTIN <br />~ <br />A <br />C SU E THE SUBMITTED INFORMATION IS TRUE, <br />E ANCLVDINGICTME <br />G ~ <br />AR <br />970-824-4401 <br />~~ <br />07 <br />Z5 <br />I <br />ENH <br />ES <br />FOR <br />B <br />President/General Flanager POSSIBILITY OF FINE AND IMPR NFORMAT ON <br />LSE <br />ISONMEM. SEE 18 U.S.C.41DD1 AND 33 U.S.C. <br />o SIGNATURE OF PRINCIPAL E%ECUTIVE <br />o end or <br />5 131 e. (Ponele9s under those sRlules may include lines up ro Tfo,o <br />TYPED OR DRINTEO mexlmum,mpdsanmem of beMreenBmoMhs endsysen.J OFFICER OR AUTHORIZED AGENT A <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />TSS i. '~UTAL IFCN LIE 175 PILL EE MAIYED, ANp SETTLEA2LE SCLICS IL!!1T AFFIIEC FGN <=]CYF,~4EF EFECIF EVEK7- <br />Sh~ bUnGEN CP P@GGf FEGUTAEnENTS UMDEA I.A.3. TD~ pONITC6I-G - I.E.3. CIL E GFEASE - _EE I.E.I.{L). <br />A or 33 1 G- Pr us 'I o 0 [~ SED.) GC1U7/COCILI-]fi4 PAGE OF Z <br />