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r'rRMITTEE NAME/ADDRESS (hu'lude FauGrv Name/Gacndon i/Digerenq <br />'NAME <br />Ti,AFPEii 17INING• 7NC. <br />ADDRESSI t+ A E k ti ti Y. I tI E <br />F.C. BCX 197 <br />FACIUTYLj~AIL CG dlt2t, <br />LOCATION <br />L TTNe r.n RnnY LFR6L~ DRF2/GGN MCL• <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (OMR; OMB No. 2040-0004 <br />1z-tsl m- 91 [1I NG 6 Approval expires OS-37-98 <br />PERMIT NUMBER DISCHARGE NUMBER (S U E b N V) <br />f - FINA1 pCFAI <br />r~MONITORING PERIOD F G N C T C C E E h G h I C E <br />YEAR MO DAYT~YEAR rM~_ -DAY _ <br />FROM CO C4 0] TO G ~ +04~ NC L~'CNAF6F ~~~ tot <br />(262 r) (zz~z3) (za-zs) lzsn) (zs-z9) po~3t) NOTE: Rea Instructions befor pleling this form. <br /> (3 Card Ony) QUANTITY OR LOADING (t card Only) QUANTITY OR CONCENTRATION NO. FgEOUENC SAMPLE <br />PARAMETER (<s-53) (5<-st) (3B-a5) (as-53) (5afit) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(sz-63) ANALYSis <br />(64-ssJ <br />69-70 <br />IL AND Gii'tASE SAMPLE C>a##70 ( 94) Yr~LAis: ACsJ000 :~~><Lt>D <br />I S U A L MEASUREMENT <br />UU66 1 G G <br />~ +~~IR~!!Et = <br />': ~,~~~~~~ } E`_=1 ~~"~+!?1.4i ~~F41F14~- ~ ' %E~O+~T~1~11Y ^, <br />, o: ,~i ,~~I~i X56AL <br /> <br />YFLUFNT i,k055 VAIUE <br />~ <br />~~ <br />Ems: <br />~"~',re <br />*1= <br />C=0 <br />i " <br />- - <br />,. <br />Cd~rr <br /> SAMPLE . <br /> MEASUREMENT <br /> ~.: L. - ~ ~ _ - .- r S . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> '! ~~'~ <br /> <br />~ <br />t t-' <br /> I EN7 _ <br />#_ <br />'L ~ r:e y;, . <br /> SAMPLE <br /> MEASUREMENT S~ <br /> !~ <br /> y , I {J// <br /> SAMPLE <br /> MEASUREMENT <br /> '#F'~ " .~~ i .a <br />Y~ t f3 x.x r a: L1 YF~ ~ ~'~ ~i" '4 -'S <br /> r <br /> <br /> SAk9PLE <br /> MEASUREMENT - <br /> s ~ ~ <br /> Yd' rb <br />-~.a. 1 , }t <br /> SAMPLE <br /> MEASUREMENT <br /> _ l <br />~ -~ RT ~ <br />~ ' i ~ S~ i <br />Z i . y.. A S <br />~ 6' <br />_ <br /> ~~ ..? <br />- <br />~ a { <br />~ -r r ~Yr= _ 7 5 <br />~~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HERE NALLY E%AMINED AND <br />IN; AND BASED ON MY TELEPHONE DA~iE <br /> <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />O <br />R <br />I <br />A _ <br /> <br />~ ~ ~ <br />W. Gordon Peters ACCURA E <br />AND~ OMPLETE~E AM AWARE <br />T HAT THERE <br />A E <br />SIGNIFICANT <br />PENALT <br />INCLUDING THE <br />E <br />FOR <br />M <br />TT <br />FAL <br />E INFORMATO 970-824-4401 CG G] 25 <br />I <br />I <br />ING <br />S <br />SUB <br />S <br />N, <br />President/General Manager POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1a U.S.C. 410(11 AND 33 U.S C. <br />r <br />4 1319 <br />ki <br />th <br />r <br />i <br />l <br />d <br />li <br />t <br />E10 <br />tl <br />P <br />d <br />000 SIGNATURE OF PRINCIPAL EXECUTIVE <br />ena <br />es may <br />nc <br />u <br />e <br />nes up <br />o <br />, <br />en <br />o <br />. ( <br />es un <br />er <br />ese sre(u <br />TYPED OR PRINTED maximum rmpdsonment al be(wsen6months entl5yeers <br />) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />. O <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/e7ence all attachmenGS here) <br />T55 G TOTAL IPCN LIPITS r;ILL BE NAIVEDr ANG SETTLEAELF ~CLICS LIC11 AFFIIEO FCN <=1CYEr~4E6 FFECIF E~f61- <br />SCE HURDEh OE' kNGGF EEQDIhFM,ENTS UNDBH I.A•3. TC~ L10NITCfilAG - I.F.3• CIL E GNEASE - °EF I.E.I.~C). <br />A orm33 •t`~ 8• ) PrevTouse ilorS ma no ease 0 I USED.) PAGE „ OF Z <br />00073/OGC111-lEiu <br />