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PERMITTEE NAME/ADDRESS (lnrlude Fanlim Name location i~D,//eren0
<br />NAME C'(d R',i; YA^". '~i'L~ 'i "1.4. ~.'C: ~.
<br />ADDRESS I e'. S'. 1, c 5 J I C J '1 .`+, t; ~ ~ '; •..1 I~ P F
<br />y1GU ~P.3'1 vIIVF.',~:, CII•CL::
<br />EN LL;"e0u.. CO tiU1S'.,
<br />FACILITY
<br />LOCATION
<br />„"";"7: "C:LtiI~ 4. KEGLEY, :, F.P'e:RaL ATNY
<br />" NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHASR, GE MONITORING REPORT (O/MR;9)
<br />Cnp02715u 0~3 a
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM a ~., u, u l TO v u v a ~ l
<br />/2041) (22291 (2925) (46211 (2829) (3P31)
<br />rAJOR
<br />(~~;aR xw)
<br />r" - FINAL
<br />!'.INE 1, FONC
<br />Form Approved.
<br />OMB No. 2040-0004
<br />Approval expves OS-3T=98~ '
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<br />!? TC FUICHL CREE~I'`
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<br />NOTE: Read Instructions before completing this lorm. ; t~:
<br /> (3 Cerd Cny) QUANTITY OR LOADING (4 Cerd Only) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46-53) (Sd-61).' (3H~45) (46-53) (54-61) EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MfNIMUM AVERAGE MAXIMUM UNITS
<br />(sz&7) ANALYSIS
<br />(6d-68/
<br />69-70
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER l CERTIFY UNUER PENALTY OF
<br />FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />AND BASED ON MY
<br />ATION SUBMITTED HEREIN TELEPHONE DATE
<br /> ,
<br />AM
<br />d Milts
<br />Rich INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />1 BELIEVE THE SUBMITTED INFORMATION IS TRUE,
<br />THE INFORMATION
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<br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
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<br />970-870-2712
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<br />Manager
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<br />PENALTIES FOfl SUBMI ~ /'
<br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. § 1 W1 AND 33 U S.C. SIGNATURE OF PRINCIPAL EXECUTIVE
<br />
<br />TYPED OR PRINTED § 131 e. (Penalties untld mesa SrB(NBS m9y include tines up ro S1o,00o end w
<br />me,lmum,mpdsonmerx or beMeen6months entl5yeers.) OFFICER OR AUTHORIZED AGENT
<br />COD
<br />NUMBER
<br />YEAR
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<br />COMMENTS AND EXPLANATION OF ArvY Viuta I lUrvs (rrererence err aaecnmenrs Here)
<br />.,L r.C4~T`: LI^7IT5 FOH TSS, IRJ9 S S6'T'fL~Af3LE SGLIDS (LOC aG') APPLY C(;LY IF C= LU-Yh, 2w-HR pkECI~ LYc!IT
<br />L'L""^I"c7. SEE I.A.1• FG 1}1, FO'; bL'HDEd OF FROCr R~vUIRE:+.EKTS. CIL b GkF.AS''-56'.E FGOTHCT£ F/, pG 2.
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<br />EPA Form 3320-1 (08.95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) 0 0 U 3 b / Ct!I G 4 G 5-15 O 1 PAGE Z OF
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