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P£RMITTEE NAMEIADDRESS NwYb fwlhy Nwv//a,Na 1/DI/7wrm) <br />NAME tLYL~I!u:, LMYIkt (,iJ+ir'L'I~ATIUIr <br />ADORES'{ OLX bG <br />~ -4RAIu LU 81620 <br />FACILITY CYr'ItU~ cMl'IRE CL)Kr'UetATjUN <br />LOCATIONLRAI~ CU 81615 <br />A I f ~ MICHAEL 'R. LUL'LVw. uENFKIi N6A <br />NATIONAL POLLUTANT DISCMMOE EVMINATION 8YB'fEM /INPDESI Form Approved. <br />DISCHARGE MONITORING REPORT /OMRI , <br />I-151 I7-191 ;1.ii} :~ U:r-•iln Tl_.OI~~7A04~-0004 <br />~Unk Nh Approve expveeQ5=1.98 <br />L~~F~ <br />PERMIT NUMBER D1scHMDENUMBER F - FINAL <br />MONITORING PERIOD M 1 C~Ok <br />YbAR MO DAY t, YEAR MO DAY <br />FROM ~ ~ ~'i0' 9 U3 31 4~4'~NU U15GHAitGE ~*~~ <br />nn: .Dal v4951 ~tl6JTl OR-091 r3asu NOT{; Rud Inetructlorr pefon complNlnp thb form. <br />PARAMETER 13 Grd Onryl QUANTITY OR LOAD !1 Grd On/yr. QUANTITY OR CONCENT TION ND fREOUENCV SAMPLE <br />131.371 146-531 151-511 /39-45 !46-53 /54511 ~~ ~X DF TYPE <br /> <br />AVERAGE MAXIMUM UNITS <br />(~AINIMUM~~ AVERAGE MAXIMUM UNITS ~ <br />rii~5m MALV515 <br />154681 <br />169-701 <br />~LL1U~, IL,(AL SAMPLE +F44+F+:ri~ #+Farrf+h~ 4444## I9. <br />v I»uLVtU MEASUREMENT <br />~ <br />~~GI/9 1 0 G ~~:. PERMIT• : "kMW~N!Vlk ~ <br />. i41-:>r4# ~ <br />... .. <br />*## :,;,.: ,.,::.>.. <br />~:, :: 4#P <br />',• <br />: ~ <br />k1r PfN,~'~ <br />~' <br />C3AX 1~13F/A1, .; .. <br />~~~:~ <br />~ <br />: <br />~~ '~#~~::: <br />~ <br />:I~.A~B~ . <br />• <br />tFrtUtNl i,KUSS VALUt REQUIREMENT . <br />4#411[: . <br />.': <br />a :::.:.::.. ..... . <br />. <br />. . <br />,, . <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br />~ , <br />~ <br /> REQUTAENIENT ... <br />;..:::,• .. <br />:: ~ ''~' <br />'' <br />~: .=;~ :;. . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> :PERMIT <br />: .. .~.:. <br />: }Z'•T~:'~k~~~. :;:. ~: ~ ~~~~ ::.,: <br />'~r.-; :`, . <br /> .. <br />. <br />. <br />REQUIREMENT. . <br />:. :.c:*r ~a:. ::~.:..,. :i.': ?; ~ . <br />. <br />•; <br /> <br /> SAMPLE <br /> MEASUREMENT <br />~~ <br /> .~. PE.RMIT:. ., <br /> <br />: ..... <br />: <br />,; : <br /> .: <br />,; ,. <br /> <br />.. <br /> ~ ~ ~ ~~~~ ~ ~ ~ ~~~~ <br /> SAMPLE ~ <br /> MEASUREMENT <br /> .': PERMIT ~ :.:: ~..: ... .... .:........ ,F: <br /> :.: <br />y.: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT; <br />~ ....... ...:.:: ..... . ,. <br /> REQUIREMENt. :.: ~~' .., :., ~. <br /> SAMPLE <br /> MEASUREMENT <br /> ..PERMIT '~.. ~ ~~ ..: .....:... .:.... .. <br /> .REQUIREMENT: :~ ~~'~~ <~~~ <br />~ <br /> ,. .. . <br />: ,:: 'is:..%. <br />~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER 1 CERTIFY UNDER PENALTY OF L <br />AM FAMILIM WITH THE INFOR AW THAT I HAVE PERSONALLY EXAMINED MD <br />MATION SUBMITTED HEREIN <br />MD BASED ON <br />/f TELEPHONE . DATE <br /> ; <br />MY INQUIRY OF THOSE /NDIVIDUALS IMMEDIATELY RESPONSIBLE fOR !/ <br />Richard tilills OeTNNING THE INFORMATION: I BELIEVE THE SUBMITTED INFORMATION IS <br /> <br />E <br />i <br />t <br />l <br />~ <br />l TRUE, ACCURATE MO COMPLETE. I AM AWME THAT THERE ME <br />510NIFCMT PENUTIES FOR SUBMITTIND FALSE INFORMATION <br />INCLUDING /J <br />nv <br />ronmen <br />a <br />I <br />r <br />alla er <br />9 , <br />THE POSSIBI <br />ITY OF F <br />E <br />D <br />PR <br />O <br />E <br />T <br />9EE <br />B U <br />S <br />C <br />1 <br />00 (9] ) 87U-Z~IZ 4 2] 98 <br /> L <br />IN <br />M <br />IM <br />IS <br />NM <br />N <br />. <br />I <br />. <br />. <br />. <br />1 <br />1 MO 77 <br />BIONATURE OF P111NCIPAL EXECIlTNE <br /> U.S.G. E t 7te. IPrrkY, u.e,. IMw mnm, m,r InrAd, nN, w ro 1 /0,000 <br />TYPED OR PRINTED rgnmvMUrr hrpYwwrwrr oJbfwwn emmeuW6vr~a/ OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />GOMMGN I5 ANU GXYLANA I I VN Vh ANY VIULA 11 VNS (Ne/elenCl s// etteMmsnts AB/el <br />,tiTLtAdLE SULiI;~ LlrLLi nAl'vLU ruh 1JYd,Z411f~ F',ZtCli~ tYt'aT-.,tc I.;1.U, Pu !v, rLx ~tuUIREMENTS. iris :. <br />V4LN~t GnAr_' SAPPLc AP:AL.Y~LS hi:dUihtU If YISLUtE ~nctN IS L'o., utYi_U. I,IY TRLY :,arPL ini, 1nSTKUCT [CNi,-i.L..r, <br />N~ x <br />EPA Form 3320-1 108-961 Previous editions mey be used. (REPLACES EPA FORM Td0 WHICH MAY HOT BE USED.( UU [ o ~ / y D 1 uu 1-1311 PAGE 1 OF <br />