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PERMITTEE Ngt.AE/ADDRESS (deYdr fmWryNrWG«anm UDIS .rr) <br />NAME (,"r:h~S ~i"I f'1KL i. L.~ruhATluIG <br />ADDRESS U 13UX 00 <br />~..ti: ALL, CU rslo2o <br />FACILITY CYPICUS tMr'IKt CiiN~'unAf LUIv <br />LocnnoNi;kAI~ Cu 3102 <br />AfTly H1l;HA~L .i. LuULi..+F ~L~VtKAt ML„t <br />NATIONAL POLLUTMT DISCHMOE ELIMINATION WSTOA //NPDfSI <br />DISCHARGE MONITORING REPORT IDMRI <br />1-f 61 i1-191 <br />PERMIT NUMBER DISCHMGE NUMBEfl <br />MONITDRIN fUD <br />YEAR MO DAY ~E R MO DAY <br />FROM, ~ J v T U3 ~1 <br />1l /11-131 114151 116171 l16-191 1363/1 <br />Form Approved. <br />~ri.,~ ~~ ;I.-~1.; T::°"~BA^L?pl~,oaoooog. <br />Approval expiieti 531.98 <br />i~bK nr. 12547 <br />F - FI'vAl <br />i9 (r,,R <br />(~ iu~a 1'14 .i l J L. n A n J t 'f M {a <br />NOTE: Reed Instruetloru belon eompletlnp thM form. <br />PARAMETER 13 Grd Only QUANTITY OR O I4 Grd on/Y! QUANTITY OR CONCENTRATION N°~ FREQUENCY SAMPLE <br />131-371 146531 /5461 136J5I 10653 1646/ <br />~ <br />EX OF <br />TYPE <br /> AVERAGE MAXIMUM UNIT ~ ~~AINIMUM AVERAGE MAXIMUM UNITS 16]691 MALYSIS <br />(64661 /69-70) <br />1L ARU UKEAji SAMPLE u4fi{a {as <br />J <br />94; ~ <br />~***** . <br />#{a{##{a ~;. ;..: <br />+~#'. <br /> <br />~ <br />'Yi~uAt MEASUREMENT <br />~ 1; <br />~ <br />' C~ `~O vl~+ <br />cY~oo 1 0 0 i7~.PfFl.MIT~ .~ <br />' .~i~i•**a <br />.. ~ :. <br />1.5 1 . <br />::: .;: <br />.. ...:. <br />,.. <br />. <br />•: <br />. <br />~~ <br />*A~1~1lI:~~~: - <br />*.. *.~'?dl:ft#~.' <br />.~::;; <br />#>p# <br />:' <br />~l!•iG~~~ <br />.~..5~,%:~.. <br />tr•rLUtNi bKUS$ V4LUL REQUIfiEN1ENT ~ NAT' , , <br />. <br />.. <br />: <br />,,:.,. . . <br /> SAMPLE <br /> MEASUREMENT ~:'1, <br /> .~ PERMIT ~ <br /> <br />. ~ ~• •.:~° <br /> <br />' . <br />:.~:x^: c:l: <br />~ <br /> <br />... <br />~' <br />~ . <br />' <br />~ <br /> REQUIREMENT ~ ~' :: ~%.f;.:.,22 <br />- .: <br />~; <br />:::: .. ... .. <br /> SAMPLE <br /> MEASUREMENT <br /> ~~'~PERMIT. .. .. <br /> ~FIEOUIREMENT. - <br /> SAMPLE <br /> MEASUREMENT <br /> ~~~ PERMIT. ~. ~ .~ <br /> pEQUIREMENT~ <br />„. <br /> SAMPLE <br /> MEASUREMENT <br /> •.:::..PERMIT ~ .. .: ~.. .. .:.... , <br /> REQLIttEMENT~ <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ PERMIT ~ ~ ~ ~ ~ ~~ <br /> ~REQl11fiEMENT. <br /> SAMPLE <br /> MEASUREMENT <br /> PER MIT ..::. <br />: <br /> <br />REQUIR . <br />EMENT:: <br />:... ~ ~ ~ ~ ~~ ~ <br />~' <br /> <br />::. ... <br />NAME/T'ITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AAI FA FY UNDER vENUTY OF uW THAT I HAVE PERSONALLY EXAMIN <br />MILIM YATM THE INFORMATON SUBMITTED HEREIN; MD BA ED MD <br />SED ON TELEPHONE DATE <br /> 91B <br />MY <br />D <br />R <br />T <br />N <br />A <br />ED <br />RE ~ <br />I~IC fl lr(I fY'I~it$ IN <br />UI <br />Y OF <br />HOSE I <br />DINDU <br />LS IMM <br />IATELY <br />SPON LE FOfl <br /> <br /> <br />Environmental A^anager OBTNNINO THE INFORMATION, I BEl1EVE THE SUBMITTED INFORMA <br />TRUE, ACCUMTE MD GOMRETE. I AM AWME THAT THE <br />INC <br />SIONIFICMT PENN <br />TIES FOR SUBMITTING FALSE INFORMATION TION IS <br />RE ME <br />LUDING <br />~? <br /> <br />970 870-2712 <br /> <br />If <br /> <br />27 <br /> <br />O8 <br /> , <br />. <br />THE POeSI81LITY OF RNE MD IMPNBONMENT. SEE iB U.B.C. 1 1001 MD 73 610NATURE OF PRINCWAL EXECUTIVE <br /> U.S.C. 1 1 ]t e. lFYnelEb uM.. eb~ .bem. rrrY ~EAA Rw. w b ! 10,600 <br />TYPED OR PRINTED es ar muhu.n Mp/swrMrorhMrm emmllrs rM6Wrra1 OFFlCER OR AUTHORIZED AOEMf CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refarsncs s//ettechmsnt9 here/ <br />~cT1LLACrL_ ;~LI~ Li: IT ;+„IV~L, L„i L~.:Y',.r14hn FKLt;/P tVtr+T-o~c 1.A.Sr pv 1Vr FUIi hi.WUlr(t11Utif5. L.1L 6 <br />~f+t .i Jt L,riao :,AMF-L~ AMALYJIS ktuUl ntU IF Vl ~It3Lt SHELPI 11 i,u ~t r. J;.p, Wk T~LY SAiiPL 1tYG II~STr2UCTIUN S-I. C.~, <br />., r. <br />EPA Form 3320.1 108.961 Previous editions may bs used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 UJ233/yo lU~ 1- 1 ~ I 1 PAGE lOF <br />