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PERMRI'EE NAME/ADDRESS pnclude Fanliry Nmne/Locmion ifOgerenq <br />NAME <br />ADDRESSyULIE '.^. .' °*+r <br />FACILITY PAOYIA C~l y1N ~7 <br />LOCATION <br />804 ~ CO Blu2tl <br />NATIONAL PoLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FORn ApprovBd. <br />DISCHARGE MONITORING REPORT (DMR, OMB NO. 2040-0D04 <br />Iz-!6) !'~- e) '; T. N C 9 Approval expires OS31-9B <br />nnn ~ (~1)I'~G it C) <br />PERMIT NUMBER DISCHARGE NUMBER _ ~ T Y $ L p N I. TA <br />MONITORING PERIOD :'?' '".;fir?#~ F01+ ~:?A <br />YEAR MO DAY YEAR MO DAY _ " <br />FROM t C TO '1T D tr :~_~^_ `J J.~C'+.9 ;i;°. L~Q. 3` <br />h T T IJ : w l L L 1 A ^ 0. . ~ A F .1 ~ ~ r r I~z.! I« .u! I~r~o! uPao tcPm row.! ...,. ~. ,.oa .. ........................... o ......r.., ...n ..._ ._..... <br /> (3 Card Ony) pUANTITY OR LOADING (4 CeN Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 48-53 (54-ef) 3E-45 48-53) 54-67) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNffS MINIMUM AVERAGE MAXIMUM UNITS aNALYSl3 <br /> (ezaT) (64-88 69-70 <br />I.CSU STA3'hF J~; ,yR ACl SAMPLE ':•?C~G4 +x ;t rRR# r?t4~'+?' k,p t?~'"~ ( ]3) <br />L ~'rl I O D A i/N }i I A MEASUREMENT <br />[Ar;JO 2 U I) 'PE$MIT.:.t '~x ~~ ar.~~ ~ ~ t#;- •1~ ~~, y_ <br />`'!r' '~ +1p1'.~ <br />- <br />' Ek_ ~ ,~ <br />LF'F'LU2NT GROS.~ Yeiq 'AEOUIBEM '";. ,('. 1 ~ ,p,..y~ ~ <br />, <br />,A r ,'~, , <br />.~.° <br />° = ~ . <br />LC7U STATkF 96Hit FC SAMPLE AYC04RL7 rk91p4 QO 3fiGrf•^.•R Ru~`~<, y~C: ( 23~ <br />PI.7t:PHALES MEASUREMENT <br />A:rDC t U U +;"!IFiBr+C , .IP"" <br />r,.nr: Y ~qo#~~:: 6P- <br /> SAMPLE <br /> MEASUREMENT r <br /> PERMIT <br />.. <br />~"• <br />~ <br />" <br />' <br />' y+.-~ <br />~ ~ <br /> EGIUIREMENT .;~ ; 4 <br />~ ~ <br />± r~! ~~a ,. <br /> SAMPLE ~ <br />• ~ "- <br /> MEASUREMENT <br /> ' <br />~ <br /> EQUIREMENT <br />". =~. <br />t ,.,o +°~,_ <br />"" ,~ <br /> SAMPLE r <br />~ <br /> MEASUREMENT ~ ~ <br />l` <br /> pERMIF <br />" ,.)" " TI ,~.~=, <br />~ <br />` <br />" s ~ <br />` ,+'"~ ~ ,:, ~:. <br />' <br />4I ~ ~ ~'-h~ '°r' <br />' ,,,Msr <br />~4, <br /> gEaUIREMENT s,~ <br />~ a , ~ <br />~ ~ ; + ; '?~ . <br />~f ` b <br /> SAMPLE <br /> PERMIT 2 c- -, <br />~ u'F ' . ""i ~A~i,~;t ..,R.u ~, +ry~{; ,p;_ <br /> REQUIREMENT i~ <br />. ' ~ ° ~ ~ ~ " ~ (~ <br /> .. .... ,. , . .. , . , .. , .. -.. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT w. ~< M y x ~`} 1 ,P •:,, ~ ~.=.a' ;' `, ,~, <br /> REL]UIREMENT n l <br />~ fi <br />. ,"_ .F"" '* ". ;x+y <br /> „ <br />_ ~ <br />NAME/fRLE PRNCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FM'IILIAR WITH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HERE NALLY E7(AMINED AND <br />IN; AND BASED ON MY TELEPHONE DATE <br /> INOUIRI OF THOSE INDIVIDUAL S IMMEDIATELY RESPoNSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEV <br />M E THE SUBMITTED INFORMATION IS TRUE, <br />~ PLETE. <br />ACCURATE AND CO <br />PENALTIES FOP SUBMLI'fIN I AM AWAKE THAT THERE ME SIGNIFlCAHf <br />G FALSE INFORMATION <br />INCLUDING THE ~ ~ „ - , <br />" <br />I <br />'~ <br />~ I POSSIBILITY OF FINE AND IMPR , <br />ISONMEM <br />SEE 18 U <br />S 1001 AND 33 U <br />S <br />C <br />S <br />O ~ r <br />T <br />, <br />~ <br />! ! <br />I , ~ <br />( <br />e <br />6 <br />I . <br />. <br />. <br />. <br />. <br />. <br />. <br />mM <br />I <br />l <br />d <br />fi <br />m <br />70 <br />000 <br />d SIGNATURE OF PRINCIPAL EXECUTIVE ' ! %. . <br />.. ! I !, I <br />TYPED OR PRINTED nc <br />u <br />en <br />v <br />rese s <br />es mey <br />e <br />res up <br />, <br />or <br />5 <br />re un <br />~mum(l <br />pdsorxrelrt of ben+eenemonlnv end5yeers.) OFFICER OA AUTNOAIZED AGENT <br />rn~ <br />~ <br />NUMBER <br />YEAR <br />MO <br />DAY <br />rnMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell etfechmen4 here) <br />,CF. PART Z.A.fl FOy DERAI;,S ~r resT 1'HOCFUUF!E. RPVO!iT 6GAEST nI!.UPI^q (Z ~FPT.11'yT) 'I:ILCY TS hF.TuAI. TO '0` <br />vP Tf.iT 0!1GAYI5^45 (ICSU) Rfi~ ATTACH AC?)T°. TJ.(ICIT! TeSr ~~'POQT °'~)7!' TO U+~. <br />Epp Form 3320.1 (08-95) Previous editions may not be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.) PAGE OF <br />Opn~~/R^~~1]-122? 1 <br />