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PERMITTEE NAME/ADDRESS Qnc(ude Faciliry Nome/Cnmriun $Dr$erem) <br />NAME SE4ECA CGAL CCrFANY <br />ADDRESSC :'. A rl E h D <br />NAY~eN <br />CO 91fi39 <br />FACILITY <br />LocATl01~<<YCEG CO U1430 <br />ATTN: t;. bUD t:H4iih, CENErlAL MANAGFN <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />(2461 (1 ]- 9) <br />~~ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING ERIOD <br />Y M DAY YEAR MO DAY <br />OM TO j <br />(10- - ) (QJ45) (26-2]l f2B-291 (30311 <br />Form Approved.w'~~ <br />~ I h 1] I OMB No. 2040-0004 <br />Approval expires OS-31-98e~ <br />(_,lith tIY) <br />. - kIBII fiCUIT <br />:.SCHAFCE RC.~EIE/f 156 CFEEd <br />NOTE: ATructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADIN~ (4 Cartl Only) QUANTITY OR CONCENTRATI N NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-61) (38d5J (4G53) (54-61) EX OF TYPE <br />` (32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> rfiz~631 (s4~sa) 6s-70 <br />L A N D f, R E SAMPLE g a ~. ; g q ( y0) qq9?00 .w~L~'.~riq ..: i : r, 1; <br /> <br />Y i ~U A L <br />MEASUREMENT ~ ~ ' <br />D <br />v UOt, 1 U I ~-PEgMIT qq q~ '86F~$T f5=1 ~ q+l4. qq C>mLRA~i q 0#t ~ G1,J.. IS <br /> <br />e.ttLUEBIT GhU55 YALUE <br />REQUIREMENT <br />_ <br />;~gT ttj:j . <br />kC=O ` 3.. - ~.. <br />~;~ <br />° <br />' <br />t+>:: <br />CEi1N -s^a <br /> , ~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ - <br />" -c: - - - . -: <br /> REQUIREMENT .~ <br />- ~:. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> -pE[iMIT - - , <br /> REQUIREMENT ~ ~ . <br /> s <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - r~":~` <br /> 39EQUIREMEN7 ;-::~~',', .. <br /> SAMPLE <br /> MEASUREMENT <br /> PF;RMIT <br /> Fi~QUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> ['BRMIT <br /> REQUIREMENT ~ ~ - ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. <br /> RESQUIREMENI', <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERUFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HERE <br />N <br />A <br />D BA <br />ED TELEPHONE DATE <br /> I <br />: <br />N <br />ON MV <br />S <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING THE <br />L <br /> , <br />POSSIBIL <br />TY <br />F F <br />N t <br /> I <br />I <br />E AND IMPRISONMENT. SEE 16 U.S.C. § 1001 AND 33 U.S.C. <br />O SIGNATURE OF PRIN AL EXECUTIVE (~ <br /> <br />TYPED OR PRINTED 4 1319. (Ponettius untler these statues mey inclutle lines up ro 510,000 antl or <br />maimum ~mpnsonment of beMpen6months antl5yeers <br />l OFFICER OR AUT ORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . DE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference al) attachments here) <br />TSJ LL"LT r+ILL cE KP.IYE:U ANL` SETTIBAULE SOLICS LICIT APPLIlL k'UA <=LG2 ,lUHii FNECIF EYEATp 155 E <br />CicTTLEA&LE SGLIJS L1DIT ~AIYED FGA >lUYtt,[4N5 PFE'(IF EYEKT SGeJECT TC BUFUcA OE EfiCCF IA I.~.i. CII G <br />.-kF~cr_ccc r a j p ~P5 ACY~.~C~IrM6~$~d 8 l <br />EPA Form 3320-1 (08-95) Previous editigns maY not be used. (REaIACES EPA FORM 7-40 WHICH MAY NOT BE USED.) n n n ++ ..... n . ++ . ~ e . ~ PAGE .. OF <br />