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PERMITTEE NAME/ADDRESS (/nrfade Facilirv Nnme.'Lncanon i/ Dl~erenp <br />NAME Se:tlECA CCAL CCMFANY <br />ADDRESSp R A M t: k U <br />hAYDEN <br />CO t1i639 <br />FACVLITY <br />LocAriot~ATL'EN CO tl1630 <br />ATT'~: (~. i+UD pbGw~, CEbERAI dANAGEF <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SVSTEM (NPDESJ <br />DISCNARGE MONITORING REPORT (OMR; <br />(2 tb) In- 91 <br />C OC <br />PERMIT NUMBER IscHARGE NUMBER <br />F~•~OM <br />(20~21j ,(2229) (2a 15) ~ (2&2)) (2929) (3091) <br />r.INaN <br />(SUBH Yr) <br />F - lll,/E <br />LISCH~le~E TC TFIE/FISt CFEEl. <br />e I1~CNAAGE ~__~ +=~ <br />Read Instructions before completing this form. <br />6CU1T <br /> (3 Caro Ong ) <br />QUANTITY OR LOADING- ~ ~ (4 Card Ony) QUANTITY OR C NTRATION NO. FREOUENC SAMPLE <br />PARAMETER 3 <br />( ) (54-61) (3845) (46-53) (54-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />1sz-sal ANALYSrs <br />(s4-sR <br />69-70 <br />E LUIi, N C NDU U <br />tiHU TNE:A Th°NT GLA f,2 SAMPLE <br />MEASUREMENT ?~ <br />D•~JJO <br />D. 33~ ( '.7) ~~ LO 0 at+ :~:C~t,~ <br />(~ ) <br />1 Q, <br />SUU`.,U 1 U 1 FEFF~~MIT -. ,p$ 7 44* <br />F .: >OCa~ Oi?0 Ai ~+• <br />~ Y3~~ <br />EFE'LUE;IT f,HUS1 YALUE ~ 'I~MENF !()$x ^AY6 D)>IE2 !IY PC.C ~; ~~L~ ''~ ~'Y48 <br /> SAMPLE <br /> ME <br />SUREMENT <br />A <br /> j <br />~. <br /> vir <br /> SAMPLE '"~~ <br /> MEASUREMENT <br /> BERMIT - ~`~ - - <br /> #E~t~UIREMEN7 <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> ~REQUIREMEN7 ~ + ~ ,. ~'~~ - <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> t1E0UIREMENT > .,.*~ ~ ,a+ <br /> SAMPLE <br /> MEASUREMENT <br /> ~ ~ ~~ ~ <br /> REQUIREMENY' ~ + <br />;_ ~ ; <br /> SAMPLE <br /> MEASUREMENT <br />PERM17~ ' <br />~ <br />- <br />AEKIUIREME2NT - ~,:-'. <br />~ <br />- <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND <br />TELEPHONE DATE <br />AM FAMILIAR WITH THE INFORM ATION SUBMITTED HEREIN; AND BASED ON MY <br />INQUIRY OF THOSE INDIVIDUAL ~ <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATION IS TRUE, <br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT ///~~~~~' <br />~ <br />PENALTIES FOR SUBMITTIN G FALSE INFORMATION, INCLUDING THE <br />' ~ ~ <br />( l <br />POSSIBILITY OF FINE AND IMPR ISONMENT. SEE 18 U S.G. 4 1001 AND <br />!3 U.S.C SIGNATURE OF PRIN AL E%ECUTIVE V <br />YPED OR <br />INTED d 5ude lures up ro SIO,00f1 and or <br />h <br />e <br />lm <br />~ <br />l <br />e OFFICER OR ALIT ORIZED AGENT <br />y <br />NUMBER <br />YEAR <br />MO <br />DAY <br />T <br />PR n <br />years.) <br />maxlmum <br />p <br />onmen(o <br />eanrae <br />mont <br />s D <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) <br />7 ,,5 Li IT itILL ~E kAIVEC AWL' SETTLEAEfLE SOLIDS LIlIT APFLI EC PCfi G=1GYF, 2uHF. PP.ECIF EVE I17; I~S E <br />:;L't'tLLAiILE SOLIDS LI/7T WALYED PO F. >l0YH,2gBX PRE(IP EVENT SUt:JECT TU EUNCCd CF FtCCE IY I.A.:. C1L E <br />~Tracc crv r c ~r ~c rrtnY TTno~r ccc r u ~ & <br />EPA Form 33261 (08-95) Previous editions may not be~used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) C~ 07 y~ y g C Et 7 - T b 5 3 PAGE ~ OF <br />Q MONITORING PERIOD <br />Y _ MO DA YEAR MO DAY <br /> V ~ <br />Form Approved !E^-; <br />OMB No. 2040-~64 <br />Approval expires 05-31-98` <br />