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PERMITTEE NAME/ADDRESS pnclude FaciGry Name¢ocarion iJDiBcrenp <br />NAME ShNECA CCAL CGlLANY <br />ADDRESSO @ p rr E h U <br />HAYDiF <br />CO.tl1639 <br />FACILITY <br />LOCATIO <br />~iAY^EN CO 81630 <br />AT29: ~;, bUG d.`iU.N, GENERAL AANAGEh <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT (OMRJ <br />(2-t6) (r]~ 9) <br />(f.~ 1 <br />PERMIT NUMBER .. DISCHARGE NUMBER <br />MONI ,g~ ~ ERIOD <br />YEAR MO DAY::~ . YEAR MO DAY <br />FROM ~ ~ 1 <br />(2P21J (22-13) (2a~25) (2621) (2819) (3P31) <br />Form Approved.`~';~p"':~.+ <br />"' 1 .h ~ h OMB No. 2040-0004 <br />Approval expires 05-31-98~ <br />~SUEF NY) <br />f - PI6A1 }•LU2'1 <br />:ISCNA6EE 7C GFASST CFfek <br />NOj~Reatl Instructions beforr, completing this form. <br /> (3 Cerd OnryJ QUANTITY OR LOADING (4 Cerd Only) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 46-53) (54-srJ (38-45) (46-53) (54-8t) EX OF TYPE <br />- (3237) AVERAGE MAXIMUIvf.•. ~,, UNITS <br />~ MINIMUM AVERAGE MAXIMUM UNITS <br />(B2~s3) ANALYSIS <br />(s4~seJ <br />69-7U) <br />C I L A N :~ :, & L A S E <br />VISUAL SAMPLE <br />M <br />AS K` ~ ~`~ vt;e U a y <br />) ~Y;zc=: aaano>', r>uzloaa O lL '~ <br /> <br />E <br />UREMENT v <br />~~SS VIS <br />H4000 I G 1 PERMIT Qt4 '~ R~ lS=1 ,~ ~' "~ ~~'~ YCIe/ I$11A <br />tFFLOE;cI Ck035 YALL'E AEQUIREMENT X1132 E#X lC=C tiSx: ECMTf <br /> SAMPLE _ <br />.P-" <br /> MEASUREMENT `fiw <br /> PERMIT .':~_- ~h a~ ' <br /> REQUIREMENT ' ? <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - _= <br /> REQUIREMENT - ' <br /> SAMPLE <br /> MEASUREMENT <br /> -PEgMlT <br />#~EQIIIFEMi_NT <br />~ <br />M~4 "' _~ <br />,;;: ~ <br />. <br /> . , . <br /> SAMPLE <br /> MEASUREMENT <br /> ` <br /> ;fiEQ~11pEMENT ~ . .- <br /> SAMPLE <br /> MEASUREMENT <br /> P~~r~nr , :,., . . <br /> i~E6LiIRFMEr~r <br /> SAMPLE <br /> MEASUREMENT <br /> PEHMNT <br /> .REbU111EMEFrT, <br />~ ,,_ - - - <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTI <br />AM FAM FY UNDER PENALTY OF <br />ILIAR WITH THE INFORM LAW THAT I HAVE PEflSO <br />ATION SUBMITTED HERE NALLY EXAMINED AND <br />IN <br />AND BASED ON MY ~ -` TELEPHONE DATE <br /> INQUIRY OF THOSE INDMDUALS IMMEDIATELY RESPON ; <br />SIBLE FOR OBTAINING I <br />\ ~I <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INF ORMATION IS TRUE, • <br />~ <br /> <br />ACCURATE AND COMPLETE. I AM AWARE THAT TH <br />PENALTIES FOR SUBM <br />TTING FALSE INFORMATIO <br />ERE PRE SIGNIFICANT <br />N <br />NCLUDING THE J <br /> <br />, I <br />I <br />P <br />S DO O I <br />L O <br /> OSSIBILITY OF FINE AND IMPRISONMENT. SEE IB U. <br />.C. § 1001 AND 33 U S.C. SIGNATURE OF PRINCIPAL XECUTIVE <br />TYPED OR PRINTED marimum~m~n'sonmertt of be(weenl Bmonlh,~entl 5utle lures up ro Sr0,90p antl or <br />p years.) OFFICER OR AUTHORIZED gGENT AEA <br />C <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence e(I attachments here) <br />:.5 G IRON LIf!ITS Yltl B° YAIYEU E 5ETTLBAF.LF _°,CL7LS LIY.IT AFFLIEC PCF <=10YB~2~FF FFEC7F EPfRi~ T`__, <br />IitUN G SEITLEAULF SCL1U5 LIMITS wAI9FD POH :1OYN~i4NFi PFECIF EYEMt ~UE~ECT 2'0 BCFCEII CE IiCCE la 1•A.Z. <br />r r. c r r <br />EPA Form 3320-7 (0&951 Previous editions may not be used. ( P CES EPA kDRM T-40 WHICH MAY NOT BE USED.1 ~.. ... ,.. ~... ,.. ~ ~ .. • ~ PAGE -. OF <br />