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PERMITTEE NAME/ADDRESS (Include Facilirv Nume/Loconnn r/D~eeenq <br />NAME 53t~ECA CGhL CC7kIMY <br />ADDRESSURAW E: EI D <br />ti r4 Y0EN CO 61639 <br />FACILITY <br />LOCATIOt~,iYL1LN CO 81630 <br />A"C'.t~: ~:, dU;: FSnUMB, CtKE'.hAL MAAAGEF: <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCNARGE MONITORING REPORT (OMR; <br />12-161 !n. 9) <br />CUU C L A - <br />PERMIT NUMBER ~ `. DIBCrIAgGE NUMBER <br />^. <br />MONITORII PERIOD <br />Y MO DAY YEAR MO DAY <br />FROM TO G ~ ~ ~ -~ <br />120.2 1 (L7-?51 (26211 Rfi-291 (3P31) <br />Form Approved.. <br />„ L V Q R OMB No. 2040-0004 <br />Approval expires 05-31-984 <br />(:;UBB 111) <br />E - PIIII 'rCLlL <br />LISCMl1I6E IC ]FIEJt]_Y. CFfE!< <br />op LISCtlIiGE (__i ~~~ <br />~ Read Instructions before completing this form. <br /> r3 Cerd ony) QUANTITY OR LOADING- NTRATION <br />!<cerd On/y) QUANTITY ORC NO. FREOUENC SAMPLE <br />PARAMETER (46-53) /5a-61) _ <br />(3B-45) (46-53) (5461) EX OF TYPE <br />(3237) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />162-aTl ANALYSIS <br />(6<-6a) <br />69-70 <br />SCLIu$, 'DOTAL SAMPLE ""''`~' ~ 9 i ri04 ( I.I <br />r <br />S U:a P E N EI h G MEASUREMENT - ,) <br />I v (J ~ 3t~ (/4 <br />OU53U 1 U U PERMIT ~ tPtO :nYt L; <br />~~ u; EI' (tA ' <br />tE'E'LUkt'T G5US5 YnLUL REOUIREMEt1T " ~XnlL`?k .,^,S, `;.'}ODA AYG , <br />OAF,~,' !G/L .'++'~ CYTtl <br />SCLIU5, ~F.TTLEAE.Ia SAMPLE ''f2+7v`'~ aa~aa~;.~T AO >oo <br />L <br />~ <br />/ ( ~=) <br />~ <br />I/ <br /> MEASUREMENT ~ <br />'< O• On <br />{ 3v 17~y <br />UUSO~ 1 0 0 PERMIT Aa ~ ;>r;y ~ ;,»; F£rC T EfC '7 E A <br />k,FFL'JtaT (;HO55 VALGk F1EQUIREMENT t;;:v <br />u ?OCJ AYG GAILI tY tL/I ~'r11YE <br />I hi1N <br />TOTAL EECUYEAAtlLL SAMPLE <br />MEASUREMENT "~'`''" r`'A"~`"`" • <br />~^'I <br />oe I ~j A <br />(,J. I~ ( IS) <br /> <br />UCydU 1 0 0 PERMIT ~ 4 •. BBF'CA / 81 <br />:.F'FLUvvT i;ROSS YALGE -ti~QUiREMENr ... <br />~ QI~~ RMG OAIIJ bX- 8G/L rCM7tl <br />u1L A~;i L; E SE SAMPLE f,x'~'~:^ r:; {;; .r ;: :50 09 <br />' OiIC U I 1 ) <br /> MEASUREMENT - N (,/ '- <br />u ,' ~ r 1 1 U U PEOM1r » ; c^ I A~1 ~ 4l i 1 E <br />cFELUBr.T E;HOSS YALUE iIFSE](JfFiEINENT ;t::: e~ XNS1 MAY I <br />t'C ' i't89 <br /> . { '4~, / <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~°r; <br /> :kiCbtlIRCAAEh1T ~ ~ .4~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . ~ . <br /> EiEOt11R~SAdEN-1' -.. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT• .: <br /> R,EkUIREMEPiF ~ "'".~; ' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT I I{AVE PERSO <br />ATION SUBMITTED HERE NALLY E%AMINED AND <br />IN <br />AND BASED ON MV TELEPHONE DATE <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. <br />PENALTIES FOR SUBMITTING 1 AM AWARE THAT THERE ARE SIGNIFICANT <br />FALSE INFORMATION <br />INCLUD <br />NG THE <br /> <br />POSS <br />B <br />TY OF <br />AND <br />I , <br />I O~ ~I <br />- 0 <br /> I <br />ILI <br />FINE <br />IMPR SONMEM. SEE I6 U.S C § 1001 AND 33 U.S.C. SIGNATURE OF PRIN PAL EXECUTIVE (/ <br /> <br />TYPED OR PRINTED g 1319. (Penettres antler Nese stalNes maY inplutle hoes up ro 510,000 entl or <br />maximum imprisonment olDOM1Ve9n6months end S <br />ears <br />) pFFICER OR A ORIZED AGENT <br />~ A <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . <br />Y OD <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all et(achments here) <br />(~:; Ll~;IT FILL ut ~AIY!C AFD SETTLEAALE: SCLIGS LICIT APFL1hC FCN <-lUYF,24Hi2 PBECIk EYE17; 7S` E <br />Sc'I'TLL'AEILE SULLDS L1Y1't YAIYED FOB >IOYA,24ttH PFEtl? EYEF2 SUkJECl TG BUALEN CF IFCGP 11 I.A.I. C11 <br />.~_ ~ <br />EPA Form 3320-1 (QB•95) Previous editions may not 6e used. (IPLACES EPA FORM T-40 WHICH MAY N07 BEUSED.) nn n e n i ~ x. n c , -, , c e , PAGE OF <br />