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PERMITTEE NAME/ADDRESS (Include Facrfrry Nanc1laatlon rf Uiperart) <br />NAME T?:APFER "INING~ IlvC. <br />ADDRESSTkAPP89 t1INE <br />P.J. HDY ltl/ <br />FACILITY "'RIG C O H 16 Z b <br />LOCATION .. <br />RfTN: v. GO400N PETERS, PRES/GRN MGM <br />PARAMETER <br />CCU 51'AT6E-4tlH3 AC <br />:tHLOUAPHMIA <br />A!13b 1 U 0 <br />FFLUENT ;n~SS VALU <br />csD sTATPE +~baR Ac <br />PIMEPIIALES <br />ASbC 1 J U <br />FFLUr'.f+T GROSS YALII <br />AVERAGE <br />unaaa <br />SAMPLE I ~` 6 ~A'} '' <br />SAMPLE <br />SAMPLE <br />.C. <br />e <br />W. Gordon Peters <br />President/General Maaager <br />SAMPLE <br />NATIONAL POLLIfrAN7 DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (OMR) OMB No. 2040-0004 <br />:'II;iOH <br />.- PERMIT NUMBER DISCHARGE NUMBER (S it N P. K W) , <br />F - FINAL 11urAT <br />MONITORING PERIOD ACUTE SET TESTIrG POR Q05A <br />YEAR MO DAY YEAR MO DAV r} <br />FAOM TO ^++!' NO GZSCHAIsGE 'a~ a'~# <br />NOTE: Read Instructions befor9'c-ompleting this form. <br />Y OR LOADING QUANTITY OR CONCENTRATION N0. FREOUENC SAMPLE <br />EX of TYPE <br />MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS aNALrsls <br />~ , <br />~` ~'~ ER- <br />'t <br />1J-L <br />I Ceridy under penalry of law that Nis documem end all ahachmerne were <br />phi DH~aC Urtdermytlira[tlolror soDernsloninaowrdenceMitha-rysromdeapned - <br />b sswre that qudlfietl Personnel propedy Bather end evaluate the inbnna0on <br />aubmttted. eased on my InquMy of me person or persons rviro menage me system, <br />or ihoce perepns Oliectiy reeponsibb br gemennB the blonnation, the Inbnne0on <br />aubmme0 b , to Ne Dest r» my ImowledBe end Dellel, We, eaLrele, end rumplete. <br />I em exam Net there ere alBniACent penaltlm for submitting labs imormation, <br />SIGNATURE OF PRINCIPAL E%ECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />ER- <br />TELEPHONE DATE <br />970-824-4401 00 10 24 <br />NUMBER YEAR) MO ~ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference elf attachments here) <br />SEE I:A.lr PP /-5, TOR DETAILS OF TEST Pf:JCE'DUnF. k''P;lrtT LC50 - ,'CA^,:•1"I";;. P.l:`:" ESTItlATF. 1+RTCH IS <br />LETHAL TO h0: OF TEST ORGANIStlS. AND AT.TACN ACUTE TC'~KI~TTY :FGT ,,P~;T f'~+.~`: ... '1,MF?, COP1F.3 OP~.~LL <br />A Form 77 P2 w us e l Ions ma be used. ~ ~ ~ J ~ ,'~ 0 ;! 7 3 / U 0 i 71 7 ~ 13 5 0 ~ O GE 1 ' °~ / <br />~, <br />