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PERMITTEE NAME/ADDRESS paclude Fanliry Nmne/Lgegrlgn ifD!$oen!) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDESJ Form ApprOVed. <br />NAME DISCHARGE MONITORING REPORT (DMR) OMB N0. 2040-0004 <br />IkAPPEB !fIRII:G. I;7C. yINOR <br />ADDRESSTeiAPPE;R `TINE ~ ~ ~Sf1i'lR Nii) <br />P. O. D D R 1 N/ PERMIT NUMBER DISCHARGE NUMBER F- i T N A L <br />FACILITY..~A`o CJ llbl.b MONITORING PERIOD 0.CUTF: I: ET Tr'5TING TOR ~101A <br />4' <br />LOCATION YEAR MO DAY YEAR MO DAY _~ , <br />FROM TO 09 ooh YO DISCHARGE ~ ~{ ## <br />A 'f T Y: :, G 0 9 G O N P F, T E H S, PRE 3/ G R N ":; P NOTE: Read Instructions before complA g this form. <br />lCiF•A" <br /> PARAMETER EX ~ of TYPE! <br /> AVERAGE MAXIMUM UNITS MINIMU <br />M AVERAGE MAXIMUM UNITS ANAL15l5 <br /> LC~U S1'ATFc ayRR AC` SAMPLE tt:'`rFCarr 7>x>Ea~m ~ <br />/ <br />x/610 ~G':'.:d:e ,kv#>`4;Y ( 23) <br />~ <br />}~ <br />~ <br /> .: .".RIUUA PEIGIA MEASUREMENT 1 <br />o / <br />, <br />+ <br /> ~ <br /> TAKjN 1 J 0 #~>7 cad <br /> EPFLU NT G;iJ55 YkLU fi~=':o -~ CENT "x <br /> L~SU SiATF:~: Y6RR~ AC <br />F' i N ;; C ~ A L f: S ~ SAMPLE <br />MEASUREMENT fir`'"s` R 4C484R ~ <br />i~~~ ,#fib'~r+ .fi$;tCd~ ~ 23) <br />~" <br />~ ~ ~' <br />~ ~ <br />-C.~4~ <br /> P1YbC 1 U 0 s#a dk- Ka <br /> !:FE'LUEaT G~,J35 YALU #fi^°'. ~'~' CENT a` <br /> SAMPLE. " <br /> MEASUREMENT <br /> M Y <br /> SAMPLE ." ~! <br /> MEASUREMENT <br /> <br />I'." SAMPLE ~'~~;. ss ,~ r~{ <br />"C~ <br />1 MEASUREMENT - '" T ' <br />~~` w <br />1" <br />h <br />~t: <br />~ <br />- <br />r~ <br />~~ <br />, : <br />" ^' '~ <br />f ~ .. ~ SAMPLIi :" __ . <br /> ' MEASUREMEN ~ ` <br />V <br />~~ <br />SAMPLE <br /> - MEASUREMENT <br /> <br /> . <br />~ " '_~- +t <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICMiry antler penalry dtaw Mat this documem and All enepMnsme were TELEPHONE DATE <br /> prepared under my tlireNan or supervision In ac Wrdance wRh a system designed <br />iM <br />HO <br />i <br />l <br />l <br />g <br />d <br />~~ <br /> n Patare <br />W <br />d <br />G Orme <br />sedpereonne <br />propedygatheten <br />eva <br />uate <br />w <br />n <br />toessuelMtqual <br />" <br />~~ ~ 970-824-4401 00 10 24 <br /> , <br />o <br />or subnihed. BBeetl on my Nqulry of Ne person or pereons who menage the rystem, ' <br />~•~~ <br /> President/General Mana ger or NOee persona dkectly rocponaible br gelhering Nelmonnagon, Ne lMormatlon <br /> submitted k, ro the beet of my knowledge end belief, true, ecwrate, end complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> TYPED OR PRINTED I ern aware char there ere slgnificam penalges for submMing false Inrogrellon, <br />Inclutlino the possibilirv of 5ne antl lmorisolwrerN ror knowing NOlagons. OFFICER OR AUTHORIZED AGENT <br />rnnc <br />NUMBER <br />YEAR <br />MO <br />DAY <br />"r,'E I.A.l. PP /-9, FOR DETAILS OF TF.'ST PROCF,UURP.. P.F.PORT LC50 - STATISTICAL PJIY7 i:`?IMATE ^9ICN IS <br />LFTHdL TO SOL' OF TEST JHGANIS!1S, AND ATTACH ACUTE TOXICITY TEST REPORT FOE;`! T1 ;i;71:1~i gi;v7l.~.'S RF ALL ' <br />A orm 332 (R ! revious I Ions may be use ~ r 00 2 4 5 / O ~ J 71 / I II?'> 1PA~T 0 M AGE O ~" r r <br />1 <br />