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PERMITTEE NAME/ADDRESS ((nclyde Faci(iry Name/Lorarlon /filrgeenq <br />NAME TtzAi'PtH MIdINC, INC. <br />ADDRESST;tgPPl'R MINT' <br />P.O. ROX 387 <br />FACILITY `" }~ A I G C O 815 2 b <br />LOCATION <br />r1ATONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FOrm ApprOVOd. <br />DISCHARGE MONITORING REPORT (OMR) OMB NO. 2040-0004 <br />MINOR <br />PERMIT NUMBER DISCHARGE NUMBER (S U 8 R N N) <br />F - .FINAL <br />MONITORING PERIOD ?OHD RS TO NO NAME GULCH <br />YEAR MO DAY YEAR MO DAY _ <br />FROM 00 07 0 TO OU 0 0 -ay 'i~ DISCNAF.GE ~~ ~_,ala4 , <br />Mft%'4" <br /> <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />P <br />T EX ~ OF TYPE <br />ARAME <br />ER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS AMALrsis <br />AIL ANJ GREASE SAMPLE e~aacta ( 911) aaKYa~a b4a+Cr## '=+; :~`t{r <br />. <br />V' I S U A L MEASUREMENT Q C7 : r~~H9~ <br />r+4Dbb 1 U U E5=3 g a# <br />c:F FLUE: 'iP GF.JSS YLL'UF NO=O nJn.°EP,'ka4'~: r <br />, <br />ri~~R '~ sai>} - ~_ - •-~, ", a~ <br />SAMPLE <br />MEASUREMENT <br />SAMPLE ~ r <br />r <br />\SUREMENT ~ `'~ '~ <br />L `} <br />Y. <br />SAMPLE Y <br />\SUREMENT ~ - <br />t,' <br />SAMPI:E_ ~ ~ ~ ~P' ~' <br />-__ __. _._ ~ a.~ <br /> SAMPLE <br /> MEASUREMENT <br /> -i <br />d <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER ICerWy under penalty of law mat iris document entl ell atlachmenis were <br />i <br />h <br />tl <br />l <br />tl TELEPHONE DATE <br />t <br />a rystem <br />es <br />gne <br />prepared under my tltreaicn or supervision In accordance w <br />to assure that quaAfietl prweonnelpmpedy gather entl evaluazethe lnfotmation ~~ 970-824-4401 00 10 24 <br />W. GO;don Patera wbmuted. Based on my lnqulry of ma person or pareons who merege the eystem, <br />1 <br />1 President/General Manager wmose pereone dreoUy resporulbb br gemering Va hlormation, melrYOrmetlon <br />submitted V , to the best d my 1maNadge entl belet, true, ecraoete, erM complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br />l ern aware tlvL mere ere sign cant penaldea for eubmiNng false hAormalion, <br />TYPED OR PRINTED Indutling me possibility of fne end lmorisonmarR br knowing violations. OFFICER OR AUTHORRED AGENT <br />__ _ CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (ROlerence ell atrachmenh; here) <br />TSS 6 IUTAL IRON LIMITS HILL HE ^A.IVED, AND SETTLEA6LE SOLIDS LI:`SIT APPLI°D F']3 <=IOYR,)1:HR PPECIV °VEN'p- <br />51;~ BUNDF.9 OF PF.OUP RE~UIR$~fENTS UN]t:R 1. q. 3. PERMITTEE MUST TAKE ALL REASDNA`dL'r' PF.AS7(?^S TD 9F:DUCE PN <br />1 4Y li A'!r L~1~GJ -lGL 11 I.. J• •VJ ~V nlL V:]l..y 1.~~.J <br />rm b-1 /9 revious e i ons may use . THIS IS A 4-PART FORM PAGE OF Z <br />00250/OOi~717-I-+5'J <br />