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<br />':.'PERMITTEE NAME/ADDRES$pnclude Faci(iry NamdLueanon ifDiJferenf) -NATIONAL POLLUTANT gISCFiAgGE ELIMINATION SYSTEM (NPDES) ~ FOml ApprOVed. <br />NAME p.R A P P E R t1 I N I N G <br />! N~ DISCHARGE MONITORING REPORT (DI41R) 1 OMR No. 2040-0004 <br />, <br />. <br />ADDRESSFRAPYER tlIRE n <br />Y 0 R <br />(SUER NW) <br />P. O. ~BJX ltl7 PERMITNUMBEfI, oiscRAgGENUMeeq p.~ _ PI*AL ~ ~~170F:1T <br />`' FACILITY`'R~I~ ~ -~ NLb2b MONItORINGPERIOD ~ POND 13 TO NfpOLB lTBAY?.•GULC~It <br />.~ LOCATION - YEAR MO DAY YEAR MO DAY . ~, ~ ~; . <br /> FROM 90 10 TO 1Z a>s# NO UI <br />SCR~RCE ) Oab <br />ATfN: <br />4 GDRDON PETBR:i <br />PNES/GE4 MGR r <br />NOTE: React nstructlons,befo r pleting this form. <br />. <br />, <br /> ' ~ - - QUANTITY OR LOADING ~ - QUANTITY OR CONCENTRATION ~ NO; FgEOUENC SAMPLE <br /> <br />i ~ <br />- `PARAMETER - - <br />'~ EX ~ - . of TYPE <br />' ~ ~- AVERAGE MAXIMUM UNITS MINIMUM. AVERAGE MAXIMUM ~ UNITS ~ - ANaL,~Is <br /> LL AIf;D., GREASE SAMPLE aaaasta ( 9u) •.. aasaa# aaat#s.' #aaana , <br /> VISUAL ~.~ ~' ME4SUREMENT ~ - - ~ ,y ~ <br />~. ~ `'`~ <br /> 4U66 x _: 0 0 ~"" + ES-1 ~1t~f <br /> EP.PLUBM~T GROSS YfLU RE ~NT a '".,xar l% 'F ,!! ~ an=n <br />NAMEfTITI PF~INCIPAL EXECUTIVE OFFICER ICan'rfy under penalty o118w Nat thb document and ell anachmems were j,P,LEPHONE ~ DATE <br />~' prepared under mydretlion or supervision in dC'.Wrggnce'w'the°~aamd~gngl__ _ -- --. -' - <br />- - - ~=--r------- ---'~- `--- --fO eSSUro t~Cqu~e~pefsonnelp/opeAygather and avaluBla Nainbrma8on }~ ~ ~~~,~^` '- ' <br />W. GOldon'.P~CrYB - submitted:'. Basedon'mylnqulryotthepeisonorperson5whomanagethesysiem, ~~+' /~" 970=824-d4D1:' Ol Ol 16 <br />Preside ~Gl1,1ES8~,'. 1ltII •! , or those pct}sons d'reCUy responsible br gathering th@JMOrmatlon, the lNOmlation <br />,~., ,..• ~ submlttedk,fothebest or mylmowledge end beYeR Clue, accurate, and pomplete. SIGNATUREOF PRINCIPAL EXECUTIVE <br />' .lam ewarq that there are eignnioant penalties hrsutSmitting /else lnlorma4on. OFFICER OR AUTNORIZED AGENT- NUMBER YEAR MO DAY <br />ED OR PRINi~q ~ Includin ttM sibdl orfine and im riaonmantttN owN violapo(la. <br />COMMENTS ANOEXPIANATIaNOF ANY VIOLATIONS(Re/erence all attachments here) ~ '. <br />TSS 6 !0'1~1L :FROM LIMITS fiILL 88 VALVED, AMD SE'F4LEABLE SOLIDS LIMN APPLIED POR <=102q~j4RR'PBECZP EVENT- <br />SEE bURD61~ OR PR130f. Rtip4IREtlBRiS UdDER I. A. 3. .2DS flONITORING - IiB.3. DTL G.GREASE =. SEE LB. }..(D). <br />TYA orm 33 0-t 9) revwus e 1 wns may a use - ' _ _ _ . _ ~ _ _ IRIS IS A 4•PART FORM PA(;i= nG <br />