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PERMITTEE NAME/ADDRESS (Inerrde Factl4y Nmne/Loradoa ifDB~+) <br />NAME Tr!APP F.R MI!11 N;;, INC. <br />ADDRESSpc;0.2pEN .TINE <br />P.O. BOX IHi <br />FACILITY `aAI., CD. d162h <br />LOCATION <br />ATTN: lie GDRDOV PeTf.HS, PkED/GE`1 HGk <br />a <br />PARAMETER <br />AVERAGE <br />..~~ ~f ncnc.voan a~ <br />~ERI7U0.?!iNIA <br />A"13B 1 0 G <br />Ff'LUEtiT GRO55 YALU <br />CSU STAIRS ybHR AC <br />PItfEPHALES <br />Ad6C 1 U 0 <br />FFtU6VY GROSS Y-L^ <br />9 <br />I;, <br />[-~•'.I h <br />• fl=' <br />fir <br />.•, ., <br />SAMPLE <br />PRINCIPAL EXECUTIVE OFFICER ICaNy and pane . Law that lMaCocumentsM all atuchmems were <br />N <br />i <br />al <br />d <br />i <br />d <br />d <br />b <br />d <br />iM TELEPHONE DATE <br />prepare <br />w r on or super <br />on <br />axor <br />erxre w <br />a sy <br />em <br />es <br />gne <br />S <br />to assure Vial pet9fietl personnel pmperry gaMar end evaluate Ne 1nloimeGOn <br />P <br />~L-~"- <br />~ ~ <br />970-824-4401 <br />00 <br />LO <br />24 <br />n <br />eters eubminetl. BasedmmylnWiryoliheperwndperaolnatpmanegetMSystem, 7 <br />. <br />or apse persau deacaY responsible for yemedrlg the irdomretbn~ Ne Inbm~etion <br />t /cane ral Manager <br />l <br />d b <br />ll <br />t <br />d <br />t <br />, true, e,xixefa, an <br />e <br />subrtsnetl le , to the best a my knoMeoge en <br />a <br />e <br />wmp <br />e. <br />1 <br />ifi <br />ltle <br />b <br />itti <br />l <br />l <br />I <br />bm <br />tl <br />t <br />N <br />l <br />h <br />i <br />t <br />b SIGNATURE OF PRINCIPAL EXECUTIVE <br />pene <br />r su <br />ng <br />a <br />n <br />ne <br />on, <br />am aware <br />a <br />t <br />ere e <br />e s <br />gn <br />can <br />s <br />m <br />w <br />TYPED OR PRINTED Includ' the sibu' N fine and lm rLSOnmem br knowi vrobtions OFFICER OR AUTHORRED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />JD ;EXPLANATION OF ANY VIOLATIONS (Ae/erence all atfachrnents here) <br />1, PP %-9, FOR OEPAILS DF TE5T PROCEDURE. HF.PDET LC50 - STATISTI~A;. POINT ESTI'fATc. QH ICH I~ <br />~~~6;.pF.:sesY QR~A~IISns, AMD::#TlACB ACUTF YOIICI?Y TE5T REPORT FOk'" T7 DHR. COPT°S pF ALL <br />,~-lf~l~~!ii'Iff~!~~'~ ~j~'; <br />Yi e ,. .. ~ <br />iv i; <br />~ rJ iE 1 - _ S s P ~ OR . ~.E .r n i. <br /> <br />f1ATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM tNPDES) FORD Approved. <br />DISCHARGE MONITORING REPORT (DMR) OMB NO. 2640-0004 <br />:7I ti D k <br />(SUAR FA) <br />PERMIT NUMBER DISCHAAGE NUMBER r- f I t+ A L ~ Mur d T <br />MONITORING PERIOD ACUTE JET T25TING FOR 417 6 <br />YEAR MO DAY YEAR MO DAY _ <br />FROM TO 9 0 anp NO DISCHARGE ~~ ( 4Atp <br />- NOTE: Read Instructions betore~o'rnpleting this form: <br />RTY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC -SAMPLE <br />EX ~oF TYPE ~ <br />MAXIMUM UNITS -MINIMUM AVERAGE MAXIMUM UNITS gNatvsrs <br />re ~rraa+x dr. .',r::r ir'.: (: yr's it ( :3~ <br />r~ <br />oc s.. rb ~~''"~`~ C' T <br />Y. Yf :Y Aran ~~ ~'J 4`r`-~Y Av /.. :fir;: YF ;Y .+: r: ( 23~ <br />~ ER~% . ~.. sk <br />s' <br />