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PERMRTEE NAME/ADDRESS (!nclude Faciliry NomsAnemion llDi$eraq <br />NAME <br />ADDRESS ti0 ~ I L 9:). .+ '. [ ;. <br />P . 0 . f c)1( '1 ~ 1 <br />FACWTY PAUhIA CO d14?y <br />LOCATIONbOiI i `. <br />CO 317 2'1 <br />AMTS: M~ILLIA' A, ".F•s4 7R_ nrkl. Irv <br />NATIONAL POLLUTANT DISCHARGE ELMINATION SYSTEM (NPDES) FORn AppfOVed. <br />DISCHARGE MONITORING REPORT (DMR~ OMB No. 2(Yi0-0004 <br />rz-tsl !'r' e1 w I al n R Approval expires 05-31-98 <br />.- PERMIT NUMBER DISCHARGE NUMBER (' fIr' a ~ C ) <br />~ - FI „A1. DF.LT~ <br />MONITORING PERIOD )SCyr; OF SR TO DFrR TkA1L r.^CH <br />YEAR MO DAY YEAR MO DAY <br />FROM TO n '17 ":C•' •+'l 't*crypP!-a )-~ #?:A <br />(zaz+l (nss) (zazs) (ze-zr) rze-zel (soar) NOTE`: Read Instiuctlonsbetore combleting this form. <br /> (3 Cero'Ony) QUANTITY OR LOADING (<Cald Ony) QUANTITY OR CONCENTRATION NO. FAEOUEN SAMPLE <br />PARAMETER (4G53) (5x61 (38-45 (46-53 (54-61) EX OF TYPE <br />(52-3~ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS lsz~l ~sq g1$ sg~0 <br />i+H SAMPLE ~#~.'da F+34.Ofc :)r-,;r~r:r: ( I2) <br /> MEASUREMENT <br /> <br />.;JU00 1 0 D <br />xr~: <br />x ~y~# <br />?> <br />r <br />G#t <br />'~ <br />tk.4 .", <br />~s <br />~r~,..>f °' <br />~+'' <br /># <br />~ <br />^'9 !c <br />~+t` <br />FFLOE GDa53 Y LU ~ v ,~ ~ t~. #e#n ~3 ~ ';. , <br />, <br />' ~' ; ~~t .~ ;5''~ <br />~ LDS, t'JTAL <br />~ SAMPLE ####t# ##nC:## ###>"~:'.' ( 19) <br />~ <br />Y E M D i U MEASUREMENT <br />OOS3U 1 0 0 `~ PERMIT - g41>fti+- ;; #3P r ~tp •.; <br />~~ °~ <br />t:t'FLUENT GflOSr YAL'I A61i IREMENT ~- ;- "T ~ <br />~ ~,. a w^ <br />~L1LID5, SETTLP.h1,t,'-' SAMPLE ~a^"Y~ ;se#atr= :~t~x='~'.+ ( 'S) <br /> MEASUREMENT '.I <br />ROANS 1 0 R'.; #oa~~t <br />~ a## ~ 1~'~` °..~ <br />t:reLUErT G6055 vAL^ aEOU ' <br />` 4 ~. von ~=',~''.~ ` v ~r:~~ <br />1 A0:1, TOTAL SAMPLE -.:f-'.-t••^•C# #+k vFG#iR #34>t*'= ( +71 t~., <br />(~ S F F~) M UREMENT <br />ULU4S 1 0 0 RMIT t#O#`. Y+t ~,~,„:. * <br />$~~ <br />`~ <br />~~ <br />• <br />EE'FLUr:}+T GROSS V U UI~EMEN7 ~) ' ~~ G### ~ ` <br />AIL A7D GREASE SAMPLE =`•#O#t# ^.;tr{x>r #crr:~. !; •,:Y++ep- ( 19- <br /> MEASUREMENT <br />v 358 1 0 0 °'P. ' * <br />;~ ~~11~# x#a ~ 4 #O+JwS_ "v,,, :, t <br />y:` ~a <br />;:E'FLUHN GROSS va;.U fi~~lU ~ <br />-g` .. - f#~:t ., ~.~`~ <br />- r <br />- ,- ,, <br />F 'ti, IM CON DII T'' I'? SAMPLE ( 03) '~##rt ^45' #:: ;_{:~.-, 4ri;4: 4>t <br />I~J ':kBAT!!E:NT i'LAq MEASUREMENT <br />50USU 1 0 0 ~r~`~ERMR' <br />' c-r EP('~'~~ ~tiI( 4 ti p~IF:{I ~ ?~~ #~'~ ~ ~~K~~ <br />cFFLUENT CkOSS VALU UIREME,k1 <br />C ~~ r• ~ ;*~'~~ <br /> <br />. -~~~~' ;',ra a#s , <br />' <br />; . <br />~~~~ <br />SULIDS, 'TOTAL SAMPLE ?~aca# axxpr~ #t~a~iw~: ( lq) <br />DI:i3ULY 60 MEASUREMENT <br />70295 1 0 G ~ MIF~ #o#( <br />~ <br />~ ''1+'1~ ac:v ~~ ~ ,~, s ~!}5~t'!`'~ <br /> <br />~ ~~'~'~' ~~ <br />'x ,<" <br />~ <br />1+"~``- <br />~. <br />.. <br />F~FF 8 GR-. S'; 7D. 1. R~EMENTi <br />A <br />~" z <br />~ <br />k <br />~ <br /> <br />F ~ , <br /> <br />x <br /> <br />z <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI <br />AM FAM FY UNDER PENALTY OF I <br />ILWi WITH THE INFORM AW THAT I HAVE PERSO <br />ATON SUBMTRED HERE NALLY E7NMINED AND <br />IN; AND BARED ON MV TELEPHONE DATE <br /> INQUIR Y OF THOSE INDIVIDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING <br /> THE IN <br />ACCUR FORMATION, I BELIEV <br />ATE AND COMPLETE E THE SUBMTRED IN <br />I AM AWARE THAT T FORMATION IS TRUE, <br />R <br />ARE <br />IGNIFIC ~ <br /> <br /> <br />~ <br /> <br />PENALT <br />. <br />IES FOR SUBMITTIN <br />H <br />G FALSE INFORMATIO <br />ANT <br />E <br />E <br />S <br />INCLUDING THE <br />N '! <br />r _/I <br />~ ' ~ ` <br /> TY , - <br />-~ / , <br />, ! ~ ~ ( POSSIB W <br />OF FINE AND IMPR <br />l ISONMENT. SEE to U.S.C. 51001 AND 33 U S.G <br />utle ones u <br />tr+ (10 <br />000 end a <br />~ SIGNATURE OF PRINCIPAL EXECUTIVE ' ~ i,J <br />. / 4 r <br />TYPED OR PRINTED mexMUm Imp <br />onmenr of beMSe p <br />, <br />n B <br />monW entl6 <br />leers) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reverence r3l! ehecnments here) <br />~e!'TLBABLe 'tit*,^; i.1!'I" 9PPLTES r)sl.Y IF C1CYiI,2uHF F5EC7D FV4ssT TS Ci.A.I"E~. IF rLATa .4PFROVFD RY ~,:Ch, <br />';~i; E IROEi LI+'[T:; .TTI, r: '7T 'r '- APPLISD 1'O REPORT?n 9FA 5'I RrI"T9T5-SEE. T. A.2, FG 5 FOR 9p RDFN OF PROOF <br />EP For h -9S~ Prevlb s editions May ndt be 1lSed.• ` • `• ' (REa CES Ea 11 Td 1 - AY ~E ED:) ~ - • - • • PAGE OF <br />- 0f1n1 7/97 t171 2-] ?? 7 1 <br />..,, <br />~~: <br />~`i <br />