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PERMRTEE NAME/ADORESS Qrrchde Foci!!ry NmneJLocarian iJDlgerenr) <br />NAME i11; ~ <br />ADDRESS 60N I 8 !i t). ? :' I V' <br />P.J. :0:! oy~ ' <br />PAOhIA CIS B7>l2R <br />FACILITY <br />LOCATON~IUy I Y <br />CO 11U 29 <br />AT^N: iLLL7 !',~ ~. '~~gA TA_ rTVr rr-u <br />NATONAL POLLUTAHT DISCHARGE ELMINATON SYSTEM MPDES) FORM AppfOVBd. <br />DISCHARGE MONITORING REPORT (OMR~ <br />tfi <br />9 <br />T OMB NO. 2040-0004 <br /> ) <br />R- (t <br />- <br />) rTgr)F <br />05-31-98 <br />i <br /> res <br />Approval exp <br /> rr ~1 A ^nt ~cll qi! a^) <br /> PERMIT NUMBER DISCHARGE NUMBER .. _ F ' ti <br />g 1 I• E L T A <br /> , <br />. <br /> MONITORING PERIOD -` ~ `+ "r ~ i/ M I G q ~ F Y C T O U F° ^ T' L <br /> YEAR MO DAY YEAR MO DAY <br /> <br />FROM <br />:11 <br />0 <br />TO <br />'1 <br />7l <br />#C:'= @ <br />^ CI°CH 9 <br />Q <br />~ __ <br />1 !%=- <br />~ <br />Razn Rzss) (zags) Re~~r) Raze) fsO~sr) NOTE: Read Instructions befo leting this form. <br />eom <br /> (3 Cmt1 Ony~GUANTITY OR LOADING t4 CeTd Ony) OUANTIT/ OA CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (54-61 38.45) (4('x53 5481 EX OF TYPE <br />~~n 'A+/ERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSts <br />70 <br />68 <br /> (szm) /5a-6e - <br />I)LL AND l;AF0.=£ SAMPLE laX:a;:ao ( 417) #a*~ca taaaa~ Aa~tMa., <br />J I `~ U A L MEASUREMENT <br />t,t1uEE 1 0 0 ~ ~~Nn 'z~:t, ~ .;= ,~ es=1 _ '~ t~~a <br />~Yr'LUEpT GR053 VALU ~9UIR@ 1 y --"'! _ 110-0 v••~ '. - -; ,- •, ~`~_'°*- ~iA03 ~ -3 `' ~- 4=_ <br /> SAMPLE <br /> MEASUREMENT 4t <br /> •: <br />• <br />i „ <br /> <br />~ <br />~ <br /> ./ <br />_ <br />~ ~ t W :I a. ~ ~. .X.IT . "(i R l.r ~ aY' i .~ ui. . [` ~ L "t , <br />y <br /> SAMPLE ~ ~~ <br /> MEASUREMENT ) ~ <br />~ ~ :...~ / ,.. , ( ' <br /> <br />PERM ~ r` <br /> <br />~ 4 <br />.,~ ~$iJl <br /> <br />~ ~f~ ~lY. <br /> AEQUI~II - ~ '~'~` ~, ~ ~ <br />' s ~ ; ,, r~ <br /> SAMPLE <br />~ ENT <br />MEASUAE <br />M <br /> ~ <br />y <br />`~HHMI~.: J rF~ <br />~ r- wAt1n '_`d' <br />t <br />' C 'r'4x ~,~, <br />` B*-~} <br />~` ~+a.- <br />' ~ <br /> AEC <br />jL11R~MENT - ~ - ~ <br />~ ,"r+ 5 ,~ ° ?a .R' <br /> ) <br /> SAMPLE <br /> MEASUREMENT <br /> t . "* . <br />~ <br />'° ; ' <br /> IpEM~Wt I <br />« ~ ~ r#; <br />~ a ,~~~. ~ <br />• SAMPLE <br />MEASUREMENT <br /> . <br /> EUUIHEMENT ~' . ,L ".: <br /> SAMPLE <br /> MEASUREMENT <br /> .', PEfiMIT- <br />~ ~, -. ` ~w.. A ~'.,' ,'zt,` ~ T'+~:' y '$:~ ~ <br />~ <br /> <br />R~UUIREMENT <br />e ~~>; ~ : <br />- - t, <br />'^~ ? <br />~ ~ <br />, <br />F <br /> , . ` <br />NAME(fITLE PRINCIPAL EXECUTIVE OFFICER I CERTFY UNDER PENALTY OF <br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMITTED HER NALLY E%AMINED AND <br />EIN; AND BASFA ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING " <br /> THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATON IS TRUE, <br />. <br />~ <br /> <br />~ ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMRRN I AM AWARE THAT THERE ARE BIGNIFICAM <br />INCLUDING THE <br />G FAL <br />E INFORMATON ., /N <br />~~:~ ~ -~ . <br />, <br />~ , <br />S <br />SSIBILIT <br />F FINE A <br />P <br />N <br />SEE <br />10D <br />AND 33 U <br />S <br />C _ <br />~ <br />~ <br />~~ <br />_~ ,r I N ~ 1b U.S. <br />1 <br />. <br />.C. <br />PO <br />Y O <br />ND IM <br />RISO <br />MENT. <br />. g <br />e <br />l <br />I <br />l <br />tl <br />0 <br />tl SIGNATURE OF PRINCIPAL EXECUTIVE r ~ <br />' ~ ' ~ `I , <br /> <br />TYPED OR PRINTED en <br />grat <br />. (Ponatt <br />es antler mesa statutes mry <br />nc <br />u <br />e (meev up ro 518,(10 <br />a <br />mmvmum/mpnsonmerx of helweenBmpnRn entl5yaers.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS ANp EXPLANATION OF ANY VIOLATIONS (Relerence all attachments here) <br />,t:fTLL'A[)LE SOLCDS LI!TT AC'C'LIr.i UYLY I1' C=lUYh,2LLdR PRFCCp FV£.`7T 7; ('LRICPC. .F CL~I!1 EPPHOV!:0 FT N~1^TI, <br />^^,i5 `~ IgON 6I°IT; a7 LL N3T 9P: <1FFLI?iU T~ hF.i`OE.TED !!F:ASJFS!"£yTS-;EE L. p, 2, P: ` POE: RUpn=N Op DROOP <br />Form 2 7 ~} Previ u ed(tlons' a no ~be sped.' A ' `' (HEPLRCES~ A'F T=6 ~Ib V OT B $ED.)='' ~ • ' ' PAGE OF <br /> <br />