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/'ERMITTEE NAME/ADDRESS paibF.rdiryN.wfamon dD10 ae <br />NAME 'IEAF'dE`1 .7I.-: K',, .... <br />ADDRESS I fi I1 t r' F C ; I ', L <br />F.O. :~;>% 11.7 <br />CdAI•,, CU 91026 <br />FACILITY <br />LOCA710N <br />•1 :'f .V: i:. ;:'_111 p[JK^~ TEF. Fi~C3/S;E9 ~~ <br />NATIONAL POtIVTANT pSCHMOE ELIMINATION bYBTEM (NPDESI <br />DISCNARGE MONITORING REPORT IOMRI <br />1-161 17-191 <br />~n0o32115 COE A <br />PERMIT NUMBER pSCNMOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM -. ~~ ~ TO - <br />l2671) 121-731 /71.751 116-771 /IB-19l 130-311 <br />FOFIl: 17 °0 U?E' <br />(sce5 ~u) <br />F - Fi~AL <br />°ITICF <br />Form ADProved. <br />G•~S~Jo. 2040-0004 <br />Approvellezpjre4 OS-31-98 <br />~.3q NC 9I SC`iA NCS ~__) :`r d: <br />NOTE: Rud Irnwctlorls before completlnp this form. <br />PARAMETER !3 Grd On/vl QUANTITY OR LOADING /I Grd Onhl QUANTITY OR CONCENTRATION ND iREOUENCY SAMPLE <br /> 116-531 !56611 I3B-I5l !1653 l5I-s11 OF <br />137-J7) E% MALrgs TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS lud3l /6/.66/ 169-701 <br />' L. .~;1. SAMPLE L::t k:}., ;r ( 9U) '.`{-+Cn;^ Ct,00{: ,:: ~{:}yr}YF <br /> <br />V L 3 U a L <br />MEASUREMENT O ~ / <br />~ <br />~:/y/.1(~ <br />tl4Jt6 i U it PERMIT #PA4#~ Rr;PQRT E.=j v~A*.r3~ OCICCC>LT 4:E.~*## #i ;- E $?; ). Y <br />7,5UA <br />c FY'LUE,1 f i,ir0_i5 YALU ~REQUIREMEN7~ ~ ~ ~IkS'P EIAR NC=O ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ O.:+k+k . <br />. . <br />~ - <br /> SAMPLE <br /> MEASUREMENT <br /> . ::~ ~ ;.: <br />~::; <br />~ <br /> :REQUIREMENT <br />.. <br />~ ~ <br />..., <br />~ <br />. . <br />.~ ~ , <br />. :~,: .,y,. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> 'HEST. MENT <br />,....: <br />~ <br />. <br /> SAM LE <br /> MEASUREMENT <br />!I: ~ PERMIT <br />,. <br />~ <br /> .~REQUIREMENT~~ <br />~~ ~ , <br />: .' - <br /> SAMPLE ' <br />' MEASUREMENT <br /> .. PERMF.T ..~ <br />- .. . ..: <br />~ <br />~ <br />~~ <br />~ ~ <br /> IRENIENT <br />REQU ~ ~ t <br /> . . r. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> ~REQUIREMENT~ ~ . <br />NAME/TITIE PRINCIPAL E%ECUTIVE OFFICER I cERnFr UNDER PENUrr GF uW TNAT I NAVE PERSONALLr ExAMINED MD <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN <br />MD BMED ON TELEPHONE DATE <br /> <br /> <br />W <br />G <br />d <br />P ; <br />MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION, 1 BELIEVE THE SUBMITTFD INFORMATION le <br />` <br />~ ~'- <br />. <br />or <br />etare <br />on TRUE, ACCURATE MD COMPETE. I AM AWME THAT TNERE ME <br />SIONIRCANT PENKTIES FOR SUBMITTIND FALSE INFORMATION <br />INCLUDING .~/ 70-824-4401 S 4 g <br />President/G@neral Mena @t , <br />THE POSSIBILITY OF RNE MD IMPWSONMENT <br />SEE le U <br />f 1001 AND 33 <br />S <br />C <br /> . <br />. <br />. <br />. <br />U <br />S <br />C <br />! 131 e <br />lPMraYr uMr W.r .YNhs III <br />A <br />A <br />M F <br />S 10 <br />000 ~IONATURE OF MtINCNAL EXECUTNE <br />TYPED 011 PRINTED . <br />. <br />. <br />. <br />r <br />rY <br />x <br />n.. W ro <br />, <br />e+ea+mvimnl Mvlm+rrr orMMwn smonMarM SY~aI OFRCER OR AUTNORI2ED AGENT CODE NUMBER YEAR MO DAV <br /><:VMMCrv 10 nrvV LArLnrvn nVrv ur nrvr YIVLn nvrva IrtererlOCl err eRBCn/nee rJ nl/e/ <br />T :iS 6 TOTAL Iaul: LI`!I':J .+ILL riE WA IY,",p, ANL SF.TTL E'. ABLc SOL IC° <br />~EE EiURuEn OF FILOnF RF;UIitENi,~'7S UNpER I.A. 1. TL'S Y,OrIITJF7B~ <br />Previous editions mey be used. <br />LIM]? APPLIED FCF <=1~YF,749F PHCCiD `.YcNT- <br />- I.P.3. OiL E OFE.4;F - ;E!s I.8.1. (U) . <br />"""'I OOC6C/977211-1bGG <br />1 <br />