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PERMITTEE NAME/ADDRESS (lnelude Facdih NrmdGnmrmn yDigerenp <br />NAME <br />CYP[iUS EPi'InE CCIIPCHATICK <br />ADDRESSEAbLE MI1:E CCCl:IcX <br />P.c. eox ed <br />FACILITY C h A I G ... ^ I t c b <br />LOCATION <br />ATTS: AGL'UnG!' i. J+.iL!- 'J_f_ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMfl; <br />ars OMB ND. 2040-0004 <br />t <br />/ n~- sl C I F C R proval expires OS-31-98 <br />A <br /> p <br />.nr~ i '~ (BUFF 1~) <br />PERMIT NUMBER DISC - GENUMBER c _ ~ FI T ! I f4 C E A T <br /> <br />=%< ~c i'- ;1 "•76E_kEE/LIIIIIt° Fk <br /> <br />FROM ~ '~~. <br />~ fIL ChAFGF {__{ ;~~ <br />Izo~ r <br />I rz+ ~ rzsvl rzc zsl /so~sD NOTE: Read Instructions before completing this form. <br /> (3 Card Onty) QUANTITY OR LOADIN ~ ~ (4 Cerd ONy) QUANTITY OR CONCENTRATION NO. FREOUENG SAMPLE <br />PARAMETER (4s~53) (54-61) - - (3845) (4653) !sa-61) EX OF TYPE <br />(3237) AVERAGE MAXIMUM MINIMUM AVERAGE MAXIMUM UNITS <br />(6:-69) ANALYSIS <br />(64~R3) <br />(69-~0 <br />:i .iLILS, 'C G'l AL <br />G I:i :, G L Y k C SAMPLE <br />MEASUREMENT •+~'Yr ~~ #~•^.#vY 9L 9>r~4 <br />`Op q <br />i oa9 ( IS) <br />0 <br />~a~ <br />c R~-8 <br />1~1y~ 1 o G PERMIT aat~a~0 4, xx; ~~#f s' <br />fF~[~C6T C~TLCiAY 'lBiT" fiA@ <br />?FFLUL•r'T GROSS VALUc REQUIREMENT *~ _, , <br />F AVC 6 1iA& CG/i <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ` d?ERMIT - - <br />~' ~ ~, - - <br /> ~~+IREIdENT <br /> SAMPLE <br /> ME,4SUAEMENT <br /> PERM! ". ,RY <br />~ ~, <br />~ ,. ~ ~ ~ .. <br /> REOUIREMlT1T <br />. ~- ,,.:~~ <br />"'.~ .. ~, - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -~ - .,•, '~ '~ <br /> FIEQUIREMENT j ~ "" <br />~,. <br />"` <br /> SAMPLE <br /> MEASUREMENT <br /> " PERMIT ~ - ~~+.~' <br /> . <br />AEQUIREily1ENT ~ ~~%~e "I '' <br /> SAMPLE <br /> MEASUREMENT <br /> PEY3MlG' ~ t ~3n; ~1 ' <br /> <br />REQbIR2MENT- <br />- . . <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ",I i:t• '- <br /> BEQUIR~M~NT <br />NAME/FITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />H THE INFORM <br />FAM <br />LI <br />R LAW THAT I HAVE PERSONALLY E%AMINED AND <br />N SUBMITTED HEREIN <br />AND B <br />SED ON MY <br />T <br />' TELEPHONE DATE <br /> I <br />A <br />WIT <br />AM <br />INQUIRY OF THOSE INDIVIDUAL ; <br />A <br />IO <br />A <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING /~ <br />Richard Mi I15 THE INFORMATION, I RELIEV E THE SUBMIT TEO INFORMATION IS TRUE, f <br />/ <br />n <br /> <br />l ti' <br />i ACCURATE AND COMPLETE I Ah1 AWARE THAT THERE ARE SIGNIFICANT <br />E <br />ION <br />I <br />' THE G <br />;l~ <br />/ <br />/ 9]Q g]Q-27~ <br />anager <br />ronmenta <br />Env PENALTIES FOR SUBMITTING FALS <br />INFORMAT <br />, <br />NCLUDING /~) <br />~ <br />~7 <br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE fe U.S.C. § 1001 AND 33 U.S.C SIGNATURE OF PRINCIPAL E%ECUTIVE "'~ ' <br />TYPED OR PRINTED maximum~nn'sonme~ol Denwer~6 maonths end 5ude tines upro Ero.000 end or <br />p y>;ars) OFFICER OR AUTHORIZED AGENT A <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachments here) - <br />FL:±w LIr,IT AYFLIES 1C CCMBItiED FLLi: FFG,1 CG?, C22 E C1U. C11 E GFcA_k GAAF SAP,iIF AhAIY,l$ BF(CIbFC IE <br />Vi;,IbLE .`•Ai:f:F Iii CF!`_EFVED. ~FTSLY SAM'eLI~C INSTALCTICTis-I.C•rI, FG A. I <br />EPA Form 3320-1 (09-95) Previous editions may not bg used. (REPLACES EPA FORM~T-40' WHICH~MAY NO7 BE USED.) ~ PAGE OF <br />~,.___ _ ., aQ~?~~goc311-1~~t 2 <br />MONITORING PERIOD <br />Y MO DAY i AFi~ MO DAY <br /> 3 ~~ . CG G3 ;l <br />