|
PERMITTEE NAME/ADDRESS prr4 FrWryNaWLr+nm l/Dipwwu)
<br />Nl1er ,. y.. . _ ... - _ _ ,
<br />ADDRESS ~I't :.+?~~ i~~ + ~ .._ i~, ~.
<br />91f!i 7' .. .'^L.
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DIBCHMOE ELIMINATION SVBTEM (NPDES/ Form Approved.
<br />DISCHARGE MONITORING REPORT (DMRI _ „ , „_ , .. ~ pMB-No: 2040-0004-.
<br />IT-I61 /17-191
<br />-.., .1,i~~1i7 nn, ~ (;., .^ ~-) APDrove, exP,i{es 06-31-98
<br />PERMIT NUMBER DISCHMOE NUMBER h _ -
<br />MONITORING PERIOD ,'T
<br />YEAR MO DAY YEAR MO DAV
<br />FROM -.` i . ` ~- TO .:, ~ ~ ..._ y ~ „ _ .- I- y A -, - :. ~ . I .:: •.:.
<br />nno n nzaer nvsr rzGZ7/ rzB-z9/ I3a31! NOTE: Rsed InFtructiaru bafwe complatln0 >fiie Iwm.
<br />PARAMETER !3 Grd On/yl QUANTITY OR LOADING 14 Grd 0nty1 QUANTITY OR CONCENTRATION NO, mEOUENCr SAMPLE
<br /> !46531 /54611 I38-45I !46531 !5461
<br />EX OF
<br />TYPE
<br />I33-37I ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMU
<br />M UNITS /e3-s.Tl (54681 !53701
<br />_ SAMPLE -:=S-:C•: .:!`:;k .. .Yv,y'c:;_r: pp
<br />O~D
<br />O M
<br />~
<br />~ I { 1 71 n ~
<br />3 ~ /~IB
<br />°;) .~;~ J, j; -p y~ o q 1 r, c MEASUREMENT + +
<br />.;. .r, 1 l' ":) PERMIT r;='r~": ,'F fi.-, :T R.Or r. k~k°nytvt ]..'1 G`.'P7.,. , ~N?rg/ :RI1H
<br />F r L'1.:ti°, :?) :E Y lL'1T REQUIREMENT "•~Y J!TTIA AY^ R1T LY RX 'i :/i hnNTR
<br />-T. I. '1 N. t1+ .7'.Ji-;YT'CLLY
<br />.
<br />• SAMPLE
<br />EM ,-.3 ~r# ~..-'+?#G tS#.'.:#': ~Q
<br />' ~ ~^^~
<br />r ( ja) ?1
<br />C/ 3~
<br />~/ I~1CB
<br />L .;
<br />; ~
<br />L y ., .1 MEASUR
<br />ENT r
<br />1.7~" ,
<br />:1 i 3U i J 0 PERMIT :T^Rpt~ ><?R~4S ., :#s•,t~~~ RFT+t7P"` a^P~P.'!' I ~RC£./ :BAB
<br />7i'L'J E"T ~R75i YALOp REQUIREMENT ':;:t ~OrJA
<br />V r: G,iCT
<br />!7
<br />':[ '1G/L 1!ON?;-
<br />-;p„Eqr Jr^-YTT6LLY
<br />.
<br />- SAMPLE
<br />SUREM
<br />T
<br />E ,..,'i= t;:#i ,•,,•;.,A{ ZZ
<br />~r~~J ^,
<br />_
<br />QrOC/cv ~ '~) O 3 R.A$
<br />,
<br />Z ~ OI V
<br />' M
<br />A
<br />EN 3
<br />:1fi!ti l U PERMIT •k 1:i:h~;: h",-;:.G"= i ` k'='~."'= OF^7'7 n~1+. xFF.E/ BAP.
<br />°~L`J 'r.'?:P GR:JS ~. 7T,r.`{.' REQUIREMENT r,: ~;,~ ~pUe ?Y^. F)AT LY Ny ./; '!ONty
<br />A`~.:AN'r:5-.~ 1'7"i'. SAMPLE
<br />SURE .. :_~.`•::~ P"::;:;::;:: :;:>r~::_..
<br />Or ZO
<br />Z I
<br />O { .,1J
<br />~ ~J' I
<br />3 G2Ag
<br />~ y ~, g p q L g MEA
<br />MENT /
<br />i~jL3 1 U PERMIT ~ ..:=`r }: '`•'i=::r,:r~; - : ........ ,v,L'1nT a..uf,..... rnr:Lv 'q•t
<br />":' L U i~. N'' G RO ~ `~ 'f R .. 11 ~ REQUIREMENT ep ;:g .y l rl ^ A 4 g'
<br />~ r• A 2 T y N ~/ ° ~ / i.
<br />i.'lw+ t'1 CUn'f11;;' .- a SAMPLE (~
<br />'~I~ /
<br />IH ~
<br />~ ~ ,3J
<br />~ ,.. ._:,.; ,. .: .;':h..,., :~R-`~ct,"
<br />Q
<br />3+
<br />~`A
<br />I
<br />!~'!1 iR?:ATMF•;° r. r,e•~r MEASUREMENT 11 ~
<br />7 K
<br />1''75.1 L 0 ) PERMIT ..;13?T i^'2i};".' `n-'.:1,=;2',t:' :'r:s:Y:Yf,: "L~.=h,~i~r'~ ir:.- I L^~.', ~!jT~`
<br />. LIJE4T GP~~'. rrT.J REQUIREMENT .j°:)~~. a+/i, •)+.iL~r M:~ yr, #+t•'•'k
<br />
<br />. ). .. a:~n iZPv"
<br />SAMPLE
<br />r. s: (: r-1:{:
<br />O
<br />~ ~ j'
<br />::..t .v.~.:
<br />~w~iF %.: "i.
<br />:4 ~5aw 7, .; 2
<br />~
<br />
<br />7 I ^ A L
<br />MEASUREMENT O J ISUr~
<br />1~ :.:, 5 1 :' PERMIT C'..... J v .. _ j ...,.,w..v °rt#!!~r,=^ ,k~rizY:`,- . r•.,. I Y Tr..l r
<br />- :,0':tiT GP'lq~ Vp. T, ~1= REQUIREMENT I',d E'^ M.•CY V~'=7 '0y"`-
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
<br />M F FY UNDER PENALTY OF
<br />M WITH THE INFO
<br />MI UW THAT I HAVE PERSONALLY EXAMINED MD
<br />MD BASED ON
<br />RMATION BUBMITTED HEREIN nnn
<br />~ TELEPHONE DATE
<br /> ;
<br />A
<br />A
<br />LI
<br />MY INQUIRY OF THOBE INDIVIDUALS IMMEDIATELY RESPONABLE FOR i
<br />/
<br />/
<br />Rici)r,rd D91IIs OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS ~ ~
<br />
<br />
<br />1
<br />'
<br />TgUE, ACCUMTE MD COMPLETE. I AM AWME THAT TNENE ME
<br />ITTIMO FALSE INFORMATION
<br />INCLUOWG
<br />PE
<br />TES FOR SUB ~
<br />~'
<br />~
<br />
<br />(970) 870-2712
<br />
<br />6
<br />
<br />25
<br />
<br />98
<br />13n9C
<br />er
<br />;_nvlronr•lentel i ,
<br />SIGNIFICMT
<br />NAL
<br />M
<br /> THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 18 U.S.C. F 1001 AND ]3 BIONATURE OF PRINCIPAL EXECUTIVE
<br />
<br />TYPED OR PRINTED U.S.C. r 1 ]te. IMWS+ uMr rMr memr+ m+Y McN.d+ n,.+ w ro S /0,000
<br />Wrnr++m+nhw:.Nwr,rwan.wrnen.+nrA, rles Y+r+l
<br />OFFlCER OR AUTHDRIZED AOENT
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION Oh ANT VIVLA I IUnS frTBTe/enCl elr ertscnmenrs nNe/
<br />'.Lf~NN~~L Lr,1T~~: 'rnC. ~ .;vT°T. -'3 ;" i]L~9: (L"IC ]lr~ gT,TY n.,T,( ro != 1^-vr+ ~II_:rz '.!-r~1 c•{^iil
<br />^t..lj',EL. S^' I.9.2+ v: 1`, F'. '' ~r7i)°''! 7F F'7JF F°^JI°'=..1,y^".~ n.L -n..1S„__ 'c T.~.~.j- r./r n^. ~.
<br />EPA Form 3320-1 108-961 Previous editions mey be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) ,~ n (; - ,1 /,~ ^ I„1 n "/- ~ .~ ? ~ PAGE _ OF
<br />i __-
<br />
|