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FERMITTEE NAME/ADDRESS tlk~+. r+../e..v.....• ems,,..,,,,, ,r u~b••nu• <br />NAME TH?PPf~D +^.i9I !i (;a ~H,^_. <br />AODRE55 T R f1 P 4 F ~i • T% Y <br />~.c+. Pox T~°~ <br />FaaLITY <br />LOCATION <br />~T',"R: 4. GORODN PPPF.RS. PRoilGl'Y aGR <br />NATIONAL POLLUTANT 019GHARGE ELIMINATION SYSTEM lNPDESI <br />DISCHARGE MONITORING REPORT lOMRI <br />11.161 117-191 <br />- PERMIT NUMBER DISCHARGE NuMeER <br />MONITORING PERIOD <br />YEAR MO ~DAV YEAR MO DAY <br />FROM TO D ] J <br />/16211 l22-131 /24251 /]6271 !]R-]RI l363r1 <br />Form Approved. <br />y ~ .1 n q OMB No. 2040.0004 <br />Approval expires OS-31-98 <br />P - Pr~rllr. M~L~, - <br />S'19i' y'lf~ Tn J4H11$OR FIILCN <br />a7ra v~ pTSCRARG! j~t aoy <br />NOTE: Reed kLStrueUarrs Mtus 881hDNtinp ~ fam. <br />PARAMETER !8 Grd On/YI . QUANTITY OR LOADING (.F Grd Onlrl QUANTITY OR CONCENTRATION ~ NO- FREDUwcv SAMPLE <br /> !46531 !5667/ /38-J51 /16-531 /5F6F1 OF <br />l31-371 E% <br />ANALrSIs TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITS !e2-e31 r546e1 r6a7o~ <br />p:~, SAMPLE aRaxCC FV.n800 ttrTROCh ~ y~~ <br /> <br />MEASUREMENT 78 ~.3 O ~'~ ~~' <br />Oi1~lUq 1 R D PERMIT 44##RP 4pgR#¢ 4EkC (•$ -. ': #!T#TitiEl# <br />....:...... '= <br /> <br />. <br />. <br />" a <br />' PFLU FaT GHn$S___y_1!Lfl flEQUIREMENt tORR , <br />~ <br />. <br />.. <br /> SAMPLE _ <br /> MEASUREMENT ~~ <br /> PERMIT ~~ ~ - ~ - <br />"~ <br /> <br />-- REOtJIREMENT <br />- ~ ~ . ,. - :y:.,< . <br /> - <br />SAMPLE <br /> MEASUREMENT <br /> .. PERMIT- ~ : , .. .. ,..::•~. <br />I REOI IREMEIJT ~ f:r•~~ "•:• ~ ~ ~~ '~"~ <br /> <br /> SAMPLE <br /> MEASUREMENT L! 3''" <br /> r.:.. . <br /> RE(3.t11jiEM6NT: <br /> SAMPLE <br />~i: . <br /> MEA`.iLIREMENT <br /> PERMIT - <br /> REQUIREMENT :... ,t.t .:,:. <br />,... ,... .': 3, <br /> SAMPLE ~~ <br /> MEA:iURf;MENT ~ - ' <br /> ~ <br />~ - PERMIT ~ - ~ ~...., <br />; ~ :; ; .:..:;:. • -. ~ ... <br />I - <br />I -REQUIREMENT ~ ~ ~ ~ ~ ~ ~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br />~ <br /> PERMIT ~ '• ~' ~~ <br /> REQUIREMENT ~ ~ ~ ~ ~~ ~ ~~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFV'uNDEP PENAl7Y OF LAW THAT I HAVE PERSONALLY INED ANO <br />AM fAMIL1AR WITH THE INFORMATION SUBMITTED NERR <br />N; AND lASED ON TELEPHONE DATE <br /> , <br />MV INOVIRY OF THOSE INDINDUA75 IMMEDIATELY RESPON9BLE FOR <br />OBTNNING THE INFORMA ON, 1 REDEYE THE SUBMIRED INFORMATION 19 ~~ / ~~ <br />W. Gordon Peters TRUE, ACCURATE AND OMPLETE. I AM AWARE THAT THERE ARE <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INfORMAi10N <br />INCLUDING 970-824-4401 99 07 14 <br />President/General Mane ei . <br />THE.POSSIBILITY OF RNE AND IMPRISONMENT. SEE 18 U.S.C. E 1001 AND 37 <br /> <br />S 1319 <br />U <br />S <br />C <br />H <br />/> <br />IM <br />Po <br />d <br />A <br />i BIONATURE OF PRINCIPAL EXECUENE <br /> . <br />. <br />. <br />. ! <br />/r <br />a ul <br />~r <br />lo yo ro <br />ar .brvgs mrY /+r <br />Nr <br />IO,ODD <br />TYPED OR PRINTED rMa+ArxinAn iprN•~Y.wN Or M(w+.nem9nNa rN 6Y.va1 OFFICER OR AUTHORQED AEIENT ~opE NUMBER YEAR MO DAY <br />L,VMMCI91D Xnv ~nr ~nomw:+vr nn. •.v~n. wo.a lns, ~, o,ae en ou•cnn,•nu uoer <br />YSS L TOTAL IRDN LIrITS ;1I LL HE WAIT F.DF AMD SFp*LEIPLR S~LII~S LIh T.P APPTt"!1 FD4 C=)OT''E?a'I~ nc orTn P-p!RP_ <br />iF:B BUP.DvM OP PADOP WE.~LIf?P.?1E9T5 UNO°N T. A, i. ap,R*,ITSE2 RrST "TIRE !1L[ P''E~~`'llA),E Hr~ggrc~ T„ Rr~IJ,.F. <br />r <br />EPA Form 3 20.1 108- Prelrioua editions may be used. ~ 1 LAC A F WHI A ~- ~ PAGE OF <br />