Laserfiche WebLink
PERMITTEE NAME/ADDRESS (lnctudc FacifiN NamalLxarion iftli$erend <br />NAME <br />ADDRES TI+dYFEh RINIAG, INC. <br />SLk9~F~h PIKc <br />r. C, rv% 1C1 <br />FACILITYCnAIL: CC C1E16 <br />LOCATION <br />A'1"CNe r. r. t~nre, Dcttr'c~ DHM ;/t:: n Mira <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (OMq OMB No. 2040-0004 <br />(z"rsl (1z Re) C I h C 9 Approval expires 05-31-98 <br />n vc (~UFt; Ai) <br />PERMIT NUMBER DISCHARGE NUMBER F- i i 1. P I !' C k it 7 <br />MONITORING PERIOD F C A C Y C 1 C D C h ,' - k L L I C P <br />YEAR MO DAY YEAR MO DAY __ <br />FROM 00 CE UI TO C CE 3L ~ %' 1,C L3~ChEbCE ~__~ tt~ <br />IzazO tzz~z31 (za-zsl Izs-z7t (za~za) poar) YNOTE: Read Instructions before completing this form. <br /> (3 Cerd Only) QUANTITY OR LOADING (a Cerd gnry) OUAN7ITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (a6-53) (54-Bt) (38-a5/ !4653) (5q-67) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> fszfi3l (61-681 69-70 <br />N SAMPLE t~:'}o_, op ,S-?Cr;A <br />~ ;~~: ,CC pl <br />' , ~) <br />~ <br />~' <br />' <br />T~ <br /> MEASUREMENT O p•J v ~ <br />fy <br />UO~:OU 1 1 C 6FgNffT iplC6qu~t x+nl>a4a1s. ca:• 6.y 'MROQaIP .5 i ffAl] 11917.1, <br />dFr'LUE!:7 Gf•.OSS YALUf R 1~Ig~ENT ~. ~ - ~ :tar ]N M - ! ~ °L ' <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT ~ . - <br /> RE'011)RI:MENT <br /> SAMPLE <br /> MEASUREMENT <br /> PEEING <br /> flEOUIRE1+lENT <br /> SAMPLE <br /> MEASUREMENT <br /> -z`. - ;,toy I 'y,, - - <br /> N' r, t 4 ea- _ ._f <br /> SAMPLE <br /> MEASUREMENT <br /> ' ~ ~ <br /> RC4411~~AIFFtl rc Sz' ~"- <br /> SAMPLE <br /> MEASUREMENT <br /> ~{?C8M1Y <br /> ACQUIREMENT - . <br />NAME/TITLE PRINCIPAL E%ECUTIYE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EI(AMINED AND TELEPHONE DATE <br /> AM FAMILIAR WRH THE INFORM ATION SUBMITTED HEREIN; AND BASED ON MY <br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />/ <br /> THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATION IS TRUE. - <br />~ <br />W, GOIdOII Peters ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMITTIN I AM AWARE THAT THERE ARE SIGNIFICANT <br />G FALSE INFORMATION <br />INCLUDING THE ~-"' 970-824-4401 GU 07 ~5 <br />Yreeident/General Plana CL POSSIBILITVOFFINEANDIMPR <br />4 X318 <br />P <br />l <br />h <br />i <br />d . <br />ISONMENT.SEEIBUSC.41001AND33U.S.C. <br />i <br />li <br />00o <br />l <br />l <br />d <br />Sr0 <br />d SIGNATURE OF PRINCIPALE%ECUTIVE <br /> <br />TYPED OR PRINTED . ( <br />ena <br />es un <br />er t <br />etulas mey <br />nc <br />nes up ro <br />en <br />or <br />t <br />ese s <br />u <br />e <br />, <br />mepmum impdsonmem p/benveen6mpndq end5yeers <br />/ OFFICER OR AUTHORIZED AGENT A <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . COD <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />7ES 7C('aL IFCLi L1r175 rill ~k. .PIVii NbC `_t171FP,FLS °LLIL:i Lil!i: P>611 is i;; <=li.'t=,<tF!rFFCIL EVc'•i- <br />SEE `..UdUkt~ OF FAGGE FE~ULkE"r.NT_° UhCkk 1.A.:. FEFCI57LF CU`_9 76NC ALL ~='~i`.Ai.L: rc:~Lr~i .C t~CLCE Fk <br />ga Form 0.T ( - ) r vl use i IoTis`may no e s d. ` (REP Ep/( MY-00 FIR;H E "D.) ' ~ _ ~ ' PAGE OF <br />~- <br />