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PERMITTEE NAME/ADDRESS (%nclude £oci(r!v A'amrlLncarron ifOr$erenU
<br />NAME
<br />TLAPP; F. i"I'+IhC, 1hC.
<br />ADDRESST F• r+ F F i Fi t[ ti E
<br />F`.4• : L:i 1C7
<br />FACILITY Cr,A I(' CO blEc6
<br />LOCATION
<br />STT[- ;Sf,hf1CN crlttf- vl.FS/f.FA F.l:~
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMflI
<br />- (1161 (r]- 9)
<br />' l 5
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM CC C4 0] TO GG CE _'C
<br />(261]) (21-231 (14-251 (262]J 1263BJ 1303p
<br />Form Approved.
<br />OMB No. 2040-0004
<br />[ L N C F Approval expires OS-31-9R
<br />~SUEF DFj
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<br />FCtrG A`_ 'IC NC t.AtE LLLCE
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<br />NOTE: Read Instructions befo!e completing this form.
<br /> (3 Card Only) QUANTITY OR LOADING (a Card Onty) QUANTITY OR CONCENTRATION NO. PREOUENC SAMPLE
<br />PARAMETER (as~53) (sa-67) (3a-a5) ps-53) (5a-sv) EX oP TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />(fi2fi3) ANALYSIS
<br />(64-fie)
<br />69-70
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<br />C~IF~Q~1iENT A t( X EC=C ~,;~~
<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E](AMINED AND TELEPHONE DATE
<br />AM FAMILIAR Wm1 THE INFORM ATION SUBMITTED HEREIN; AND BASED ON MY
<br />INQUIRY OF THOSE INDIVIDUAL
<br />Gordon Peters THE INFORMATION, I BELIEV
<br />W
<br />ACCURATE AND COMPLETE S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATION IS TRUE,
<br />I AM
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<br />~ ~ ~„t._----
<br />970-824-4401
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<br />PENALTES FOR SUBMITTIN A
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<br />HA
<br />ERE ARE SIGNIFICANT
<br />G FALSE INFORMATION
<br />INCLUDING THE 4
<br />President/General Yana er
<br />S POSSIBILITY OF FINE AND IMPR
<br />4 t3t9. (Ponel[ies wader Mere s ,
<br />ISONMENT. SEE 16 U.S.C. 4 1001 AND 33 U.S.C.
<br />retr4es may urGUde firers up to Ef0
<br />000 entl or SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />NUMBER
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