|
PERMITTEE NAME/ADDRESS (/nNrrde Facl(Iry NameA-otadon IjDlpereap
<br />NAME r; cP^t ,"~L~dI?I~a P.=.
<br />ADDRESS T , : u i•' ~: g - fi ;.,
<br />.... .. i!. .'11
<br />FACILITY ~ ~ A: ,-., .~ i ~~ ZS
<br />LOCATION
<br />NATIDNAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form AppmVed.
<br />DISCHARGE MONITORING REPORT (OMq) OMB No. 2040-0004
<br />'r
<br />r ., ~ )
<br />PERMIT NUMBER DISCHARGE NUMBER _
<br />MONITORING PERIOD - ~ ~ ~ • ~ ~~ ~ ~ ` ~ `~ ~ ~~ -' c 1 ~ A.
<br />YEAR MO DAY YEAR MO DAY 1
<br />FROM ~q TO .11 ,!,, z .. ~-~1,-_.ir >ti.
<br />,. ~,~- .r -. .t' ray l _o/.
<br />,.. .. ,,.OUA
<br />PARAMETER
<br />AVERAGE
<br />. " r.. ~ P P.: i~ r u ~, l! cf i L~ SAMPLE :t :•: f : •< :-
<br />. ::~. I ] „ 9 P ~' -: I A MEASUREMENT
<br />..-.'1~ 1 J :i ~,, ~. ~~
<br />t'' L.,c :l' `~,J; 7AiJ N`E+,-+ 3., or.*ttyy*, ."r
<br />-, :. rJ ~i nl'q;': 'l '..at iLc SAMPLE r. ~•`.~.Z~~,
<br />i" _. i I: A L F S MEASUREMENT
<br />.., :~ ~_ .: 1 U t~
<br />SAMPLE
<br />~`~.ir
<br />SAMPLE
<br />SAMPLE
<br />SAMPLE
<br />MAXIMUM UNITS MINIMUM
<br />
<br />
<br />
<br />Y,: Y,: Yr lj :} r
<br />.`~ ' ~~` ~~
<br />i
<br /> :
<br /> ~~
<br />'xr:
<br />
<br />
<br />~>
<br />flu
<br />~~r s
<br />~~
<br />Yom. t-``-.
<br />I~".rv ..
<br /> ~_.:,
<br />/' .5
<br />
<br />QUANTITY OR CONCENTRATION
<br /> AVERAGE MAXIMUM UNITS
<br /> . ... .5 :. .-ter ( ~~~
<br /> Y !-
<br />
<br />
<br /> r
<br />
<br />4.
<br />JO. FREDUENC
<br />EX OF
<br />ANALYSIS
<br />a
<br />a_
<br />m.
<br />..-1
<br />TYPE I
<br />~'~ srtrMti" :'_ ~r,T` ,ni ~ m, ~ > `i =~ ,;!t
<br />REQUIpEMENt ~' ~r.r°c >`~ ,A, ri br`-fit
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFCER IceraN untler paraay of law thst Nis tlocument and ell attachments wp~a TELEPHONE DATE
<br />preparatl under my tlire~tion or supervision In accortlance wHh a system tlesignatl ~~ /l
<br />b assure Net qualifwtl personnel properly gathw entl evaluate Ne Infortroaon f~ / /~ L/
<br />W. Gordon Peters eubmiaetl. Basetlonrtrylrqulryollhepereonwpereonswhomarxgetheeyetem, C-' G T~I~L_ .~. 970-824-4401 Ol 07 '"
<br />w those Petsan IXmctly responslbla bt gatheang the Imomaaon, Na IrAO~melion "'
<br />President/Gonersl M.iuager submlaed ls,bthe bestdmy knowledge entl bellel, true, ecrurate, end complete. SIGNATURE OF PRINCIPAL EXECUTIVE
<br />TYPED OR PRINTED I em aware thm there ere s'gnKeaM penalties br eubmittlng klse inrormeaon, OFFICER OR AUTHORIZED AGENT
<br />Indutlinq the possibility altos entl impdsonmeM br knovdrq violations. _ cnnv NUMBER YEAR MO DAY
<br />COMMENTS AND F~(PLANATION OF ANY VIOLATIONS (Reference elf attachments here)
<br />.t. ....~r r~ /-!~ -.l, .. .,.-L:, ''r :~--~.. .,,_..ii~.'r.. r ~ ,..:0 - -r 'l +:- 1. ~ .: YHIC'i I_
<br />.. :{:11 _ ''i '''F T.. ti: JY.;4"I~^S, AS~~ AT-.. .' --!°F i',tI.:iiY !:P::il' '~=.. - ~ ,f.
<br />ALL
<br />A Form 3329 (REV 3/99 Previous aions may be us ~ ~ ~ ~ ~ e ~ ° n ~ ~ } ~ ~ ,I v ; ~ ;.~ 5 T~IIS:IS A 4=PART FORM G~ OF
<br />
|