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PERMITTEE NAME/ADDRESS pnelude PaeiltryN --/r.....xon yDigerm9
<br />NAME
<br />ADDRESS r ~ Ji i F :. d " I '. .
<br />FACILITY ~ I ~.: - :' l •, .C f
<br />LOCATION
<br />NATIONAL POLLUrANr DISCHARGE ELIMINATION SYSTEM MPDES) FOrm ApprOVed.
<br />DISCRARGE MONITORING REPORT (OMRJ OMB NO. 2040-0004
<br />PERMIT NUMBER DISCHARGE NUMBER _ - .
<br />MONITORING PERIOD ~ ' .l ~'' ~ ~ ~ ~ "' i ` L
<br />YEAR MO DAY YEAR MO DAY
<br />FROM `7 w TO G i ~ v ~ ~~ .. r .f ... ~. a i. ~ i I J~(~ f:.`.
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<br />PARAMETER
<br />~ \I AVERAGE I MAXIMUM I UNITS I MINIMUM
<br />SAMPLE ' - .:` * .... .
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<br />`FLU ° ~ ~ u n .) 5 : ~. Y A L U REC{lj[~iEA~NT "" ,~ r ... ~`
<br />S~LL~!3, "UPRI. SAMPLE ..:-4Y :n ;~:::;-ar-:~:
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<br /> MEASUREMENT
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<br />''LJR, i9 CJNDUIS UR SAMPLE ~ I'1
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I Ceniy untlar penalty of law that this tlocument antl all attachmerns were
<br />prepere0 untlar my tlirectlon or eupeMSlon in eccomance wiN a 6yslam designetl
<br />W. l~ordon Peters bnuure gtM qualifietl personnel properly gaMar antl evaluate the inlormatlon
<br />submlltetl. Basetl on my Inquiry of Ne person or Desons who manage the system
<br />re~:ldent/General Manager or NOSe persons tlireNy responsible br gamedng Ne lnbrtretlon, Ne imonnation
<br />submitted Is , b Ne best of my ktgvAetlge antl be11el, W e, accurate, end complete
<br />I em aware that (here are sign~cam penalties br submfiting false ktlonnation,
<br />TYPED OR PRINTED Inclutlina the possib~liN of Me antl imprisonment br knowing violations.
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refen;nce all attachments here)
<br />
<br />QUANTITY OR COI
<br />AVERAGE
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<br />r}p r: repn 1 c~trc:-r `: ~ ra 4tS¢rr~
<br />VO. FREOUENC SAMPLE
<br />EX OF TYPE
<br />aNALVS/s
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE
<br />OFFICER OR AVTNORIZED AGENT
<br /> L." / L (-
<br />TELEPHONE DATE
<br />970-8~4-4401 01 07 25
<br />NUMBER ~YEAR~ MO ~ DAY
<br />..- ~:.~ Ia~a L1"11'; ,ILL rt.. ,.Ir:J, A'r ("L!~A I: ,,_.IL; i."!IT R:~kL. ~ ~ ~ ~ .'~::CII' ~V:..-
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<br />... -!..":G1. .>F PfiUDf RE~'1I+`L ~..:ST`,At!;.CER I. 4. 3. ~i~,. ..NITOHj,.., - ~... 3. -: ~ - i...'.1. (.~)
<br />EPA F'orm•332 •1 (A ) revwu edi ons may u>;ed. ' ' ~ ~ ~ / THIS IS A 4-PART FORM PAGE , O~
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