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PERMITTEE NAME/ADDRESS (!ulru/e Facility NamNLacanon ifDiffmrniJ <br />NAME L, :r ~ ti r , r <br />~'P i•i' 'i. ~Ga Iv~. <br />ADDRESS, ~. ~ , i ,, of .' !1 <br />f'. J. ~~ Jr: 1^ I <br />LOCATION <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM MPDESJ FOrm AppfOYed. <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 204P0004 <br />-...rz ,i.. - ~ <br />PERMIT NUMBER DISCHARGE NUMBER _ .. <br />MONITORING PERIOD _ .. ' ~ i ~ ... ~ ~. 1 LC N <br />YEAR MO DAY YEAR MO DAY _ <br />FROM '1 1 ; li ; 1 TO : 1 ~ p ) Il • ~ _ " ' ~ ~ XX ) >:"%'~ <br />..J......~6Mn.d'TRlnnlnlinn this inrm <br />~n_r. cn::. / _ _____ _ _ <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PAR <br />E EX DF TYPE <br />AM <br />TER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 'Wa'~!S <br />! l i ' .. ,.. 1 .~ t- SAMPLE <br />.. <br />.. ... ( ~. ~i l .- , :;: y. r: ... .. <br />~,' i .; ' ~ L MEASUREMENT <br />. 1 ? ` L _I -r. <br />~? s5", a ~. '~" '- ~ <br />~ Y: ~ = 1 . ~ ;1F u <br />~ iF 4' <br />#' . ~~ ~~#Y ~" ~ E. <br />•~ . <br />' r' L <br />1' ~ ~ v M1 , <br />~ fy ENT ' <br />h~' <br />" <br />~ <br />1 " <br />" =') ~' w <br />' <br />', <br />~' ty)" <br />~ , . <br />~ :r ~~., ; `;'c <br />• <br />. . <br />, <br />r <br />; s <br />3 N0 . <br />. <br />~. <br />., q <br /> SAMPLE <br /> <br />SAMPLE <br /> <br /> <br />SAMPLE <br />~~~~ . . <br />SAMPLE <br /> SAMPLE <br /> MEASUREMENT <br /> f, <br /> t i;.-, r <br />~ <br />NAMERITLE PRINCIPAL E%ECUTNE OFFICER I Ceniy antler penalty of law Nat Nis tlocumeM end all abachmarns were <br />d <br />l TELEPHONE DATE <br /> es <br />gnetl <br />prepared antler my dlreution ar eupeMslon in exoroance wiN a system <br /> <br />:J <br />t <br />P m assure NM qualmetl personnel properly gather entl evaluate the Inbnnation <br />ersonar <br />ereonewhomarie <br />ethes <br />Metl <br />Ra <br />n <br />ln <br />ul <br />glNe <br />stem <br />b <br />tl / /~ <br />~.--'/ C <br />~-~-}----- - <br />a <br />, Gordon <br />era y <br />. <br />y <br />q <br />ry <br />p <br />g <br />, <br />eu <br />m <br />se <br />on <br />p <br />Na Inbnnetlon <br />or None pereone tllrsctly rssponslble for geNedng the Inlormetion ~ 970-J24-4401 Ol 07 2~ <br />resident/General Manager , <br />submlttetl le,bNe best of mylmowletlge end belief true, erzurate, end complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED l am aware that Nee me sgnifiram panaNes for submNing Ydlse lnlomration, <br />Including the oossibiliN Of Me entl imodsonment for knowing NOlations. OFFICER OR AUTHORIZED AGENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />.. ~J`~L :Hf.. i.I ._... -1iL tr. ~LI'•...-, 4'.. .._; ..., L' •,I _,~ ;,I `:i': A~FLL .. ~ <~=1:Y"', 2t, .,+ ,,pulp -:Y :. - <br />. .Iwi~ !' )~ [vG:)6' r. '•;L°4,..'!ii.. ..,..1."S T. A. 1, rr...i°~':IT;dING - I.li.~. OIL E ,,r .. - SEF ..:.1.(C) <br />SPA Form 332 1 (RE $)99) rewo s editions may ~ use ' ~" ~ ~ ~ ~ ~ ~ 0 0 3 5 2 / O li I, 7 1_ 'HI ~ I ~ $ n PART FORM PAGE OF _ <br />i_ <br />y~) <br />