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<br />NATIONAL POLLUTANT DISLNAl10E ELIMINATON SYSTEM INPDESI
<br />DISCHARGE MONRORING REPORT IDMRI
<br />11-161 l17-191
<br />1
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITOR NG PERIOD
<br />E Rt' DAY s~ YEAR MO DAY
<br />FROM :' 1~ylp~~,f!' U ~G
<br />126211 /22;y3/ l11. " ~ 126.771 !IB-29l !363/1
<br />Fonn Approved.
<br />;. c j L a J O I~ ~'/ i n 1 „0~~+~;g" 204Q-P004
<br />Approval a ~I es 0531-98
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<br />l32-371 f46-53! 154-67) 6/I
<br />~. 138-151 146-531 I EX ANALYSIS TYPE
<br /> AVERAGE MAXIMUM UNI MINIMUM AVERAGE ~ MAXIMUM UNITS /62-431 /61-6B1 169-701
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<br />NAME/TITLE PRINOIP L EXECUTIVE FICER', I cERtI
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<br />53 uw rHAr I HAVt PERSONAIIr EXAMw
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<br />' TELEPHONE DATE
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<br />' MY INDUNiY OFD Try05E I
<br />OBTAIND,C THE INFORMATION :
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<br />pIVIDUALS IMMEDIATELY ~RE@PONSIB
<br />1 BELIEVE THE SUBMITTED INFORM LE FDR
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<br />Iichard I~!Ills TRUE,.A000MTE"-AND COM PLETE. b AM AWME CHAT THE RE Al1E
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<br />eIGNIryryLANT PENALT FOR SUBMITDNG FALSE INFORMATON, INCLUDING
<br />4n VIf 7~R:@(1 t71 .M11s Hager THEPOSSIBRITY OF RNE AND IMPRISONMENT. SEE ,e LLB.C.11001 AND 33 SIGNATURE OF PRIN
<br />IPAL EXECUTIVE (970 870-2712 ~O /f:) n3
<br />U.S.C„ f 1 ], e. I/yIYIYI! udr n1IY .6fun+nrr AsAd~ rYMS Ie ro ! IO,ODO
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<br />OFFlCER OR AUTHORIZED AGENT AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference s//ettechmsn/s here/
<br />xI ILcAuL~ SLL1~'"S LIfIIT +tAIYtJ FOR i0Y'cFd4b~' F'RCCIP tV~NT-~r_c I.A.Q. r~ IVE FGR REQU~REY1n1S. 11~ ~-
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<br />EP Form 3320-1 108-951 Previous editions may be'0eed. /REPLACES EPA FORM T~0 `~/RICH MAY NOT BE USED.1 ~ PAGE , OF
<br />JUADii/9cIUU1-L311 ,
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