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<br />~_ ~ ---573]r-STA~~aiF~GlI-G-A-~I~--------
<br />~JCE A- -CQ-81b 4-L
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<br />NATIONAL POLLIIT CHARGE ELIMINATION BYBTEM (NPDES)
<br />DISCHARY~, MONITORING REPORT (OMR)
<br />(z-161-~ n1-19) MINOR
<br />(SUER NW)
<br />PERMIT NUMBER pl.cnweoE Nusleee F- F I N A L
<br />
<br />F~[~/~pProved.
<br />aa~~~~ No. 2040-0004
<br />---~ --------- --. "~ MONITORING PERIOD PEST ,:PIT SETfT'"P-0""'1'l7"1']l>Y1dR CAK
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<br />FACILnY -
<br />_
<br />---- - --- -~ TEAR MO DAY YEAR MO DAY ~ `• ~. '
<br />--------- - - T.~
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<br />L_OGATION--------------------= .FROM
<br />95 06 30 aaa N ~ =aaa
<br />95 04 O1
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<br />I. NOTE: ea nsfruc ona befor 'C letln this form.'
<br />(10-1/) (11.13) (I4-2f)
<br />.~ (16-I7) (18-19) (ao-nl ._ ~
<br />" (J fSb Only) QUANTITY Oq LOADING (4 Clrtl Only) ~ QUALITY OR CONCENTRATION
<br />
<br />PARAMETER - I
<br />(46-5J) _ (SAfI) V. ~.
<br />(J8-45) _ (46-53) (54-61J I - NO:.
<br />.E% FREWENCY
<br />~ SAMPLI
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<br />- AVERAGE ,MAXIMUM f UNRB MINIMUM AVERAGE ,- MA%IMUM ~ UNITB (41bjJ ~ (6Ib81 (A9-]~/
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<br />HRU THE ATN ENT PLANT MEASUREMENT - •
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<br />0050 1 0 =0 _ REQ~u`?R~;Er
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<br />
<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I cERnFV UNDER PENALTY OF LAw THAT I RAVE PERSONALLr ExwMINED4 ~ ~
<br />'~ ~ TELEPHONE D A T E
<br /> AND AM FAMILWR WTI THE INFORMATION SUBMITTED HEREIN AND BASED. 1
<br />~
<br />
<br />f ~'
<br />HSEG & LAND MANAGER O' '~ ON MV INOURY OF TIgSE INdVIWAL$ IMMEpATELY RESPONSIBLE FOR=
<br />OHIAINING THE INFORMATON I BELIEVE THE SUBMITTED INFORMATICfJ IB
<br />GNEFIUNTUPENALTIES FOR SUBM?TING FALSE INFdiMATION HINCLUDING j' ~ t ~
<br />_ - .'
<br />970.824-0451=~
<br />1
<br />~g 5
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<br />2
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<br />THE POSSIBLRY OF FINE AND MPRISONMENT. SEE IB US.C. 1, 1001 AND
<br />33 USC f 1318
<br />(P:nalu'ea under Nese aramsa ma
<br />in[Nde' finea u
<br />so
<br />$IGNATURE OF PRINCIPAL E%ECUTIVE
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<br />f IOAR7 end or masimum imprunnmem N 6enveen 6 manNS aM J yw.) - .~ OFFICER OR AUTHORIZED AGENT ARE NUMBER TEAR - MO DA
<br />~ COMMENT AND E%PLANATION OF ANT VIOLATgNS (%elertnCe all fllaCnmenta Oert)' -
<br />SETTLEABLE SOLiOS LIMIT APPLIES ONLY IP <~ 10-TR/ 24-NR PRECIP EYENT IS CLAIMED. IPiCLAIM APp,ROYED BT
<br />WQCG, TSS E IAON LIMITS WILL NOT BE APPLIED TO REPORTED MEASUREMENTS--SEE I.B.lA• PG 4 AND I.B.1D• PG 6.
<br />I
<br />EPA PDTIII 3920•t (RBY. 9-aa) IievlOUS BdIrIfNW may OB IISB(/. (REPLACES EPA FORM T-40 WHICH MAY NOT BE UHED.1 PAOH OP
<br />0001.3/737109-1.171 i
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