|
PERMITTEE NAME/ADDREbb QKLAI F•c.eyNa+JLor.um IJDlpnru)
<br />NAME ~r)1,r.)~,[Yp (.;)0.L C'JIiiP.AN'L L..P•
<br />ADDRESS C O [, O'E) Y 7 41, j V H
<br />'.EY.il STA PC I!I ;IIY9Y 13
<br />I)!:t:n'•.!' CO 81641
<br />FACILITY
<br />LOCATION
<br />NATIONAL POILVTANT DISCNMO[ ELIMINATION SYSTEM INPDESI
<br />DISCN1 R6 E MONITORING REPORT IDM91
<br />PERMIT NUMBER DISCNMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAY
<br />FROM 9/j U/ U1 TD 9R U9 3n
<br />110-111 !72.731 (1b161 11E771 17b-791 13x311
<br />Form Approved.
<br />ST ryI:!:T F^. ~I.I f.^u T.)O~fnZ~~'0004~.P
<br />Approval gXg4~C35- 1-98
<br />(SU9R N,I) 111LJ
<br />}' - FTN1~J.
<br />MT N D!?
<br />,._...: yn DT crNAr!/.: f•1 I--I ;=0#
<br />A NOTE: Read Inelruclione before completing Ibis form.
<br />PARAMETER !J E'•rd Onlyl QUANTITY OR LOADING l e Grd Onlrl QUANTITY OR CONCENTRATION Np FREQUENCY SAMPLE
<br /> (x[:63 (53-bf) 13B-Ib 146-63 6bbF
<br />EX OF
<br />l37-371
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE ~
<br />MAXIMUM
<br />UNITS 1
<br />67.631 ANAlrss
<br />(µ66l TYPE
<br />Ib9-lol
<br />l'11 SAMPLE ##5::.`•: ~ .r:'~;:±F -t `'
<br />' :; ~t###:;
<br />~
<br />~ ( ~. ')~
<br />~ ~IO
<br />d
<br /> MEASUREMENT (.
<br />7 • ip
<br />UUVII I) :L U I) ~ : PERMIT~~:~~~ : ~:.#iR##=t 4t. ~..
<br />.
<br />:.
<br />: .. :.4 u".`..~t)~: :. ~:: #'~r 5. S ~.......: ~ ::.:.: .:~'.Ktr ~'~?Giz::~:. : ~..p:::.~:;~ ~~:.-~~.:~': ZY ;RAB
<br />
<br />`.;FFLU;:7T dl, C)5:J VP, L'If REQUIREMENT.
<br />:. ..... . .
<br />.
<br />~ ~ '~
<br />. :.: ~.: ...;::. :~~..~:.:
<br />~::~:..~~~~
<br />:;r,:;
<br />~~T~~.
<br />'::M~...~.. ~...~i-
<br />~(1
<br />
<br />.
<br />;OLID'i, rUf1l, SAMPLE
<br />EME
<br />T #R7^G~ ;t:xr,;.'::t , c,'F'.':` 4
<br />ZJ
<br />23 ( Tn~ ~ 2
<br />:iUSPRVI)E, I) MEASUR
<br />N d~
<br />Ull`.7:1U 1 U .) PERMIT .' :: #La{t~4:=.:. :::;f S`~: 'x-'x .: ~ ~x •. 4;;# ~;~.:. 3g'... .:.,::: :: '70
<br />~ gCE/ ;RAR
<br />+~, F' FL U r:.J T ': ;' J.`.::; VAT. [I ~ REQDIREMENT ~:::::::~..::~: ~~: ~ ~ ..: ~.. :..~ ~~ :;:~x c: G ~.. ~
<br />.. ....6:.
<br />.:..t1~.~ `E (:
<br />
<br />'..UL1U~, :~::!'TLF:A.f[L^,
<br />SAMPLE
<br />####',`•;: ,..x.. ~ is ~,
<br />:t:t~;::::x ...,~f .,Y. V ;.
<br />.,
<br />
<br />~~
<br />5 ~
<br />
<br />( 7 ~1,
<br />/
<br />2
<br />
<br />G
<br /> MEASUREMENT • ~ (cjp
<br />gUURS L 0 U ~~PERMIT ".s##;<tfr::..::. ..~:'#x`#~:k~~ >; ;_;::: 4'~#'S::'"#:R~:.~~ ~ .=~#;rYS!#;: 0::~.~~'.~:~:~:~~ ~~ I FICF/~~~. .RAD
<br />•: . r
<br />„}'FLUi'..i, i;[!t)s; V4J.U"r REQUIREMENT
<br />, .... ~~ .~...'~:.. ~~~
<br />... .:..:.: ...:..::
<br />....::..: ~
<br />,:'::A ~
<br />r .
<br />JI I. 9VJ) ':i c'.A'F:
<br />T SAMPLE #r{<~, ~ ~:x~:;=:~ •..~~. w.:.....x:4;t
<br />NI 7
<br />( 1
<br />~
<br />~I~
<br />~!A
<br />I:-;; it;lU .'; ~'1`!~
<br />t'NI:(I1+ i(C MEASUREMENT A
<br />
<br />'.IUSSh 1 iT ;)
<br />PERMIT:
<br />~
<br />>r~a.a#=. .. ####lk:x >; :x x -.r. -r=~#,:#... ::: >::r.#::rk:::-. tn.:.:::::.::'.::::::::. ~1NriTa ;RAa
<br />cFl'LUi~.'iT GP~)S`; VA1,I1I: REQUIREMENT:~ ~:...:~~:::-..~::i~:i:'.....r:~ .. . :.: .:.:....:~~~~ ~~~ :'I:R~T~T~:y:IIX~: 11 L
<br />m.
<br />I IiUN, TU:IdL SAMPLE
<br />MEASUREMENT :~###;:} r~~4-',. ;t , .-. ..
<br />~'3Z O.,JZ ( 19) O N R
<br />~ N
<br />'
<br />I
<br />(1'i Fc~) •
<br />I
<br />;IlUll ~ 1 (! l) .~.. PERMIT..... ~ : '#;kt.:tc##-:.' ~~:.~~~..?x,+,r#~'": it'~.-'. ~:~:~
<br />ya"•#'1#.:'
<br />3~:5:'::'.:::::::;:::
<br />7:(1::;::':: `:::
<br />NCE/
<br />.RAR
<br />IiFt'LU'(,:iT ;;SUSS vAI,O[. REauIREMENt. .., ,:•::..: .,, '.:.. .;:.::' #~;.« 3UD~..`AF.r. ::i)AT:zY:.~T r!r: L .
<br />MONTFI
<br />F'Lr)w, lii C?1100IT O4 SAMPLE
<br />ZD~
<br />vc
<br />Q'LD~ ( p3j ;:#:x#:t+: t:xr;:#:;: .•. ^'. ~••'•w
<br />p 1(0
<br />n5~4.~
<br />A
<br />l'IIRU l'ii fsAT11 :;'IT PI. .1 FI'J MEASUREMENT , ~~ ,
<br />5D[1,U 1 U U PERMIT.°:. PTItl,NAG'.::'. .:`I{EPDRT..
<br />r;;y.rr:A.
<br />,.::w:;r:x#?'c!x.
<br />:
<br />:
<br />:.... X;~'~`ix>,:# :.
<br />..
<br />fi[(L7
<br />N5TA:~
<br />
<br />.eFFLUt:?tT !;'?:)~:.> j6.t.n. IiEQVIREMENT ~ ~~~ ~
<br />3oD~ .AYG!::
<br />;olkiLY,:.HR:
<br />r?r-.p ~ ~~ ~ ~~ .
<br />:
<br />...
<br />
<br />
<br />,.
<br />. . .
<br />~OL1D;i, 1'JTAI, SAMPLE ###,"-~x:t #:x#:•;te~ ###:`':^ '•#^.A.:`•': O
<br />2~ ~ ( [))
<br />2/
<br />1
<br />U l:i :: !)I,V F;U MEASUREMENT O 9p ~
<br />1r4
<br />lU1.95 L U f: PERMIT yc... #T+~'''::::
<br />...
<br />>: :::::.h##fi#.,..
<br />
<br />...:. ~:: ~: rxYp##;:
<br />
<br />
<br />,:. '.>;<at# p.; :.: :: j. i?(•'1~;'1'
<br />
<br />
<br />RLY AR
<br />
<br />
<br />~R
<br />~•, I
<br />i~: }'t L!1 r, ll'f ;s!U<-_~ 1[, 1F REQUIREMENT: ~~.~:...:. ....
<br />....:::::.:~~::~. ...;::.~::
<br />
<br />,.:: ...: ...
<br />:~•::; :::.. .~. ~
<br />
<br />... .
<br />t.. J.
<br />
<br />;..,
<br />NAMEITITLE PRINCIPAL EXECUTIV E OFFICER 1 CERTIFY UNDER PENALTY OF LAW TNAT 1 NAPE PERSONALLY EXAMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH ME INFO RMATION SVBMITTED NEREIN; AND BASED 0
<br /> MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSBLE FOR
<br /> OBTNNINO THE INFORMATION, I BELIEVE THE SVBMITTED INFORMATION 15
<br /> TRVE. ACCURATE AND COMPLETE. I AM AWARE TNAT TNERE ARE
<br />INCLUDINp
<br />SIGNIFICANT PENALTIES FOR SUBMITTINp FALSE INFORMATON
<br />e
<br />}~
<br />J. U . 4r U ,
<br />THE POSSIBILITY OF FlNE AND IMPRISONMENT. SEE IB U.S.C. 1 1001 IWD J7
<br />
<br />51
<br />
<br />NATURE OF PRINCIPAL EXECIITNE
<br />U 7 5
<br />O C •y
<br />V O
<br /> u.s.c. L I31e. ItMW1M• Inds eMN ,erut•. mrr AicAA~ m.• W ro t lo,op3 AREA
<br />TYPED OR PRINTED •M Or IrYlAnVII AIIP'IIJMMnr O/MMNn 6TL.lII1!/nA6rN.(1 OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS !Reference en ettscnmenfs here!
<br />Siil'TLc~1r.~ ~:~1.IU5 J.711IT APFLIF,5 ONLY IF C= lU-YIl, ~R PRFCIP FVa,NT 7S CT.A7MF.n• IF CL?T?' 4~VP.p UT
<br />aUCU, l'S~ CI+;)'' 1.1"+7'P; '>tILL NOT 8E APPLIED TD RP:P D MF.45UP,~"IP,>7T5--SP,E L. P. 1. .A, P.^ II 5•JO ? D, ['G 6.
<br />EPA orm 320-. ,J8-951 Previous editions may be used. (REPLACES EPA FORM , JO WHICH MAY NOT BE USED.1 ~ ~,~,~ ~ ,,, ~ ~ ~ „ ~ ,., rq,GE OF
<br />
|