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PERMITTEE NAME/ADDRESS Pnr6d. FeAlryNsndl,ecsua~ UDIdnnq <br />NAME C.)Li)1iY;] ~OAL C0;^,P:1.~Y L. P. <br />ADDRESS COLJWYD '1iti? <br />_i731 ST4TF: Illh'IKAY 13 <br />ME:i:!;I:li CO Hlfi41 <br />FACILITY <br />LOCATION <br />I .I F~- <br />NATIONAL POLLVTANT DISCHMIOE ELIMINATON SYSTEM (rNPDfSI Form Approved. <br />DISCHARGE MONITOAINO REPORT IDlNRI M~-, 7,op~L ~9 <br />7-161 17-19 1,On nnuT ;F..nI ^n N!?AVb7dNe~kptr~~d~-~i ~3e <br />PERMIT NUMBER DISCHARGE NVMBER (-'nn~ NV1 12345 <br />F - FI %AL <br />MONITORING PERIOD MINOR <br />YEAR MO DAY YEAR MO DAY __ <br />FROM ql3 O1 U1 TD 9O 09 30 '~#:~ NO lli^CH ,.a I ~`~ <br />126111 172-?31 !Yd-151 11E171 179.791 !3631/ NOTE: Rsed Lnetruetlone belord LR11F161etIn0 Ihb form. <br />PARAMETER l3 CaFd Only1 QUANTITY OR LOADING /1 Grd Onlyl QUANTITY OR CONCENTRATION NG FIIEOUENCY SAMPLE <br /> l4E63 61-61 JS-16 46-6J 6461 DF <br />lJ1-371 EX <br />ANUrsIs TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />l et-e9l I61-6W i6&70) <br />pLL ANU hliEq`.i .°. SAMPLE yt CrR .`-r# ~ 91~~ M'$##"-;~. <br />~ .:~-«w ~;t .~.~~..~y..•. I <br />/ <br />Un <br />~ <br />V I .i U n L MEASUREMENT O O 7 IS <br />!:4066 1. l) () ~ ~PERMIT...~~~ ~....-.-'#.'~-~4~~: 0.:::: ~:. :~: ~:....:.... _ <br />ES 1 :'hr.:Yc~k~4lfi#~:: :.~:~~$w~K..r:~-ur:.: ~: i~~::::. <br />;'~~!ye-' .r!~'r ~ FARI. <br />Y <br />I5UAE <br />r r. <br />CF'E'LUE:N C` D'J_ S Y LU REQUIREMENT. ': <br /> <br />,,::: <br />•:: •: <br /> SAMPLE <br /> MEASUREMENT <br /> <br />ERMI <br />~ ~~..: ~..:.. .. :.. <br /> <br />;...: <br /> <br />~ <br />, <br /> REQUIREMENT~ ~ ~ ~ ~~ ~~ ~~ ~~~ ~ ~ <br />.... ~~~~~ ~~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ... ~ ~ ~ <br />: <br />~~ <br />~ ~~ <br />~~ <br /> REQUIREMENT ~~:~:~ ... <br />. <br />. :.::~~. ... <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT. .. .... .. <br />~.: ~: ~ ,: ~ <br />~ ... ~. .. <br />... .. <br /> REQUIREMENT ...:. ~..~;::.~:: ~. <br />.. ... .:.... ~~..... .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT': ~ ~. ... .: ~: ~ ... <br />.. .. <br /> REQUIREMENT' ~.;~:~~,. ~~:~. .. : <br />..... .... ~ , <br />.:~..:..:..... ..~.~..::~.:: .. <br />... <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. ~~ ~' ~ ~ '~~ <br />~ ~ ~ ~ <br />~ ~ <br />~~~ <br />~~ ~ ~~ <br />~ <br /> REQUIREMENT ~ .. ~~ <br />..:~: ...:..: ~ <br />:. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~' .::. ~.. .... <br />:~~ <br />~ <br />: <br />~ . <br /> REQUIREMENT ~ ~~~ ~.:: ~~ . <br />. <br />... .. <br />... <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERT <br />AM FA FV UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINEO AND <br />MILIM WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDIVIDVAlS IMMEDIATELY RESPONSIBLE FOR <br /> OBTAINING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION 19 <br /> TRVE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE <br />~r+ `~ SIGNIFICANT PfNALTF9 FOR SUBMITTING FALSE INFORMATION <br />INCIVDINO <br />~ , <br />THE P0951BILITY OF FlNE AND IMPNSONMENT <br />SEE 18 U <br />S <br />1 1001 ANp 7] <br />C `~~~ ~~ ~/~? I ! LI F <br />J U I ~ n'LC11 . <br />. <br />. <br />. <br />U <br />f t ] t e <br />S <br />C <br />lh <br />A <br />d <br />M <br />d <br />d <br />r SI A RE OF PRINCIPAL E%ECUTNE & i <br /> <br />TYPED OR VRINTED . <br />r. un <br />x bl.« .nnnr. mrr <br />. <br />. <br />. <br />.rA <br />l <br />u <br />. <br />Aw. w ro 110,000 <br />enawnr.Ml.s inPdFavr.nr er Mn.«nemP,ro. AAS6r«n.l <br />F CEq oR AUTHORIZED AOEf/T AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />GGMMI:N IS ANU CAYLNrvXIIVn urnm vl~~nlrvna lnewrsnce en eaacnmems oars! <br />SE'f'L'L.i':AUI S~hlf15 L,Z"ll' APPLIES ONLY IF C= 10-Y8F 7' 1R ?4.FCT.9F,YENT TS CLA.i)1F..0. SF CI,AI:1 AP ygp ?;Y <br />v~iCl!, '1'[;'~'Ik)R LZrt7T3 ~1ILf. NOT RE APPLIED TO RP.PI~;D 1F1.ASlIP.'t'FNTS--SP.F T..n.lA, nr, EI /!?In T,~p, P; 6. <br />.•r•I c.rm nLy1 ~f'LsT-}--fl~~ <br />P Form 3 20-. ,J8-951 •Prevlous edltlons may be used. LREPLACES EPA FORM .10 WHICH MAY NOT BE USED.1 nn~, ~. ~~ ~ ~~ ~ ~ ~ • ~ aGE _ OF <br />