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PERMITTEE�.7 E/ADDRESS (include Clude NATIONAL POLONT DISCHARGE ELIMINATION SYSTEM(NPDES) •FicuifyA'CM Lu!arlon1I diffferent DISCHARGE MONITORING REPORT fDMRI <br /> N AM 4__ �MZD CONTI�NFNT RESOURCF,S, .I NC._ (:./a 17.iv E — FINAL <br /> AUDREss PI�0 BOX 158 coU039136 001 A TOTAL DISCHARGE FACILITY <br /> --- 105a 100 ROAD_ PERMIT NUMBER DISCHARGE NUMBER <br /> __— CARBONDALE ----- CO 81623 _ <br /> — ------ MONITORING PERIOD <br /> +�Aclury __ <br /> LOCATION YEAR MO DAV YEAR MO DAY— <br /> ______ FROM TO MINOR PITKN <br /> NTT : QCUGLAS W BOWMAN — 120.21) (22-23) (24-25) (26-27) (28-29) (30.31) NOTE: Read instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (54-61 FREQUENCY SAMPLE <br /> (3845) (46-53) (S4fi1) NO. QUE OF <br /> (32-37) ?< — EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63) (64fi8) (69-70) <br /> OIL AND GREASE. SAMPLE <br /> YISaAL MEASUREMENT <br /> 84066 1 0 0 PERMIT .' ES-1 Y ####M# ###;h## ### EEl�L v S,DA <br /> EFFLUENT GROSS VALU REQUIREMENT DAILY MlG NO=O <br /> SAMPLE .. . .. ..._ ... <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENTIS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQULREMENT - - <br /> SAMPLE <br /> MEASUREMENT <br /> 777777777 <br /> PERMIT <br /> REQUIREMENT <br /> I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> RffiQUIREMENT .. .. + <br /> I" <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> V Q�„r-.cyr ON MY IN OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> (n'J,i,�[� S OBTAINING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION R ^ <br /> / IS TRUE ACCURATE AN O COMPLETE II AM AWARE THAT THERE ARE SIG <br /> THE <br /> IC ANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br /> THE POSSIBILITY h, FINE AND IMPRISONMENT SEE IB USC S 1I" AND SIGNATURE OF PRINCIPAL EX UTIVE <br /> !— "' U.SC 4_I 3-t9 rp.am(hrr urufrr tfi— afafufvs -Id meludr Jrnv„ up fu fia,nnlr — - -' <br /> TYPED OR PRINTED nruf�.r mas nrum lmpnson nu•nr r/Avtu r.nFmonrhv arrd5war.1 OFFICER OR AUTHORIZED AGENT AREA <br /> NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (XeJerencr ull ufluchrnrnLs heir) Coori <br /> IF NO DISCHARGE OCCURS REPORT NO DISCHARGE ON YOUR DMR. OIL E GREASE NOW 2 PARAM. NO SHEEN: 84066=0, <br /> 556=0, A SHEEN: 84066=1, 556=GRAB. SALINITY KEAS. AS TDS. TSS,SETT. SOL, 6 IRON NO LIMIT PREPRINTED ON <br /> E A 91i'ri r2 `? eY. 7 --' T S D REPLACES EPA FORM T-40 WHICH MAY NOT OF I.ISFr).)UNTIL SUPPLY IS EXHAUSTED. <br />