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PERMITTEE NAMEIADDRESS Ilnclude Facilin J4ame/Lw ation if Dii ferend <br />NAME <br />+AY•D2N i:DU'LCH F:RM SAL, NIC- <br />ADDRESS HAYDEN GULCH LOALOUT <br />r" Tox <br />STEAMBOAT 9PRINGS 90^;q--.' <br />FACILITY <br />LOCATION HA'" DEN 1 <br />- ?- r - c-• r t" r, r-,-. <br />NAnomi. POLLUTANT DISCHARGE EUMINAnON sysTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM rS +•?TO t P. <br />it , -'2 -2 T' <br />!) <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />F F I NAL "Ut 1 j <br />)t'?, ;. lrvr f.; t^ r?iv YAMF-P <br />^,,rJ DISCHARGE I <br />NOTE: Read Instructions befo completing this form. <br />PARAMETER QUANTITY OR L OADING QUALITY OR CONCENTRATION NO. FREDUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE r. k is t is # I ; r ## sf # ### C 1 2 ) <br /> MEASUREMENT <br /> PERMIT tF+9###iI #ia### ### 6. 5 # ##x# 9. 0 JEEKLY INSIT <br />EFFLUENT GROSS REQUIREMENT ## ti ? MINIMUM 111A X I mum aLt <br />'_:?L?L..i: T'lT AL.- SAMPLE r l tw## # fi p i_ ##3? ii ? ji x it ?: 1 ? 3 <br />SUSPENDED MEASUREMENT <br />04*-1 S..;0 _ 0 PERMIT ##•it.•### ?F#•iEif••iQ•ii• ### #3i•-ti•### 35 70 1 3NCE/ GRAB <br />EFFLUENT GROSS VALUE, REQUIREMENT i a 3004, r-VG DAILY MX M%= %L_ MONTH <br />C+'•_..ii" =;=.r..;.LE,jLL..) <br />ti SAMPLE ####ittt i s?### #### # 25) <br /> MEASUREMENT <br /> PERMIT ######- #1 ##3e# #!F# #ltaf#fi# REPORT 4. 5 UNCE/ DRAB <br />EFT- L_UENT GROSS VALUE REQUIREMENT 30DA AVG DAILY MX !'IL=L MONTH <br />'.rt;IP, i';_iTAL SAMPLE ###### ##iiiE## #ii#### 1' Ie?) <br />53 FE) <br />01 MEASUREMENT <br />, <br />(i 1041 F C! PERMIT # Iz 3E##3I ####is# ### ##### k 3, 5 7.0 NCE/ RAB <br />P 1 , -r GROB VALUE REQUIREMENT ###? 30DA AVG DRILY MX MG"L MONT <br />"lA'•IG A N'E : E_ 's.Ci1AL SAMPLE ± i; 3>i£ii# t=# °### #IF#### ( 190 <br />! AS MN) MEASUREMENT <br /> PERMIT #'##### ###### 3t## ###### 3. 5 7,0 NCEI RAID <br />EFFLUEN7 GROSS VALUE REQUIREMENT test#> 30DA AVG DAILY MX MGfL MONT <br />`._jIt_ AND GREASE SAMPLE ??st?#IE# ,..??##? #?#### ?###tl# ! 1?) <br /> MEASUREMENT <br /> PERMIT #### ## ### ####;? ##### 10 ONTI <br />N <br />RAT <br />VALUE <br />EFFLUENT GROSS REQUIREMENT ;E?f DAILY MX M^ =.. GENT <br />T CIR SAMPLE i 03) <br />f> ###ii# <br />ii 3i #### <br />#tF# rr# sr <br />THRU TREATMENT PLAN MEASUREMENT <br /> PERMIT REPORT REPORT <br />#?i### <br />??tt it#?t# <br />##sf#i <br />?t## <br />EEFiLY <br />It?#S°?A <br />EFFLUENT CROSS VALU REQUIREMENT 30DA A V(3 DAILY MX M G D ??#?' <br />NAMEMI'LE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were <br />TELEPHO <br />NE <br />DATE <br /> prepared under my direction or supervision in accordance with a system designed <br />?o??j? <br />er? ?' <br />Ad Nis to assure that qualified personnel properly gather and evaluate the information <br />submitted. Based on my inquiry of the person or persons who menage the system, <br /> <br />1 <br />l <br /> the information <br />responsible fm gathering the information <br />or those <br />ersons directl <br /> p <br />y <br />, <br />d com <br />lete <br />li <br />f <br />t <br />t <br />f <br />k <br />d b <br />i <br />d i <br />h <br />b <br />d <br />l ul? 04 <br />07 <br /> p <br />. <br />, <br />rue, accura <br />e, an <br />now <br />ge an <br />e <br />e <br />s, to t <br />est o <br />my <br />subm <br />tte <br />e <br />e SIGNATURE OF P NCIPAL EXECUTIVE <br /> <br />aware that then ere significant penalties for submitting false information, <br />1 am <br />OFFICER OR ORIZED AGENT <br />AREA <br /> <br />NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. COPE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIUNS (Rererence au airacnmenm nere) <br />APPLS:E O=NLY IF 1:.0--`f'R, 34-HR PRECIP Et'ENT IS CLAIMED. EXEMPTIONS ?=ROM <br />LIMITATIONS - SEE I.B.i.D <br />PAGE OF <br />EPA Form 3320-1 (Fes. 3199) Previous editions may be used. ?? {?:7 i ,b?? a 4'p??fl?;