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PARAMETER <br />(32 - 3 7) <br />(3 Card Ogly) QUANTITY OR LOADING <br />(46 - 53) (54 -61) <br />(4 Card Only) QUALITY OR CONCENTRATION <br />(38 -45) (46 -53) (54 -61) <br />NO. <br />/62-63) <br />FREQUENCY <br />OF <br />ANALYSIS <br />(64-68) <br />SAMPLE <br />9 <br />/669 -7070 1 <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />F H - <br />0400 1 0 0 <br />I• FFLUENT GROSS VALUE <br />SAMPLE <br />MEASUREMENT <br />*Y*# * <br />r Y ' <br />** <br />$ <br />•r* <br />PERMIT <br />REQUIREMENT ^ <br />#3 #*#* <br />** * * 41* <br />6.5 • , <br />MINIMUM. . <br />,.$****, <br />9.0 <br />1SAZIMQ <br />ONCE/ <br />.CRIB <br />NORTH <br />LIDS, SETTLEABLE <br />0..,45 1 0 0 <br />FFLUENT GROSS VALUE <br />SAMPLE <br />MEASUREMENT <br />• ,4 **Mt: <br />***tit Y <br /># #* <br />Y YY <br />#* * <br />ML/L <br />PERMIT <br />REQUIREMENT <br />, # # #•': #* <br />444 * ** 4 <br />- • ** ** <br /># ## <br />0. 5., <br />DA MI <br />ONCE / ' <br />MONTH <br />•IL AND GREASE <br />REON EITR -GRAV METH <br />0556 1 0 0 <br />FFLUENT GROSS VALUE <br />SAMPLE <br />MEASUREMENT, <br />* *•y•y*'`^ <br />** *Y <br />* * *# <br />* * **#* <br />* # # * #'r <br />rL <br />PERMIT <br />REQUIREMENT <br />* # * *Y# <br />YY # *•r <br />- ' <br />: *'><$ ## <br />'2,412 <br />: , t1 • <br />10 , <br />- INST•• FX ' <br />CONTINGRAB <br />GENT <br />LOW, IN CONDUIT OR <br />HBU TREATMENT PLANT <br />0050 1 0 0 <br />FFLUENT GROSS VALUE <br />SAMPLE <br />MEASUREMENT <br />( <br />1� <br />, <br />-IJ <br />i � � <br />C ei <br />MGD <br />i�Y�r #*-* <br />tc**'>;',k# <br />*�XY~ <br />* <br />* * <br />* * <br /># * <br />C7 <br />N <br />PERMIT <br />.R EQUIREMENT <br />REPORT <br />30 `DA . A♦ <br />R PORT , <br />DAILY NY <br />; ** ** : <br />�,• 1,„: ' ` <br />' *4* *** . <br />* * ** <br />� <br />WEE11Lr NSTAl <br />- <br />• OLIDS, TOTAL <br />DISSOLVED <br />0295 1 0 0 <br />EFFLUENT GROSS VALUE <br />SAMPLE <br />MEASUREMENT <br />* * * *Y* <br />- <br />* # # # *# <br />* * <br />* * <br />* * <br />* * # # *# <br /># * # * #* <br />NG /L <br />PERMIT <br />R E QUIR EMENT : <br />#4**** -• <br />" • <br /># + # <br />*** ', <br />, * * * * ** <br />-REPORT, <br />"DAILY NZ <br />QTRLY • GRAB <br />• IL AND GREASE <br />V Z1 A L <br />E , D6 1 0 0 <br />FFLUENT GROSS VALUE <br />SAMPLE <br />MEASUREMENT <br />• * * # *Y* <br />NO =O <br />* *YY *# <br />* * # * *# <br />*` #Y #'YY <br />* * <br />* <br />* * <br />PERMIT <br />REQUIREMENT , <br />1 :g***** , <br />0 • , IES=1 <br />INST'MZ <br />, * * **** <br />* ***** <br />+$ **** 4 <br />. ONCE/ VISUAL <br />MONTH • <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />, I <br />r. <br />• <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED <br />AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN, AND BASED <br />ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION <br />IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG- <br />NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING <br />THE POSSIBILITY OF FINE AND IMPRISONMENT, SEE 18 U.S.C. 4 1001 AND <br />• 33 U.S.0 : I. 1319. (Penalties under these statutes may include fines up. to $10,000 <br />and or maximum imprisonment of between 6 months and 3 years.) <br />� " <br />Y - /� 1 <br />TELEPHONE DATE <br />-•� <br />�Q <br />y <br />0r' • � <br />U , • <br />C,Jr•' , <br />�-t'Stiii - A h rrall 6l <br />1 )` <br />�i i <br />�Q .2 <br />7W-3953 1 <br />6 <br />V <br />� <br />SIGNATURE OF PRINCIPAL EX CUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />' TYPED OR PRINTED <br />AOpE <br />NUMBER YEAR <br />MO <br />DAY <br />r LnMiI I tt NAMIiA''' "LSS( Include <br />/ecday Name/ 77! W. <br />I ' <br />NAME ' r_L COA NUCLA ,!lIIIE <br />AD COLA 4. Y ROAD• AA' <br />�"�' - NUCLA . • • -' " ' 'CO' 81424 <br />FACILITY 1 <br />— — <br />LOCATION — _— _-- - -- <br />ATTN: DENNIS STEVENSON, PRESIDENT <br />EPA Form 3320-1 (Rev. 9-88) Previous editions may be used. <br />NATIONAL POLLUT SCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCH ,ONITORING REPORT (DMR) <br />(2- (17.19) <br />FROM <br />C00000213 <br />PERMIT NUMBER <br />(20 -2/) (22 -23) (24 -25) <br />MONITORING PERIOD <br />004 A <br />DISCHARGE NUMBER <br />M D TO 10 2 0 31 <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all atlachments here) <br />IF NO DISCHARGE OCCURS REPORT "BO DISCHARGE". OILE AND GREASE; SEE FOOTNOTE F/. <br />(REPLACES EPA FORM T -40 WHICH MAY NOT BE USED.) <br />(26 -27) (28 -29) (30 -31) <br />Approved. <br />F - FINAL No. 2040-0004 <br />S T O R M W A T E R DISCHARGE Approval expires 6-30-01 <br />MINOR (SUBR WC) MNTRS <br />NOTE: Read Instructions before completing this form. <br />00087/900810 -1402 <br />PAGE 1 OF <br />