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NAME___C (�1 i 6'.'11i_� 1J (�`i iCl d �'Il t:) ....r..,.r.r.... •.. .,..rvl.lnv ncr—MI tw".l "My No. ZU4U-000 <br /> _ _ _;C h /' V- _ I (17-19) pires2.29-84 <br /> A DORESB� fXXtX XXU XX S X X XXX M X X TX_X.X X X X X X�_ 1 13 5 <br /> IVNVV•V1/Y_—__UYY 1lV LM------- <br /> PERMIT NUM 9ER OISCHARc.E NUMBER <br /> Q�Q�Q�r�/�F�� ffLAZ_ MONITORING PERIOD <br /> J`alb_�111t�a_�lCl£-41------.__..__S2LrY1L+__ YEAR MU 'JAY YEAR MO DAY <br /> LOCATION Montrose Cqunty, Colorado FROM ,, r. TO br 1 <br /> (20- 1) (22.2 ) ( 4-25) (26 ) (28-29) (JO.31) NOTE: Read Instructions before completing this form. <br /> (J Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (16.33) (316 NO. FREQUENCY SAMPLE!) (J8-43) (46-SJ) (JI•b1) DF <br /> (32-37) EX ANALYSIS TYPE <br /> >< AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 6263) (64.68) (69-70) <br /> SAMPLE <br /> FL-1 '' (FFFLi1i±•-T) MEASUREMENT No Discharge <br /> PERMIT G(I <br /> REQUIREMENT r <br /> SAMPLE <br /> SQ •IVCJ T"T- S;�SJ MEASUREMENT <br /> (IEf FLuE\IT) PERMIT LE/!. : I' r/L <br /> REQUIREMENT * ye * + .k hh * 35 <br /> 7 0 1/3 0 Gi F <br /> SAMPLE - I - <br /> I;t�ri . TOTAL MEASUREMENT <br /> PERMIT ��C/1"i` ?iG/L <br /> (. 114CS REQUIREMENT y >~ * * t *, _ 5 710 1/30 GR <br /> [, f' MEASUREMENT <br /> SAMPLE - <br /> C-) P H E F I LLD ,�. * •k i• * -ir >< <br /> 1' <br /> PERMIT r S LI <br /> a V l REQUIREMENT * t * 1t 7k M 9. 6 1/ 0 GP <br /> SAMPLE <br /> OIL '� GirE 4�3E MEASUREMENT <br /> VI3tJI•'(,. PERMIT v II'r/L <br /> a c 0(;Z REQUIREMENT + ,M # * *, ,Y >y * * •!• fC * * * 1 r 1/3 0 V I <br /> SAMPLE <br /> CJvDIJCTIvITY S/,J:< MEASUREMENT * * * * * 4 <br /> TDS (`FFLuE.,T) PERMIT <br /> 7J4v•i REQUIREMENT * * * YF Yr ?t * i * * 7E ak # Yt * * * * 1191) (jR <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <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 SA 5ED <br /> Cm ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR () <br /> Smith <br /> OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION <br /> $fil H. Theodore <br /> IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERF ARE SIG <br /> Hydrologist NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDIN(; <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE III USC 1 1001 AND SIGNATURE OF PRINCIPAL EXECUTIVE 602 774-5253 86 07 24 <br /> 33 USC 11319 /Prnalarw undo Ihvav .Ialulrs mar mrlu/r /Inr. uP I,. rlrr lwwr <br /> TYPED OR PRINTED a.vl'or mevmum lmPnummrnl a/MruvrnFmonlh.and.i OFFICER OR AUTHORIZED AGENT A A NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Re/erence all olluchmenls here) <br /> TF I.1'^ OISC�,:,FvE �'CC(,W',;E(, I,Ikiki, G Ti(I': riFFi ;iTl'ry -4EPU?T 'I' U GISCM!IRGEn <br /> 1 1 <br /> EPA Form 33 eV. 10.79)PREVIOUS EDITION TO BE USED (REPLACES EPI T•40 WHICH MAY NOT BE USED.) PAGE OF <br /> UNTIL SUPPLY 16 EXHAUGMED <br />