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PERMITTEE .MFIADDRESS (Include NATIONAL POLL- ANT DISCHARGE ELIMINATION SYSTEM(APDt SI <br /> FacdtryName Lorallon1dl/crenr DISCHARGE MONITORING REPORT (AVR) <br /> NAM4__ 4,ID_ CjU TI�NF74T RESOURCES, I-hC. (2-16) L7-19 F — FINAL <br /> ADDRE3s P O BOY 15H _ _ _ C00039136 OOl A TOTAL DISCHARGE FACILITY <br /> 1050 100 ROAD _ PERMIT NUMBER pISCH AROE NUMBER <br /> _-- CARBONDALE ---- _ CO 81623 _ <br /> ------ ------- MONITORING PERIOD <br /> FACILITY YEAR MO I DAY YEAR MO DAV <br /> LOCATION FROM To MINOR PITKN <br /> ATTN: DCUGLAS W BOWMAN (20.21) (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 (46.5J) (54-61) (J8-45) (46-53) (J4-61) NO, FREQUENCY SAMPLE <br /> (31-37) >< EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM .1► UNITS MINIMUM Jay AVERAGE MAXIAM.UA.M�L. UNITS 62-63) (64.68) (69-70) <br /> OIL AND GREASE SAMPLE YY�M IAY MY YYY YYYYYYY <br /> VISUAL MEASUREMENT <br /> 84066 1 0 0 PERMIT REPORT 1ES=1 VEEKLI YxSUA <br /> EFFLUENT GROSS YALU gREQUIREMENT DAILY NX NO=O <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <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 BASED <br /> 0 / ON My INOT HE OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> IAVI OBTAINING THE INFORMATIO`! I BELIEVE THE SUBMITTED INFORMATION <br /> I, TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG <br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING / <br /> 1 THE POSSIBII ITV OF FINE AND IMPRISONMENT SEE IB USC 1 1001 AND <br /> 33 U S C 41319 Ipl•nnitu•, undrr the,e Ftafutr., ma, Im ludr J,n- up N, $100H9l SIGNATURE OF PRINCIPAL EX UTIVE [ / <br /> TYPED OR PRINTED and Ilr mavmum mron,un rn,nr ,I ho vrn 6month,and 5,van I OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Re/vrente Itll attachments here) <br /> IF NO DISCHARGE OCCURS REPORT NO DISCHARGE ON YOUR DMR. OIL 8 GREASE NOW 2 PARAM, NO SHEEN: 1914066=0, <br /> 556=0, AA SHEEN: 84{0066{=�j1, 5,�56=GRAB. SALINITY MEAS. AS TDS. TSS,SETT. SOL, E IRON 00 LIMIT PREPRINTED 03 <br /> EfA OI ZV'� eY. 7 �E' RMIT <br /> 1 19 t`UfY Ib� T S D REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) , •� - <br /> IINTII %']PPI V IS F%HAL/CTFM <br />