2014-03-07_REPORT - M1974041

• Permit No: M1974041
• IBM Index Class Name: REPORT
• Doc Date: 3/7/2014
• From: Lawrence Construction Company, Inc.
• To: DRMS
• Email Name: TAK
• Media Type: D
• Archive: No

COR900000 Annual Report Form Page 2 of 2
Part F: Corrective Actions — indicate whether any of the following conditions occurred at the permitted
Yes
No
facility:
- An unauthorized release or discharge observed (e.g., spill, leak, discharge of non - stormwater not
authorized under COR900000 or another permit);
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- A discharge violates a numeric effluent limit;
FO
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Facility control measures are not stringent enough for the discharge to meet applicable water quality
standards;
- Modifications to the facility control measures are necessary to meet the practice -based effluent limits in
permit;
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LOW
- The permittee finds in a facility inspection, that facility control measures are not properly selected,
designed,
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installed, operated or maintained.
IVN
- Construction or a change in design, operation, or maintenance at the facility significantly changes the
of pollutants discharged in stormwater from the facility, or significantly increases the quantity of
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pollutants discharged;
- The average of quarterly sampling results as described in Part 1.1.2.e of this permit exceeds an
F-1
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applicable benchmark.
If the answer to any of the above questions is "Yes ", provide a description of the conditions that met the criterion /criteria
and describe the corrective action(s) taken" (attach additional pages as needed):
Part G: Required Certification Signature (Reg 61.4(1)(h)]
"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the Information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is to the best of my knowledge and belief, true, accurate and
complete. I am aware that there are significant penalties for submitting false information, Including the possibility of fine
and imprisonment for knowing violations."
Name:
Title:
Signature:
Date Signed:
Submit Annual Report form (ORIGINAL ONLY — COPIES, PDF, FAXES, EMAILS ARE NOT ACCEPTED) by March 31 to
the following address:
Attn Annual Report
Colorado Dept of Public Health and Environment
Water Quality Control Division
4300 Cherry Creek Dr South WQCD P -62
Denver CO 8024E
Form date. November 2013