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PERMITTEE NAME/A SllmiudsFacility NaneLoearr.nljD(ffiwmt) <br />NAME 0 A Kit E: :, N K R; Y I r; • <br />ADDRESS CAR 8DN J,UN�-TIDN yT,P)to <br />278 SAWYER DRIVE <br />UURANG0 ': CO 41331 <br />FACILITY 0AKRIDaE- ENERSV INC. <br />LOCATION <br />c6w <br />~ W <br />A T T N : hr vn <br />NATIONAL POLLUTANT ARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGI IITORING REPORT (DMR) <br />2-16) 17-191 <br />n <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO 1 DAY YEAR I MO I DAY <br />FROM7 TO <br />(20.21) 122-231 (24-26) (26-27) (28-29) (30-31) <br />Form Al d. <br />OMB No )-0004 <br />N S E D I PD 2. TO C {AptpAV6 aapir;s 05434188 <br />(SUElR SSW) 123145 <br />F — FTNAL <br />r,It.hR <br />NOTE: ee instru ions e�or camdieting this form. <br />PARAMETER <br />(3 Cord Only) QUANTITY OR LOADING <br />(4 Card Onlyl QUANTITY OR CONCENTRATION <br />NO <br />FREQUENCY <br />SAMPLE <br />>< <br />146-53) 154-61 • <br />136-45 146-53 (54-61) <br />EX <br />OF <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM _ <br />AVERAGE • <br />MAXIMUM <br />UNITS <br />(32-371 <br />r62-631 <br />AN164 -681_681 <br />TYPE <br />(69-7o1 <br />UIL AND GREASE <br />SAMPLE <br />( 94) <br />aV:, <br />;�C:�a #:x <br />r=>•;>:_ :: <br />MEASUREMENT <br />V I S U A L <br />PERMIT <br />tiY ztY p( <br />0IR <br />�" ; at «� <br />.: ;-•.. 'fit <br />r <br />:l� o1 v ..L1t <br />s E !� <br />I r ti A I <br />8 4 U rl h 1 p: ;_p <br />q. <br />F Z I <br />: t <br />REQUIREMENT <br />r n <br />r <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />•' <br />SAMPLE <br />;• <br />MEASUREMENT <br />; <br />4 <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />t. <br />REOUIREMENT <br />SAMPLE <br />MEASUREMENT <br />k� <br />PERMIT. <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />" <br />PERMIT <br />REQUIREMENT <br />' <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />f. <br />REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECU E OFFICER <br />I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY EXAMINED AND <br />- <br />TELEPHONE <br />DATE <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON <br />MYTAIJNQUIRY OF THOSE LE FOR <br />NING THE BELIEVE <br />AWARE BMITTLY ETTHATE ApTORMBALTION IS <br />t�,1�i�,, {I7- <br />l�ff7.('t/ r it V ;t�� <br />)�� 1 , <br />TTRUE,ONSI <br />ACCURATE� AND COMPLETE AME HERE ARE <br />SIGNIFICANT PENALTIES FOR SUBMITTING F INFORMATION, <br />FALSE ON, INCLUDING <br />I' <br />/� <br />�J <br />THE POSSIBILITY <br />( , J/ 1-'2 <br />OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 AND 33 <br />U.S.C. 1 1318. r ww*l s under thea statuas may Include Anes up to $10,000 <br />and ormax)mun inpdsonm ntofbetween 6 months and 6 years.) <br />SIGNATURE OF PRINCIPAL ECUTNE <br />OFFICER OR AUTHORIZED AGENT <br />�+ / <br />TYPED OR PRINTED <br />AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />GOMMtN 1 S ANO EXPLANA f ION OF ANT VIULA i TUNS Ilielerence all attachments here! <br />SEMEABLE '5DLIr5 LImrr hPPLISS 04LY H (= 10 -YR, 21.4-Nf7 ?RE::Ir s:Yi;hT IS CLRTI•)i,i). IF ('I. I:t aPE'f?OVF:D 3Y <br />-VVCD, TSS 6 IROtt MlTt5 MILL N, -)-f BE APPLrED'TD RFp6nri:D `9EASUAi:XEh'1Y;--S F. I.13.1I1, PG ") rtln I.11.1D, i'; 6. <br />Irl X70►1 08 9) f= •tions-tria ba Lied. t - t - - (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />