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PERMITTEE NAME/ADDRESS (Include <br />F~rOlfy N~me~Loratlon if diffen:ntl <br />^A~E 4hS'?~~I FLL:>-~O f.ttf~('I.-f~~C--- <br />'ADDRESSFI 1 ~L H (7 "r. I Z n N !7I fJ c - - - _ _ <br />---?~~ _ROX 52t1 -_ ------ <br />---yUCI,A ---------- CO 37121: -- <br />FACILRY <br />----------------------- <br />LOCATION _ _ _ _ _ <br />AT3N: R. LANCE ~AJc"", Y.IIiE (1ANAGEk <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SY9TEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />(1-16) (17-191 <br /> CnCOC0213 C05 A <br /> PERMIT NUMBER olsc.weae wuHeeR <br /> MONITORING PERIOD <br /> YEAR MO DAT YEAR MO DAY <br />FROM ~ y y TO <br /> /10-1/1 111-III /11-151 /16-17) (18-191 !7631) <br />'".INOR <br />(5 U B R N C) F4SP*,+AP~oYad• <br />F - FINAL OMB No. 2040.OOOM1 <br />POND R U N O F FAPB'R~4'~~SfofJ'+A'9B R A Y <br />'kOrF NO UISCHAi!GE ~~I IX <br />NOTE: Raad Insfrucfions fJefore wmpletlng tlllB form. , <br /> (J Card Only) CUANTITY OR LOADING (4 Card Only) DUALITY OR CONCENTRATION <br />~ <br />t~ataaCY ' <br />PARAMETER (46-53) (5461) (7875) (4h-SJ) (5461) NO. <br />E% <br />ANALrss B/1MPLE <br />TYPE <br />(31-J7) , <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNRS (6F4J) (6168) (64701 <br />4 SAMPLE C: ,:4 xj# .' u-f :,`. YF +: I.{F `•:F ft:Y Ls:: ( 12) <br /> MEASUREMENT <br /> PFRMR _. __- =.. - .~iA>d>.ttt4 9~ElY~' ..- t ~AY~:--• <br />:FcLUE:J':' Gi10S;: YALUE '~4ulR0~g"r' _ <br />' ___~~_* tiINLf7Utt BATIIfiUM SU . <br />~' .- <br />!{ <br />'OLIDS, SE1'TLEA:'•L~ SAMPLE ;"~Ik~~:x ~"`'^``r`'' ( 25) <br /> MEASUREMENT ,- <br />J545 1 0 C' PERnuT oaoaaa± ~o~aa~ r ;=:x~F OPTIONAL REPORT .. 6.5 :-+5' Nfi Nc „ <br />. $ ''~. <br />=.FFLU°NT GROS`: Ye1L1J ~uI~~T =%+~:1i~~= QRTR AVC 34DA.AVv DAZL :!X ML/ <br />L =' lKJ:S. _ <br />iL P.tiG GF c.;n:. SAMPLE "'inch.+,: . . v=f 4`~: :4:;.;:. :.:: :rvS Y'-':F X/:; r <br />f <br />( 1 D) <br /> MEASUREMENT <br />S '. iS2 1 U J PERMIT CIIdOYk Cs ft +01#G+D#CI •;s:: I Ccds}oR~KS 1)"J C/O'.JIfF ~~ .., ~'. Q~~'. <br />B''PLUFNT Gk(J5; VALUE REnuIRE~1ENr 'F::.::U INST.~".AY YG/L 's' ~G~'11,Tr= '` ' <br />'LUa, IN CONDUIT OF. SAMPLE ( !.'3) -u•"4~=li '.': ;: ie C:¢Qfr: 44hbb:} '~. <br />'NiiU TR EATYF:NT ?CANT MEASUREMENT <br />Sa050 1 0 0 PERMIT dTiFDaT RF:FOfiT ;*t~~~a~s ooao#z al>arkga.~ un,: <br />~r <br />N~~:~ <br />:}'YLUENT GROSS VALUc ReauIREMEN7 3i'DA AYr, DAILY KY Y:Su •• ,= <br />'" Cl#^: .. <br />-. , <br />.l16Nx ' <br />>uL=OS, T~,TnL SAMPLE Ixha•,::t::: h...:.1:r;Y h:y:::zc: ( 19) - <br />)I;;aOLYED MEASUREMENT ' <br />a2'i5 t 0 u PERMIr OC,CIQYt# OOnICo~+O -y:~-: pp~ElA4 REPORT OP?YQ L ~ ; .; <br />"FYiUENT GHO55 UALUc REgyuiEMBNT C1(vil RTR. AYG R~lR~MA% MG/L ' = -~' '?' <br />IL AND GREASE SAMPLE .. ::t}:.`•!}!: ( :lll) 4.{;:;::y:~h s%>kl}:}il~: ##OOfJd <br />L S U A L MEASUREMENT __ ' <br />~406G 1 ~~ G PERMrt ##a#~ao s= t ola.alr~C=# $~aa+aa+l~ ~oolosoit oov <br />EFYL'JENT GRJSS vALUi '~°110P°''~ INS? nAX 9G=a - ~u~o a <br /> SAMPLE <br /> MEASUREMENT : <br /> PERMIT .. - ~ m', <br /> R@CUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CEFTFY UNDER PENALTY of LAw THAT I W.vE PERSONALLY ExAMINED <br />^ ~ ,~ TELEPHONE - DAT E <br /> <br /> <br />N k /NG AND AM FAMWAR WRM THE INFORMAT... <br />N SUBMITTED HERE W: AND EASED <br />ON MY WOURY OF THD9E Y-IdV1DUwL5 AIMEDIATELY RE3PON9BLE FOR <br />OHrAWIIJ!•i THE INFORMATON I BELIEVE THE Sl1BMITTED WFORMATION IS <br /> TRUE ACCURATE AND COMPLETE 1 AM AWARE THAT THERE ARE <br />IG <br />NT P <br />LTIE <br />MITT <br />FOR <br />UDI <br />F <br />R <br />F <br />E <br />O <br /> <br />A/ <br />, <br />~ <br />If <br />~ <br />S <br />NI <br />KA <br />ENA <br />S FC <br />SUB <br />WG <br />ALS <br />IN <br />MATI <br />K INCL <br />NG <br />THE PO551euiY of FINE AND wPRI50NMFNT sEE 10 uSC 1 IDOI AND <br />~ ).1 <br />/i/ <br />/(f~ ~Y~T <br />VV <br />9~ r,L~ <br />y <br />I <br />^ , <br />~~ <br />y. , <br />„y J <br />33 USC 1 1319 (PCnalliu ulxlCl IMir )).lulu rtuy nclude %mr) u <br />!o SIGNATURE OF PRINCIPAL EXECUTIVE r <br />r <br />TYPED OR PRINTED p <br />f/0000 end or meumum unpruonmrnr N betran 6 month) snd 5 yun) OFFICER OR AUTHORIZED AGENT AREA NUMBER' YEAR MO DAY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference ell alRChmenls here) <br />GdT":LErlb:.i': ~U:.IJS ~.Itf;T 4r:L'_ 9E 4~.?VE'GrO!' ??!'Yd,_-+t12 9SCI~ c:V~N':-3EP. I. &.1(D), PG Y, FOR REQUIREMENTS. <br />QkTitLY SAnPLING INSTkUCTIUNS-I.C.S, RG 8T. ?0 UAY P.VG I3 HLG!i~>T '!OMTHLY AYG DURIYi, PP.RIDD REPORTED. <br />9.881 1~BVIDIIS edllion5 r71BY bB fsBff. (REPLACES EPA FORM T-10 WHICH MAY NOT BE USED.1 PgOE OF <br />