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PERMITTEE NAME/ADDRESS P.eY4 FrWryN~/L«mlw I/Dlp....r/
<br />NAME CtiAVU Y.41,1._~Y .,'L~, ., ,•~;.;
<br />ADDRESS ;?UtIG°R C: e."Y'Ia ejc•
<br />P.O. ROX 7J
<br />LII ~;, CO
<br />FACILfTV G°A F~ Y!. 1. 1. '!' "UeL '.:(~,YPAyY
<br />LocATIDN
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<br />NATIONAL POLLVTANT dSCHARQE EUMINATIOM SYSTEM (NPDESI
<br />DISCHARGE MONITORING REPORT /OMR)
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<br />PERMIT NUMBER „ ~. ;DISCNMGE NllfAaER
<br />31514-OOTO MQNR •RIOD
<br />Y AR MO A YEAR MO OAY
<br />FROM f0 ~ !'
<br />~ocl nA9]I tlR_9R1 /.20.1//
<br />Forth Approved.
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<br />PARAMETER
<br />13 0.rd Ontyl QUANTITY OR •s -•e -
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<br />/I G,d Onry/ QUANTITY OR CON ~
<br />NO.
<br />FREDUexcr
<br />SAMPLE
<br />/32.371 Id653I /51-6
<br />~ /39-r.ll (1653 15F6/1 EX DF
<br />ANMYSIS TYPE
<br /> AVERAGE MAXIMU ITS MINIMUM AVERAGE MAXIMUM UNITS 3•s! iN-681 163701
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<br /> MEASUREMENT /S /(/~1
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<br />(~ ~ ~ t? i MEASUREMENT
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<br />LFFLU~'NT GROSS YALII ::REQUIREMENT ;: :rr,.r `~.:.': :>r<~.'~}. ... ,?. ~ ..:~. x MC/L .}54~14"f .
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<br /> MEASUREMENT
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<br />~Hn!I 'fN F:ATAP.NT OLA'+ EAQUREMENT
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<br />:, [ _; ,:0 L Y t: D MEASUREMENT
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<br />F:FFLUF:!IT ;RU55 YALU :AEQU.IREMENT.' .. [?q.S't t!..A'L'. '~~)-C Cr^rf
<br />NAME/TfTLE PRINI>fPAL EXECUTNE OFFICER I cERn
<br />AM FA FY ImDEfl PENAiTY DF L
<br />MIUAA WITH THE MIFO Aw TNAT I NAVE PERSO
<br />RMATION Sl1aMITTEO H NALLr ExAMIN
<br />ERDN
<br />AND aA ED AND
<br />aED ON ' TELEPHON E DATE
<br />
<br />IC7HN M WALTERS ;
<br />MY INOURY OF THOSE INDIVIDUALS IMMEDIATELY flESPONSYSIE fOR
<br />OlTAINING THE INFORMATION, 1 aEVEVE THE a11aMlTTED INFORMATION IS
<br />- -
<br />.
<br />MANAGER OF MftJE SERVICES TflUE. ACCURATE AND COMPLETE. I AM AWARE THAT TNERE ARE
<br />AGNIFICANT PENALTES FOR SIIaMITTTNO FALSE INFORMATON
<br />INCLUDING
<br />Q
<br />470 $58 3608
<br />9 ~
<br />i0
<br />28
<br /> ,
<br />THE POSSIa1L1TY OF FINE AND IMPWSONMENT. SEE to V.S.C. f 1001 AND 7] IONAT
<br />E OF PI
<br />NCNA
<br />I
<br />EXECVTIVE
<br /> U.S.C. I I I IP. II V~rbY1 uAr tlwM FYnms mry hcA.W l~+Y w 01 S 10,000 a
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<br />TYPED OR PRMITED ndar.numun irwnsrnwn elArfwwn tmmeh. rM SYrt/ OFFICER OR AIRHOR12E0 AGENT CODE NUMBER YEAR MO DAY
<br />CIQMMENTS AND EXPLANATION OF ANY VIOLA (IONS /NS]K~ncs M/ sttscnmsn/s nsel
<br />l 11A'': 'i F:NL'j a:`YIT. -f"!'-'. .' I.C. iF i'. ~. .1" Od'! .'~: ~:'~. L;:^ ?° I ~.~ i" ^'.'t °Hi.Y nVl-. .'UsI'. r, i'-~-l j)r. :, pOE'T?i.
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<br />EPA m 3320.1 108.96) Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.( U 0 2 8 3 / 9 G 1217 -120 (f pA`G lOF
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