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PERMITTEE NAME/ADDRESS Brbt. FrrhryNwW!<nNOn r)OrpwmO
<br />NAME bu.J:.hHUr::+ Cad! r~lyt'Atii
<br />ADDRESS nUA'J :.;I/:. °::: ~:, !. ; ii.l:T.: L.'i
<br />FACILITY
<br />LOCATION
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<br />NATIONAL POLLVTMT DISCHMOE ELIMINATION SYSTEM (NPDESI
<br />DISCHARGE MONITORING REPORT (OMR)
<br />I2-181 117-191
<br />00072716 C15 A
<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM ') f u4 v L TO '~ l; h ;'J
<br />!16211 l12-131 !24251 118-271 118-191 !363/1
<br />Form Approved. a=
<br />PORC 9 TC COLORADPI`^~°Y?OIAO-oooa
<br />Approval e><pl ae OS-31-9~
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<br />NOTE: Reed Irntmctlorn be re eo Ltlnp this form.
<br />PARAMETER 13 Grd ONYI QUANTITY OR LOADING !I Grd On/Yl QUANTITY OR CONCENTRATION NO. FREOUENCr SAMPLE
<br /> 146-531 !54611 !38<5l 146-531 !54611 °F
<br />l32-371 EX
<br />MALYSIs TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !s2-s]I 166681 169-701
<br />a SAMPLE .. ~[: e? ;::'s:, {: Yr ::t
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF lAW THAT I NAVE PERSONALLY E%AMINED MD TELEPHONE DATE
<br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON
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<br />MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNINO THE INFORMATION
<br />I BEDEVE THE SUBMITTED INFORMATION IS\ ~
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<br />SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
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<br />1 THE POSSIBILITY OF RNE MD IMPIIISONMENT. SEE 1B U.S.C. 1 1001 MD ]] ) gIGNATURE OF %11NCIPAI E%ECU7NE j
<br /> U.S.C. E 1]10. lPrrlbAYWr elrr mron. A:.Y prcld~ rn.a up ro t 10,000 / AREA
<br />TYPED ORP INTED wrnvam,.e hrPdern.r:t ofMwwremonMa rM SYrr+l ~/ OFFlCER OR AUTHORIZED AOEM CODE NUMBER YEAR MO DAV
<br />COMMENTS AND EXPLANATION OF ANY VIOLA( IONS lHeterence e//ettscnmen(s ~erel
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<br />FyA Form 3320.1 108-961 Previous editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 ~ 0 T rl 7 / 9 tl L 1 ~ j - 17 °r b PAGE _ OF
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