HYDRO22842

• Permit No: C1981010
• IBM Index Class Name: Hydrology
• Doc Date: 4/14/1999
• Doc Name: COLO CDPS WET TEST REPORT FORM ACUTE
• Permit Index Doc Type: NPDES
• Media Type: D
• Archive: No

pERMITTEE NAME/ADDRESS (Include Facihre NamdCocation iJDifferenq
NAME
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NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER
PENALTY OF
AM FAMI
AR WITH THE INFORM LAW THAT I HAVE PERSO
ATION SUBMITTEO HERE NALLY EXAMINED AND
AND &1SE0 ON MY
IN TELEPHONE DATE
LI
INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON :
SIBLE FOR OBTAINING

Gordon Peters
W THE INFORMATIbN, I BELIEVE THE SUBMIT7E0 IN
ACCURATE AND COMPLETE. I AM AWARE THAT TH FORMATION IS TRUE,
ERE ARE SIGNIFICANT
C.
70-824-4401
0
04
27
. PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE
e id IIe 8 II8 T POSSIBILITY OF FINE AND IMPRISONMENT. SEE to U.S.C. § 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE

TYPED OR PRINTED § I3t R. (Penalties under mesa statutes may inGUde lines up to 5+0,000 end or
mextmum impnsonment o+fietwean6months and5yeers.) OFFICER OR AUTRORIZED AGENT
b E
NUMBER
YEAR
MO
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COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence ell attachments here)
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