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PERMITTEE NAME/ADDRESS Qnelude Faciliro Nome/Comrion iJD~erenq <br />NAME <br />CULO~rTT~ C!?},L C~."PF`~Y~ L~i~~ <br />ADDRESS[-rTLOti Y G ': 'I F <br />;731 `.•'"iTF: H,C•ILAY 13 . <br />" i t r i ~ CO 81641 <br />FACILITY <br />LOCATION <br />D.TTN• .1. D. 4ARr'O •,_ GEti T~~. 0.T '+R ", A•.~' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMA <br />(2161 f1] 9) <br />rr n nf, S1 C.1 nA9 h <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY?w;';~ YEAR MO DAY <br />FROM VU 07 C}~~,xx'.~T~O QU O~ 3O <br />(2P21) (22-291 (24851~~' (26-211 (2829) (3P3/) <br />Form Approved. <br />OMB No. 2040-0004 <br />Y 7 '• J" Approval expires OS-31-98 <br />v - Fi~AL rOFA' <br />t•.VI v'.; FIT TC Ff{OSEi'CT PO':D <br />,:nr' •.!) SI'rHADi,r -_( +..:'lrr <br />NOTE: Read Instructions before completing this lorm. <br /> (3 Cartl Only) QUANTITY OR LOADING (a CdRl Only) QUANTITY OR CONCENTRATION NO. FAEOUENC SAMPLE <br />PARAMETER (46 s3J (54-6 /) - <br />, (38-451 (4653/ (54-671 EX OF TYPE <br />(3237) AVERAGE MAXIMUM ~- UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />fee ~1 ANALY513 <br />(6468) <br />69-70) <br /> b~ ~. <br />S ii LI CSr T;+TAL SAMPLE ~:nrt,rn cn;i:.}~.:.. ~' rt4ri404 ( 1'.l~ <br />c IJ j p F fi 7 ;. ~ MEASUREMENT <br />();l `.f3U u G PERMIT L~nCO:tO ,A ar.OXr I}1t Y iI,Y::: '-~.: a'~tJ' 7D (, 1~CF/ ;6~7 <br />':FFL'JC~.'(1 3kC155 YA4Ui REQUIREMENT p,~;rc: .,,_~i' .,~,3$Q;{",~,~:~ Dp?LY Y% M':/L T`sCN ; <br />•:~h SAMPLE r'*. Ki r.'.7 r,: aalPau# O4bKYC# ( 1°) <br />°CTAL F, E. C'~YF9n°L:' MEASUREMENT <br />U('+:7U 1 U G PERMIT K:erXr4rSr} Ov<AC[*r? K l+lbr, ,.~: .i(J R~POg2 ( 1CCB/ %~A5 <br />•: cFLU E;lY t~F:^SS VALUI REQUIREMENT r.. r, r: v` -' °..~..- ~DDA.~API~ DA LY nY rr i D 9C <br />FLGir I~ COtipUIT OF SAMPLE ( Qi) ri4CRlprp uOn,iwR ,t.Ct:a ;: <br />T.!^; :1 "-'?L4T!i£hT PLh4l MEASUREMENT <br />SUU~U 1 U U PERMIT 8';FORY K`POF.7 ~!N! ~'-".'1~4CIt7ld¢,.- vrkfi>P~ld K #t:>: C SCF.J CNSTA` <br />4'FFi.UF.UT Gi;OSS VALU°. REQUIREMENT 3DLA RVi DAILY `?Y ":: i' _;V ~ <br />"" F~'a`.',w`. ~ ~'+~x'•"' TS .N " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT T;~ ~ -. <br /> REQUIREMENT ,~ .~^^+_'-:' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />J,• <br />~ "~' - ' <br /> REQUIREMENT ' ~- '~.,,'`.: ~" ~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ ~ ~ ~ ~ ' <br /> REQUIREMENT - <br />..!-, ' <br />.: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t -:> ~:. <br />- , <br /> REQUIREMENT _~tls-.~ <br />y ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINEO AND "' TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN'. AND BASED ON MY <br />1 <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />~ <br />~ <br />~ <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, \, <br />? <br />rA <br /> <br />ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIGNIFICANT ~ y~ <br />~j~///f~~/// rl (f~ <br /> <br />`~ T N r~ ~ r PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE <br />POSSIBILItt OF FINE AND IMPRISONMENT. SEE 18 U SC. § t Wt AND 33 U.S.C <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~j <br />L I~ [ <br />\7 ~ 4' JFL'l~ <br />U J <br />I 'l <br />d ~) <br />TYPED OR PRINTED ma.imuml~mndsonme ~o~l belwee ~6 maonlhs end 5ude lines up to AIO.ODO and o. <br />p years.) GOFFICER OR AUTHORIZED AGENT A <br />DE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />I"~:tiITt7iI:G Ai';417.IREKE~.TS St'F I.H~1.Fr PG• 5. .°L'.ur,Fti CIF Pk00P Q~~iUINEM,L!dT`' -SFE I. A.ie PG. u. <br />EPA Form 3320-1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />•±'~`: 9,0046 /004 ~Q~~F~ 7 1 <br />