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PERMITTEE NAME/ADDRESS preclude Fncifiq Name/Gncanon rf Digerenq <br />NAME <br />C~l.~~w'YO C;:;,1. C~'I."pn::Y, t.. F'. <br />ADDRESSC,~ L Q L Y O !` I *'°. <br />5731 ET!;?' HIG}:4.AY 13 <br />~F:r'.i ti CO 91h41 <br />FACILITY <br />LOCATION <br />3*^,':(; .I. L~. t'. A'~'!Oti_ (: rT~F'F"_1 Y: :D~'t'c <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR; <br />r~nnn GT l1 nno >, <br />PERMIT NUMBER ~ olscHARGE NuMeER <br />FROM <br />MONITORING~PERIOD <br />YEAR MO DAY YEAR <br />~ MO DAY <br />00 07 O ,~~TO -00 0~ itl <br />l20-211 ]222.]) r2d]29~ /26~2]I l2a~29.` /3591) <br />Form Approvetl. <br />OMB No. 2040-0004 <br />1 ~ ') r Approval expires 05-31-98 <br />;~C 16 FOND TO G0~6 ;PH:•';i~ !'n <br />OM,o~-~D DIS~HFHGE ~ ~ ~~~~ <br />.:NOTE: Read Instructions befor coinpletinq this form. <br /> /3 Card Ony) QUANTITY OR LOADING ~ ~4TC-Ward Onry) QUANTITY OR CONCENTRATION <br />~ NO. FREOUENC SAMPLE <br />PARAMETER (as-ss) (5461) _ ~ <br />(38-45) (4653) (5461) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UN.TS ~ MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> (6267) (6468) 69-70 <br />.L A6U '?F,GA]F SAMPLE rA, ~G .k' ~ r'U) ,:'-:+C EIO~t .^. Ss C: •;: c.': s•v r,: sti ti::c„ <br />Y I~O.iL MEASUREMENT <br />., .:UbO 1 U U PERMIT 4X:OIC~R RF. "' 1 F`-: Ipr10 §i:. ' VICLIOQr~ +pY tYgMat A +h+fri :;~1 ~~!(LY ISLrA7 <br />?FiCt'sT I•PCSS Y4LGt REQUIREMENT , , ,fr,~`, c,t ~ `~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,-'"- <br /> REQUIREMENT ~ - ~. _ s>itv5 F ~,: -_, <br /> SAMPLE 'T,a ` <br /> MEASUREMENT 9 <br /> PERMIT "~" {~'' <br />` <br />~ ~ - <br />`' <br /> REQUIREMENT " - - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' } ` <br /> REQUIREMENT -- - <br />~~rd~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <br />'~ '~ <br />"6~~~' <br /> REQUIREMENT +' - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT `~' x'~- <br /> REQUIREMENT - ~,;,~ ~;( <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT * K~ k- -. <br /> REQUIREMENT ~ ~%ti <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF IAW THAT I HAVE PERSONALLY EXAMINED AND <br />AM FAMILIAR WITH THE ~'~y <br />~ TELEPHONE DATE <br /> INFORMATION SUBMITTED HEREIN; AND BASED ON MY <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING 1 <br />I <br />' THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, ' <br />~ ~'~ <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING THE ~ .. ! <br />. <br />~~ ~'h(~//lam <br />\ <br />~ . <br />POSS <br />B <br />T l <br />\ \ ` ; <br />I <br />' I <br />ILI <br />Y OF FINE AND IMPRISONMEM SEE IB U.S.C. 4 1001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE ~ T lu 1 <br />: l %. <br /> 4 1319. (Penalties antler Inese statutes mar include lines up ro St0,000 end or <br /> <br />TYPED OR PRINTED <br />manmum rmpnsonmeM ClDeMeenBmonMS andSyears.) OFFICER OR AUTHORIZED AGENT <br />ADD <br />NUMBER <br />YEAR <br />MO <br />DAY <br />t.vmmcrv 1 ~ Hrvu cAruarvH I Irv ~r nrvY vl~La I I~rv~ lHererence all attacnments here) <br />:;~:TLF;P~LL SFiLI^5 LI."'IT k"FLIES L•"1.Y IF C-1:IYh,24N5 PR%CLF 'r:Vi::P IS CLAI'cD. IF~~LAI` r1PPflCVED FY L'_C~!, <br />TSS 6 IROK LIC7T5 HILL L(1'," FE APiLIED TO °.Y.PCFTE'C~ P:F6apl;c«2NT5 - 5FE I.J1.2, PQ .~,$ FOR fiUkOBM 01' PR^L`F <br />6PA Form 3920.1 (09-95) Previous editions •may not be usetl ~ ~, ~ ` ~ ` r(REPLACES SPA FORM T=40 WHICH MAY NOT BE'USED'.)~ ` ` ""~ ~ ` ~ ` ~ `~ r T ' ~ ` ~ PAGE OF <br />.:.40084/000403-1007 2 <br />