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PERMITTEE NAME/ADDRESS pnclude Faci/i0•NamdLomlinn ijD~erenu NATIONALP <br />NAME 58NECA CCAL CCNF)N1 D1 <br />ADDRESSjjh'AY~M D <br />UAlDEN '~' <br />CO 61 b 35 '~"" PER <br />/ .a s <br />LOCATION~AtUEH ~•~'~~ ~~-~~-0~ `~" YEAR <br />•Iilb30 <br />FROM '~ <br />AiTM: 6+ BUD BHOah, Gt1:ERAj ~~ !A ~ (-~;// <br />T DISCHARGE ELIMINATION SYSTEM (NPDES) Poxm Approved. <br />IE MONITORING REPORT (DMR OMB No. 2040.OOON <br />n>~~el !7I M C R goproval expires OS-31-98 <br />011 l ~5UAA tlti) <br />dBER DISCHARGE NUMBER E- E'I Y l I~ ,I ~C U T 1 <br />MONITORING PERIOD SED. PClL L'"S,CG t, 7C GFA_51 CFK. <br />DAY ~;~ ~ YEAR MO DAY <br />-+-nT•:,Tq -~7 u7 ~u ~~~ dC II9CHARGF ~~ ~~'~ <br />Tzazsl. ,.^~ rza-an /aav/ /,wan NOTE: Read Instructions belor, completing this form. <br /> <br />PARAMETER <br />'(3 Cab"Only) QUANTITY OR LOADING <br />~~(45-53) (54-67) ;c; :=,,sm: <br />(4 Gerd Only) QUANTITY OR CONCENTRATION y <br />~ (3a~45) (46-53) (54.61) <br />NO. <br />F~( <br />FREgUENC <br />OF <br />SAMPLE <br />TYPE <br />(32-37/ AVERAGE MAXIMUM UNITS N f MINIMUM AVERAGE MAXIMUM UNITS <br />(r>z-s31 ANALYSIS <br />(sb-se) <br />ss-70 <br />U L L A H U U a t A 5 t SAMPLE , a ~aQg ~ ( YVj .asap ~~9a~~>o va aca <br />Y I SU A L MEASUREMENT <br /> ' <br />i3UUbt 1 0 1' ;Y;~PERMIT ?s a . <br />• '':'6tPU>R 1,5=I a" qo+~ <br />~~ oa>o c ReY/ (ISU~I1 <br />sE'FLUENT GRO55 YALUE ~REQ~LIIREMENI! '',' ~*}jj ~ Q <br />~ ;.: ~, " <br />.Ate - ~.: 4Y _ <br />"~ _ <br />4'y l4s~ MCi1A <br /> SAMPLE _ <br /> MEASUREMENT <br /> 'PERMIT~'~" <br />~ <br />~ ~ <br />~'~ ~ "ice <br />' ~ ~ r 4 <br />r ~`~" z~` 'r y .;`lo <br />~ ' ut <~~ = <br />`~I <br /> REOUIREMENT , ry <br />~ <br />I _~ <br />k z < ' <br /> :L - <br />, <br />fi ~~~ ~:: r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. <br />• r , rn re. ~~.- ,: <br />~' <br />` <br />_ ~~, <br /> REQUIREMENT _ <br />I ~~ .`. <br />,~ <br />- • <br />{~.. x.~' , <br /> SAMPLE .~ - <br /> MEASUREMENT <br /> i_o-+ <br /> PERMIT' - ,~-' <br />o - <br /> <br />c., - <br />, x <br />~ <br />• REQUIREMENT - - . t <br />: I y <br />'t ~; <br />-- - .. <br /> ~, ~ ~, <br />z .~ <br /> SAMPLE <br /> MEASUAEMENT <br /> s"PERMIT.f- -- - - ~'~ ac's-" `- r <br />` - <br /> RE~UIREMENT c -' ~ <br />@C ! - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />`REQUIREMENT - - - <br />-' - <br />- ~~" <br />i ~ .`~ ,~.a xn <br />`t',e - <br />~{ ~: .;I <br />`'~ ~~ r.. <br />Y'w - - <br /> ~ t r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. ~ <br />Q x~ ~. `~ <br />"~ ' - ,~ ~ - ~ <br />~~ ~'°'C`,~ <br />` wa:~~'_ <br /> RE <br />UIREMENT . <br /> ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND <br />AM FAMILIAR WITH THE INFORMAT <br />ON SUBM <br />ER TELEPHONE DATE <br /> I <br />ITTED H <br />EIN; AND BASED ON MV <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING THE ~ <br /> <br />. <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE to U.S.C. 4 1001 AND 33 U.S C <br />_ <br />SIGNATURE OF PRINCIPAL EXECUTIVE y <br />T { <br />( <br />f, <br />(/ <br /> <br />t <br /> ~ up ro 510,000 and or <br />mefilm <br />m~ <br />~ <br />~ <br />n <br />l <br />~ <br />M <br />TYPED OR PRINTED m <br />u <br />s <br />o <br />merrt of <br />Dertve9 <br />monfhs ends yeers.j <br />B .OFFICER OR AUTHORIZED AGENT of NUMBER YEAR MO DAY <br />L:VMMtN I5 ANU tXPLANA I ION UH ANY VIOLATIONS (Re/erence all attachments hale) ~ - ' <br />T:iS 6 IA01i LIHI15 -Ili BE 3iAIQED )FD SETTLEAALE S,CIIDS LI!!11 At=PLIEC fCF. <=10YA~iU6F FFEGlE E\Ei7~ 159 6 <br />IROY LIMITS ~AIiED ECF )lUYA,24HR PRECIP EYEMi SUE.IECT 10 BURD2:N tiF P6CCF IN I.A.I. CII G GlE)~R-SFE <br />r I n Inc OnYr+~cra~_c cc T- u t p <br />EPA Form 3320-1 (08-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ~ ~, ':_ :: ~ PAGE. OF ' <br />