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PERMITTEE NAME/ADDRESS Qnclude Fpmhp• Name/Cocalipn iJD~erenq <br />NAME <br />ADDRESSpCF7!: 1t:C~`.i=i:6 C}cFl, y~i,?.- <br />17t1 C.)°i'i5 C}I4l, GUT_1: 1J; <br />L-nf.L JUM1C7ICD CO tli`_G': <br />FACILITY <br />LOCATION,, .,I .. ,:u!L2. CO 8s` ~' <br />:•.; J. ~. :iICYfR, CCK~ULTI6S <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITOgING REPORT (DMR~ <br />(z461 (1 ]- 9) <br />PERMIT NUMBER DISCHARGE NUMBER <br />., .. MONITORING PERIOD <br />FROM <br />(za.a5) (zfi-vJ (z8-2e) (30.31) <br />Form Approved. <br />OMB No. 2040-0004 <br />~~ : R C 'r Approval expires OS-31-913 <br />(SUCK iC) <br />CahCt+1C ~cn it°_f]}C fCF CIF <br />4¢ S 1. I:_ C 4 N~ C t ~~_ I .. <br />NOTE: Read Instructions before completing this Corm. <br /> (3 Cerd Onry) QUANTITY OR LOADING ~4'.Cerd Onry) QUANTITY OR CONCENTRATION N0. FREOUENC SAMPLE <br />PARAMETER (48-53J (54-67J /36.45) (48-53 (54-61) EX OF TYPE <br />(32.37) AVERAGE MAXIMUM UNIT MINIMUM AVERAGE MAXIMUM UNITS <br />(6 <br />7 <br />63) ANALYSIS <br />(64.66) <br />69-70 <br />}'F`C: _. d': i. !_ /LAk SAMPLE qC. Y, .. .:. ~~: r,~r, Od:7 i. :: :: :y ;.YKr:: 1 ~~) [ <br />j ~ <br /> <br />:~•. !1 C L :, 1:" `- b F H F I F <br />MEASUREMENT <br />7/u~ ~ /- <br />TCN3P _ ~. U PERMIT ~Qyt1p ~ 4fi0E.tA.,~ t+0~` Zj.C '`,1,~:~11a10 _ ~ M'116R9t F Fh- ~ EL7 C1lFCS <br />rC"'r..; ~~'iCw REQUIREMENT ~ ~'! ~09{, pJb YALLE -'.,~1, CEh7 <br /> SAMPLE <br /> MEASUREMENT ' <br /> )ifv1FT ,. , ~ <br /> RED ENT :' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - ~° ~'=:5~ ~-=`'-, _.: <br /> REQUIREMENT ~~ .;, - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <p~: ' ,. <br />~' ' <br /> REQUIREMENT ~ > ' <br />r`r <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ - - <br /> REQUIREMENT _ -~--'~~'-- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY E%AMINEO AND TELEPHQNE DATE <br /> AM FAMWAR WITH THE INFORMATION SUBMITTED HEREIN, AND BASED ON MV <br /> <br /> <br />I V INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br />THE INFORMATION <br />i ~ ' <br />"r ' ~ '~ U JG , <br />I AM AWARE THAT THERE ARE SIGNIFICANT <br />ACCURATE AND COMPLETE ~ <br />~~" <br /> . j , <br /> <br />. ~:~, PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S C § 1001 AND 33 U.S.C. <br />!SIGNATURE OF PRINCIPAL EXECUTIVE ,/ ,/~ <br />4.-5~'f! p~ <br />(1~ <br />TYPED OR PRINTED maxi umPmpnsmmBnfol bBMeen6mpnfnllS ~tlSu~rslas up to Ef0,000 ontl or OFFICER OR AUTHORIZED AGENT <br />oD <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />) !.1.~ .:..~ ':LLI 'r}G: r.L•i;6t.. :,i''i h;;UL:`_ C} .. I'FLI'Y L:hIYA'::Chc F. "=tfFFC:", ChCIrYF E fcffCLLC1IC~ <br />:,.':iVA:i~'+5 6~ "1Ci]C17Y". nVI LC~EJ" tr'tL nI 4kICh LTF1:SIiCAI1'! 9iC`::} L'IiP tcTMEFh IPC1 L CC!'?FCI <br />EPA Form 3920-1 •(OB-95) Previous editions may not be used. ~ (REPLAC;ES EPA FORM T-40 WHICH MAY NOT BE USED.) G C l 7 G / G G C 1 3 7 - 1 C i . • , ~ ~ PAGE i OF <br />