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PERMITTEE NAME/ADDRESS (Include Fanlih h'amrlLocarwn ifD,fferenll NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />NAME DISCHARGE MONITORING REPORT (OMR(
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<br />FACILITY h F. F p. `" Ft _ CO 81641 ,y.~ MONI,T,ORING PERIOD
<br />LOCATION ~ VEAFi] (HMO DAY!'' ~ ~ YEAR MO DAY
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<br />Form Approved.
<br />OMB No. 2040-0004
<br />"T A (1 R Approval expires OS-37 -9B
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<br />NAME(TITLE PRINCIPAL E%ECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY E%AMINED AND
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<br />B /~ 1 / (( TELEPHONE DATE '
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<br />MITTED HEREIN; AND BASED ON MY
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATION
<br />I BELIEVE THE SUBMITTED INFORMATION j / _ ' r
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<br />tiF.'TTLEAt1LF: SOLIDS LIY:1T APPLIES .ONLY IF C=IOYF.,?.LLHF PRr'CIP £VE!iT IS CLAIM.2D. .F CLAI`! APPROVPD AY kr•Cii,
<br />TSS G IRON LICITS BILL NOT Rte' AYPLI?D TD P.FP(?RTF.D +4 EASUREF!ENTS -
<br />^ ^ ^ ^ SEE I. A. 2, PG. 5 POR PUROf,N OF PFOOF
<br />EPA Form 9920.1 ~08-95 Previous editions~ma not be used ~ ~ ~ ~ •
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