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PERMITTEE NAME/ADDRESS Qnelude Fari7iry NamelLocm,on i/Oge~e,q
<br />NAME
<br />CL?Lf..7G GOAL CO"PA':'f, :..".
<br />ADDRESSCOLOYYO YLYE
<br />5731 tiTATE NIGfiYAT 13
<br />FACILITY ,r,"t"I`Ek ..CO 81641
<br />LOCATION
<br />4"Tf;: J. (IS /fAR!"Oh, ('7'IrO,nL «,T .:r"..~; 1
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />' DISCHARGE MONITORING REPORT (DMR;
<br />(&16) (11- 91
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<br />. PERMIT NUMBER ~ DISCHARGE NUMBER
<br />~~ _ MONITORING PERIOD
<br />YEQFiL MO DAVa. .~ YEAR MO DAY
<br />FROM -~~j:QY ~ TO OD Ov 30
<br />(20.1 2T131 f24~25);"i ~~~ l26~2]) (28291 fJ0~31)
<br />Form Approved.
<br />OMB No. 2040-0004
<br />r;i I~ C' Approval expires OS-31-9R
<br />(g!!F4 NY)
<br />F - FIeAL Iit1FAT
<br />YARERQUSB SEDI TC TAYLOR CREEK.
<br />NOTead Instructions before completing this form.
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO
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<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON
<br />THE INFORMATION, I BELIEVE THE SUBMITTED jINF IN; AND BASED ON MY
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<br />POSSIBILITY OF FINE ANO IMPRISONMENT SEE~,BfOTS.C ,
<br />. § 1001 AND 33 U.S.C.
<br />SIGNATURE OF PRINCIPAL EXECUTIVE ae
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<br />TSS b INOY LIKITS PILL NOT flE APPLIED TO REPORTED Kl:ASUHE!!EM'!~,- CEE I.A. 2, PC. 5 FOR BQRDEN OF PROOF
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