Laserfiche WebLink
PERMITTEE NAME/ADDRESS pMi6 FeYeyNwd/or.//w r/o/6.w/) <br />NAME S r, y r .: F. .: , :•. 1, '..: °. I .'~ . Y <br />ADDRESS `J !f n + c : J <br />h6Y_~"~ C~ E163a <br />FACIIITV <br />LocAnoNe,;YJc`. CO d1o30 <br />~r,.,. .,. :, ;;o i'.;:Ne, .,. ,. r.A?. °,nNArEa <br />NATIONAL POLLIfrANT OISCHAgGE ELIMINATON SYSTEM INPDES) Form Approved. <br />DISCH~ R6E MONITORING REPORT /OMRI -:, „ ~ G T ~ n r ~ - •OM~ Noi12040~0004 <br />117-191 I. <br />OO OG! r~l C04 X I'_itcr, I'-.) Approve l.e.?fPiv 705-3198 <br />r° <br />PERMIT NUMBER DISCHMGE NUMBER r _ r I ., A ?, <br />MONITORING P RIOD ~ I I r ~ <br />YEAR MO DAY YEAR MO DAY <br />FROM i.7 .1 ~_'1 TO ~ L .. ~: 9. i; ':r ~.. ~__~ ... <br />NOTP• N••A In•ameNnn• N./n.. nmm~LUnn a6u fn.In <br />PARAMETER 13 Gre only/ QUANTITY OR LOADING /1 prd Onryl QUANTITY OR CONCENTRATION NO• FgEOUENCY SAMPLE <br />!37 371 !46531 /5L811 ~ :• .•R3@-151 146-531 151-611 OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs1-s.Tl 15b591 /59-701 <br />~. : r , r.:; _ J i A F C~ q ' SAMPLE .::I: r,; . ~;::'. - ~ .. .. . , ( 31 <br />C Y r C t. t : ~J.i !t F' ri F ? MEASUREMENT _ - -' <br /> <br />:Crj ~ _ U G PERMIT .. <br />"s,:: >r•.. .;w, <br />~ , ^•~k#;• :.:.. <br />.. S7. 9 ~ ... <br />:.>. - <br /> <br />JcL. C.: iti`.; ;r'S HLO~/ <br />REQUIREMENT <br />-... <br />qpi Y1~ <br />$E <br />i <br />, <br />~ _ <br />:+tF `CC1' i'., r 7f,'A Y SAMPLE .e:~fc , ( <br />. ') <br />L a li ? 1 .'! r. / ~.:, ! MEASUREMENT <br />~- _ - ~" <br />;::r;.C ~ PERMIT .,..~ ......-:a .. <br />Y 10.8.::. ~~Lq ..+,-r~:f~-: _ ':.':i:.Y _ <br />.. <br />- t; l;~l'.'..'. 'T ~. ~. 1.,-~-. QUIREMENT ./ <br />. MA .,~~~~~S~E ~ <br />II <br />LA L 1/ <br />N O V V4 MPLE <br />MEAS REMENT <br />V <br />LJ <br />~ <br />~ REQU E <br />\J <br />~ v S! <br />v I NT <br />M <br />+ <br />l <br />A ~. V J'P ~ SA PLE <br />MEAS EMENT <br />. <br /> RMIT <br /> QUIREMENT <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 />NAME/TITLE PRINCIPAL E%ECUTR/E OFFICER I CERTIFY UNDER PENALTY OF lAW THAT 1 HAVE PERSONALLY E%AMIN <br />AM FAMILIAR SMTH THE INFORMATION S <br />MITTED HERE <br />A ED AND <br />SED TELEPHONE DATE <br /> <br />T <br />V QS <br />L`t'^ " <br />' <br />~ UB <br />IN; AND B <br />ON <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ~ <br /> <br />\ <br />. ~+10 <br />' <br />. OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB ' <br />~ <br />ar <br />G' I <br />~ ~ TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ME <br />SIGNIFICANT PENKTES FOfl GUBMITTING FAISE INFORMATON <br />INCWDING _ _ <br />"'~~~ ~ ~ <br />/ <br />Lf ( <br />y, l <br />J l O q 1 ~ , <br />THE POBSIBILITY OF RNE AND IMPNeONMENT <br />SEE iB U <br />1 AND <br />S <br />C <br />1 <br />0 'r 1L J ~l) <br />~ Q <br />ma <br />r . <br />. <br />. <br />. <br />1 <br />0 <br />3] SIGNATURE OF MI <br />L E D <br /> <br />V TYP OR P <br />ED U.S.C. E t3te. IP•rrlaia uMar /Mw awrona InaY L+rh/a Awa Ie ro S 10,000 CIPA <br />%ECUTIVE <br />RINT .,1a+muMun i•Ipviaon/IVrr P/Mrwa•nsmNtrha r/eP•va.l OFFICER ORA NORIZED AGENT CODE NUMBER YEAR MO DAY <br />..vmmo• I a nnv cnrcnnn I Ivn yr nnr vlvLn I Iona InereisnCe s// errecnmenls ne/e/ <br />EPA Form 3320-t 108-951 Previous editions may be used. IREPLACE6 EPA FORM T~0 WHICX MAY NOT BE USED.I PAGE - OF <br />