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YEHMITlEE NAMEIADD' Tpkb4 F.cnq NmndLocaum l/D~rmU NAME COLOtiY COAT. COHPANY L. P. ADDRESS C U L O R Y O I'. I 41i S"/jl S'L'ATE; !ITG}INAY 13 l4?dKE!( CO 816'al FACILITY 1LOCATION ` r, P. NATIONAL POLLUTANT C WOE ELIMINATION SYSTEM NPDESI Form Appr I. DISCHARGE ITORING REPORTPORT O~ - T-!6, ,7-, 9, GRLCR A sFnr. PoNn~A4,~"P~t• P-~~4, (SUBR N~) PProva12Q145o -~t~a PERMIT NUMBER DISCHARGE NUMBEfl F FINAL .-ii MONITORING PERIOD YEAR MO DAY YEAR MO DAY FROM 9B 0'1 O1 TO 9fJ O( 30 110111 /11-131 /1416/ /1617) !TB-191 !30311 MINOR ;NOTE: Read Inatrucllona beiori complatlnp thla farm. PARAMETER ! 3 Grd On/yl GUANTITY OR LOADING ! I Grd On/yl ~ QUANTITY OR CONCENTRATION ND. FREOUENC'f SAMPLE (46631 (546! 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' ~ :.:kr .tr:#MS:, ....;:..:''~• 'tM„ti#? :k"'::. .. . :.:::::RF:F.C11iT:: (TR.LL. .RAE(- . , _ ~ I•.FFLUI.tIT L,RJ.>S YAI,U F~REQUIRE.MENT; _ ... .::..... ~::..~~;.::::>:~:::::::::~.~~:.::~ :.:..::.....::.:::.:...:...:...: .:::::. ..:':~:~~: :~:•~:~::~...: :::.::..::.:...:.:.:.<.::.:.:,... ~...;,;~ .,-., <:::'.:'~::::.: :::a:...;:::.... n ~• I-LY...Cf:X )7G/L NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF AM FAMILIAR WITH THE INFO LAW THAT I HAVE PERSONALLY E%AMINEO AND RMATION SUBMITTED HEREIN AND BASED ON TELEPHONE DATE ; MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE fOR OBTNNINO THE INFORMATION, I BFDEVE THE SUBMITTED INFORMATION IS TRUE, ACCUMTE AND COMRETE. 1 AM AWARE THAT THFRE ARE SIGNIFICANT PENALTIF9 FOq SUBMITTIND fALSE INFORMATION INCIUDINO t~ , THE P IBIDT F E IMPN E EE C 1 CIS U TMDIY OSS Y OF IN AND SONM NT. S IB U.S. . 1001 AND l] 610 A E OF PRINCIPAL EXECUTNE - U.S.C. 1 1a1a. I/NrWdr. u.Mr d... .prvr.. nrY hckl. hwa y ro 110,000 AREA TYPED OR PRINTED .r.d ornw`inun irW-Ivtmw~ralbtvw.(mme,..rq 6'Y./..1 O ER OR ADTHORI2ED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Ra/arence ell elrechmenls here/ SG'fTLEAULii SULIU~ LIt1TT ApPLIBS ONLY IP <= 10-YR, 2a-IIR PRP.CIP RYPNT IS CLA7MEn. IF CI,AIt7 APP.ROYF..D nY !(<ICU, TSS F. INOfl LI1fIT:> HILL NOT FIB APPLIED TC REPORTED iRASBRRHF,NTS--S FE^I.II,lA, PG 4 AND I.O.1D, PG 6. P orm 3 0-1 IOa-9 1 ~ Previous a Itiona~mey ba used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.( PACE OF