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PERMITTEE NAMElADDRESS fIrL4 FrWryHSy/(arla. I/D~l <br />NAME , , ~ ~ ~ ~ . Y <br />ADDRESS L " r. i - .. <br />N6Y.,. ,. CO hj'~31 <br />FACUm <br />LOCATION ;'. n [ „ l r ~., ~ J <br />~i.,,. ~. ,~'~ ~ , <br />NATIONAL POLLUTANT DISCHAflOE ELIMINATION SYSTEM /NPDESJ <br />DISCHARGE MONITORING REPORT IOMR) <br />1-161 17-19/ <br />PERMIT NUMBER OISCHMGE NUMBER <br />MONITORING PERIOD <br />AR MO DAY YEAR MO DAV <br />FROM ' ~4 1' i TO '~ " • ' ~ ' <br />tl0.711 lJJ-J.TI 06751 06-171 l78-191 1363/1 <br />Form Approved. <br />• I T - s ~ - ; ~ i ~. OMB No. 2040-00041st <br />I, H ~ Approval e><pir~e OS-3 <br />i - FIAAL <br />.tC~ <br />NOTE: Reed Inetnrctloru before completin0 this form. <br />PARAMETER !3 Grd Ontyl QUANTITY OR LOADING IA Grd On1Y1 QUANTITY OR CONCENTRATION NQ FREQUENCY SAMPLE <br />131-371 /OE531 Ise-d1/ !JB-e51 !46531 150-511 EX µ~ <br /> µ <br />ps TYPE <br /> AVERAGE MAXIMUM UNITS ,{d1~11 <br />U <br />M <br />M AVERAGE MAXIMUM UNITS /ep.esl ll6e-66 <br />1 169-701 <br />Ll 7'.. , .'. r F 41 ;; ^ n C i SAMPLE - .. ~ .. ~ I I <br /> <br />l-:. !~ i ij G .. ~. i~ 1 <br />MEASUREMENT ,, <br />` <br />n <br />~ I C V xp <br />6J L~..~ <br />F.:'. .; I - .. <br />' PERMIT. .-..',<`t=~ <br />.. ~ ~ :-OA f j;t ~~ ~a«•"." ,•: :}r, :: r,->; - "nh f:. <br />cFr <br />I,I~F..i: ...~:;'. .IaL'..' REQUIREMENT: : ..n Yt([;c - , <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 /> 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 EXECUTNE OFFICER I CEATI <br />AM FA FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EAAMINED AND <br />MILIAR WITH THE <br />NFORMA <br />' TELEPHONE DATE <br /> I <br />TION SUBMITTED HEREIN: MID BASED ON <br />MY INQUIRY OF THOSE INDIVIpUALS IMMEDIATELY gESPONSIBLE FOR / <br /> <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~ <br /> <br />TRUE, ACCURATE AND COMREIE. 1 AM AWME THAI iNEgE ARE F <br /> SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING l <br /> , <br />THE POSSIBILITY OF FNE AND IMPgI50NMEN T. SEE 18 U.S.C. E 1001 AND 33 610NATURE OF P <br />IPAL . <br />(, <br /> U.S.C. f 131e. lhMIM MW~ tl~~ rheuns m.Y YI[A.d~ Film W ro t 10.000 RI C <br />E%ECUTIVE AREA <br />TYPED OR PRINTED rMrntuirAn inprGNwtrrt a/brrbn smmNaWelwra/ OFFICER ORA ORI2ED AGENT CODE NUMBER YEAR MO DAV <br />...., n.u..+ ~..v ~... ~nr.. rv. ~r no rv~.+ ~ wn.a Inosanm on suecnomnw noq <br />.;I Iit "'L~^ r..i:.."'`Ii•.. -1.~~ "T 1;91f1. (° 41'FLGF':'J +::Ir;l: i': 1. T- <br />c iF.L <br />~~: ~~F '! ~.~? .. :~,YIS^` ~ (L_iL.•) At:D A?Tagil ire';..: .'~!;'_:~:.. !F~ipf ~~i °~Fr ,:. CNr. Cr;4'IE. uF ALI. <br />EPA Form 3320-1 108-951 Pravloue edlttone~mey be used. (REPLACES EPA FORM TAO WHICH MAY NOT BE USED.) PAGE OF <br />CJG12/`1'11J31-1'31.1 i <br />