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PERMITT[[ NAME/ADDRESS (/ncludt <br />Fatillry Name/LIXOllon Il dlgrnnl) <br />NAM[ I`~1''11):I I' 1•, I j'1J ' <br />_-__ __I _____________ <br />--1• I T-T------,- ~ ~------- <br />----~-------r---------- <br />LOCATION J i_______ <br />NATIONAL POLLUTANT DISCHARGE ELIM INAiION SYSTEM INPOGa) ,,, nytr....... <br />DISCHARGE MONITORING REPORT (OMx) OMB NO. 7000-0004 <br />(z-161 nd9) Expires?-?9-84 <br />_ .. I ~ STATE OF COLORADO <br />DEPARTMENT OF NATURAL RESOURCES <br />PERMIT NUMBER DIeCHARGE NUMBER MINCD LAt•!D RECL!',MATON <br />423 CENTENNIAL 13UILDINO ~ <br />- MONITORING PERIOD '1.313 SHERMAN STREET R;,. <br />- YEAR MO DAY YEAR MO DAY PFrIVER+COLQ~Q 80?113 <br />FROM TO <br />r1D-11/ rn-v) 1 •-nl r16 ] r16./91 r/Ba/1 NOSE:RBBd ImINNIon•bBton eomplNinp thb form. <br /> (J Card Only) GIIANTITV OR LOADING (~ Card Only) pU ALITY OR GONOENTRATION <br /> <br />PARAMETER <br />(16-lJ) (Jlbl) <br />(JB~J) (16-lJ) (!16!) ND <br /> <br />[% FR COU ENCY <br />or BAM PLt <br /> <br />TYP[ <br />(31.37) wNALr~1s <br /> A VERAOE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UNITB 6143) (6166) (69-70) <br /> BAMPLE <br />1 I ~ 1 (I I (~ I rl I 1 MEABU REM ENT - • . ~ + <br /> PtIH11T T I • ~ m <br />~ <br />r 11 ~ " R~gU1R~IreN~ ;.' f t TY t • y • a r • a ~ t r • ~ ~ a l j ;r (~.'~' <br /> BAMPLE <br />^•111 1~-. T"t '~ MEASUREMENT I • ~ + <br />(1 Y 1 ', 1 <br /> <br />"I ~, /• .' r+a1M IT <br />R[OY111EMBNT <br />f • - 6 <br />• t • • <br />. n <br />, <br />:' ~ <br />~ <br />j / '- . <br />(, <br /> BAMPLE <br />I I, ~ ) ~ ~ I I MEABU REM ENT • • . + , <br /> PtRY1T ~ ~ '. <br />'' I /j'1 ~• RBOVIREMlNT • r ^{~ s 1~ a + • .. . yR!'; { <br />} f ! (+» <br />1 <br />BAMPLE <br />• <br />• <br />IT)(rl I• ( (~, (Y I MEABUREM ENT ~ ~ + + f . <br /> <br /> R[OYIRpdtNT f~ # A A .i a 0 • • + rv + + Nr • k + ~~-~'• .. 7uJ ~+f;f~ <br /> 9AMPLE <br />1' 11 ~ h <br />} ~ I , <br />MEABUREM ENT <br />• 1 • • <br />1 - . <br /> PtRMtT ~ . <br />O U rl II 1+ RtONIRDl EN7 - •. • A ~ a • • .. • f 1 ; r ~ ?, i°' <br /> <br />' I 1 I ' 1, .1 • I. BAMPLE <br />MEABU REM ENT <br />• • • <br />• ' <br /> <br />A ~' n I • cY RYOPV ~IIaSENT 4 r k • f . v! i' ' • a - r ., a a * a r } (J 1 ~ , .1> <br /> BAMPLE <br />4111, 1' +, ~I T }I I P 1+I I MEABUREM ENT + • • r <br /> r 'ltRMlt :. <br />+ <br />.. <br />' / ~ ~ , <br />'111 T~'!S . <br />R~pU1Rt91iNT. 'B ,* ;;. } ..~ Y } <br />• a i ! 11 • v •, 1' '•- . • }f~ :il: <br />NAME/TITLE PRINCIPAL E%EG U~IVE OFPIOlR I CERTIFY UNDER FENALTr of LAw THAT I HAVE vER$ONALLr EIIAMINED <br />ANO AM i1MIL11R WITN THE INFORMATION SUBMITTED NEREIN 1ND BA$CO • Tl LEPHON[ OAT [ <br />' ON MY IHOUIRV OF TNOSE 1NpVIDWI$ 1MM[dATCLr RESPONSIBLE ipR <br />' • OBTAINING THE MFORMITION 1 BELIE V6 THE SUBMITTED MFORMATION <br /> I$ TRUE rrCCURATE ANO CONFECT[ I AY AW1RC THAI THERF ARC SIG <br /> NIi1CANT P[Nl1l T1[$ rOR SUBMITTING rALSE INFORMATION INCLUDING <br />• . <br />' r THE P05519artr Or FINE AnD IMPR¢ONMENT SE[ IB USC 5 1001 ANO <br />DUSC f IT9 <br />rb~ rrmi <br />na n <br />l•• lln Nn <br />l <br />M <br />l <br />d <br />/ <br />P SIGN ATU RE OF PRINCIPAL E%lCUTIVE <br />~ <br />' <br />TYPED OR PRINT[D urx u <br />o <br />n <br />r <br />u <br />t <br />mn up <br />I <br />rna <br />nM.r. maarmum lmpruonnrrnr../MNwn 6mnnlA•and5•w.+1 OFFICER OR AUTHORIZED AGENT A NUMBER Y[AR MO DAY <br />COA`M ENT AND E%PLANATION OF ANY VIOLATIONS (xr/nrner all RNUtnmrnrr Rnr) <br />•1 <br />EPA Form 3320.1 (Rer. 10-79) uNrli ~u PPLr 1[ [%NAUST[D D (REPLACES EPA FORM T-~O WNICH MAY NOT BE USED~1 PAGE OF <br />