Laserfiche WebLink
PERMITT[[ NAME/ADDRESS llnrludr NAIIUN AL POLLLIIwNI 01BCNAMOE luM[BA nUN SYSTEM (NPOG•I ~•~~~ •rr•-•-- <br />Farillly Name /LPrarlon I dlflennl) DISCHARGE MONITORING REPORT DMR <br />( ) OMB No. ?0441X104 <br />~L jnl f115I• N~~(•1 .•(r, (-~I,~ 7 / Expir672-79-84 <br />HAM! - (7.161 1~ <br />-~ ~ 1 ~ Ij1~, 1 y ~------------- ( , r~ z, 1 <br />ADDR[~B ___ _ ________ <br />' ~~•~~- ~-~ '?fir P[RMIT NUMBER D1ecNARCE NU•IeER STgT[OF COLORADO <br />---I-~n- ~j-{rT}--------------- OEPgRYMENTOFNATURALgESOURCE$ <br />--~~,-i1F--------T------------ MONITORING PERIOD • MINBp GgND IlECW1M.~TION ~ ~ ~~ <br />~~~ -------------------- Y{AR MO DA Y R MO DAY ~z" CENTEI`N1A~ OUILDNG <br />LOCATI ------------- FROM TO 131351-IERr I;fN ;1~RrET <br />--------. 1xo-x)1 1u- JI / f-xtl Ix6~ ) 1x8-x91 13o-J)1. 7~~~I~ISf~flI~UbIBOMOn eompbllnp'fhb form. <br /> (! Card Only) QUANTITY OR LOADING (i Card Only) QUALITY OR CONCENTRATION <br />PARAM ETE! (•6-73) (JI6/) (J81t) (16-73) (t16!) Np, <br />~ FREQUENCY <br />w BAM PL! <br />TYP! <br />(3I-J7) ANw <br />ele <br /> AVERAGE MA%IM UM UNITS MINIMUM AVERAGE MA%IMUM UNITB 6z6J) (616!) (69-]0) <br /> •AMPLE <br />f I, lli4 I f { F ( II 1 } M[ABUREM ENT + a • ~ 1 1 • , <br /> .e•.: <br />I I <br />• ' <br />', U q 5 n IlftgW wosvir r <br />~ r r • • . • r . ~ ~ .. • ~' .~ •~ <br />'i, .. . .,} t) . ~ L T <br /> BAMPLE <br />Q(1 1' ~ I•II <br />[_ j ti • T I I T I f <br />MEABUREMENT <br />• • • • • <br />• + • <br />IrF Fj ll(I,IfY ~. ,: <br />1~~ ~ , <br /> <br />P 1J S ~ f• ~p <br />~~iT <br />11rOU1MlN[NT <br />f~' ! • f <br />5 • i • <br />• • • • <br />T+i} ' "' <br />' <br />:T ~ " (( <br />ki R' <br /> BAMPLE <br />f 1j I1"I. 1'II 11 MEABUREMENT . • + • ~ • Y <br /> nurlr ~ ~ , <br />n j I~:J'i . R[gVlMiNIWT f. • i •~ v fry: s • r ~• f + /~~ tk w' ~j! ~+5 ~f° <br />. , - . <br />I BAMPLE • ' <br />(LI AII)11I <br />~~ y j T Y ., /~ I MEABUREMENT i + <br />. <br /> r ~ <br />reww ,_- ` <br />1 <br />T~7UlJ a a <br />,RBgYiRWlMT <br />•~ * it • <br />4 !'k • <br />3s + • <br />.. .f •F m.f.~l. <br />4~'.ify 6r'•r"".y <br />jt~~, y~ <br />c. <br />AEA <br /> <br />PHrF Ttl 11 BAMPL[ <br />MEAW REMlNT <br />• • • • <br />s • • <br />a • . <br /> ., ~. ~~ <br /> <br />~ <br />i ,. <br /> <br />s <br />i <br /> <br />~. <br />` <br />~ <br />a <br />° <br />~~ ~ - <br />- <br />a`~~~ <br /> <br />^ ~ <br />-~ ~ <br /> <br />~' <br />- <br />~~~~ ti <br /> <br />~~ <br />RUUpfI out <br />~ * <br />• <br />•° • <br />• i <br />. ^ <br />~ <br />... r <br />, , ~~ <br /> , , <br />(IjI ~ 1.1/I•ASF MEABUREMENT I <br />VjClJ 41 R ' i ~ .. ~ 1 ~ +. ' <br />. <br />00 U 7 ~P41M <br />~rBduupwsldi +• .w :,E w• . <br />i f : w `.~ : f : .• . r i E 1 ~P ~ /7 - l•f• <br /> <br />FUI jl•c R <br />. 7j TTl.L k,lt MEABUREMENT • • • } • • I <br /> m <br />.1~~ <br />'T' z <br />% <• ( <br /> - <br />Jy <br />R!$4NkpEElli: <br />N !, Bx : •" ` bt <br />..i ' +-~' f "'W ~ <br />~- <br />Aa • A' " • f, , <br />6 N • -~ r ~ ; <br />x •R" • r. 3 <br /> _ <br />NAM[/TITL IRINCIPAL !%[C`1TIVE OFFICER I CERTIrY UNDER PENALTY Or uw TNAT I NAVE PERSOmuv E1IAMINED <br />LN FAMILIIR WITH TNC rNFORMrLTION SUBMITTED NERErN AND BASCO <br />•ND T[L[PNON! D A T [ <br />.• % ! <br />' <br />~ Y ~+' // '- ~ r <br />ON MY INQUIRY OF T.N)5E IHpVIOUALS II.MEpATELY RESnOIrSIBLE FOP <br />G THE INF011MATION I BELICVE TNC SUBMITTED INfOPMATION <br />T <br />I <br />/ Y N <br />OB <br />MN <br />IS TRUE ACCUPATE ANO COMPLETE I AM AWARE TNAT TNFPf ARE SIG <br /> NIr ICl1NT PENALTI[5 FOII $UBIITTING rAL$E INfORMAiIOH INCLUdNG - <br />• <br />Y - THE Pa551eartr Or nNE ANO IMPR6pNMENT SEE 1B u5E f 1001 AnO <br />undrr IArr Naluln nra <br />33USC f IT9 rP <br />mrl <br />dr /,nr <br />In /IrI IxN <br />ll BIGNATU RE OF PRINCIPAL E%lCUTIVE + L <br />TYPHD OR PRINTED rna <br />vr <br />u <br />r un <br />Y <br />aM..r manmum.mOnrunm.nr .~/M1.mvn 6mnnlA. and .[..a..' OFFICER OR AUTHORIZED AGENT NUMBER Y[AR MO DAY <br />COMM[NT AHD E%PLANATION OF ANY VIOLATIONS (Wr/rrrnrf all allurnmrnu nnf) <br />TF t.ln II I'I~ •n= (.f 111. Ll, r.V ~ I.. 1 I T I. .. L I I j 1 , <br />`+~F PII•'ff (rlM LT'll~ hul J~.,. I'f .'i ,1~ 1l-:'li II". <br />:' I <br />EPA Form 3320-1 (Rev. 10-79) uNiii~uP~~r ii [%NA UBT[BD D (REPLAOlB EPA FORM T-LO WNICM MAY NOT BE USED.) PAGE OF <br />