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PERMRTEE NAME/ADDRESS (Inchde Faclliry Nmru/Locnnon iJDiffercnq
<br />NAME
<br />FACWTY PAOiIA CD b1f123
<br />LOCATION
<br />dUili~ CO 911129
<br />NATIONAL POLLIffAM DISCHARGE ELMINATION SYSTEM (NPDES) FDf1T1 ApprOVad. I
<br />DISCHARGE MONITORING REPORT (DMR~
<br />118 OMB NO. 2040-0004
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<br />1 (1I 91 +!TUr~q
<br />Approval expires 05-31-98
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIF Y UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY EXAMINED AND TELEPHONE DATE
<br /> AM FAM ILIAR Wmi THE INFORMATION BDBMRTED HERE IN; AND BASED ON MY
<br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON SIBLE FOR OBTAINING
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<br />0005?/ ~ • ~ PAGE OF (
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