HYDRO30070

• Permit No: C1981010
• IBM Index Class Name: Hydrology
• Doc Date: 4/2/1998
• Doc Name: COLO CDPS WET TEST REPORT FORM ACUTE
• Permit Index Doc Type: NPDES
• Media Type: D
• Archive: No

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NAME TkA?r F!{ ;il .'il vG, TNL.
ADDRESS T kl A {° !' ~ ~i ~ : I .: k.
P.O. P'J7: 1 .7
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FACILITY
LOCATION
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NATIOMN. POLLUTMT dSLHMOE EUMINATON SYSTEM /NPDfSI
DISCHARGE MONITORNNO REPORT IOMR)
12-761 17-I9I
CO 3 115 COF A
PERMIT NUMBER dSCNMOE NVMBEA
MONITORING PERIOD
YEAR MO DAV YEAR MO DAV
FROM TO _
114211 l11-231 /1436/ lI627I 128-291 /34311
FONC Al TO UT~
(5!;F4 A4)
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Form Approved.
G IA.RQ.~o. 2040-0004
Approve1lsxp~rRq-05-31-98
NOTE: Reed iMtNC71oRi belwe compleUnp this lorm.
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NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cmn
AM FN Fr UNDER PENALTr OF uw TNAT I NAVE PERSONAUr ExAMweD MD
NILIM WITH THE INFORMATION SUBMITTED HEREIN
MD BARED ON TELEPHONE DATE
;
MY INOWRY OF THOSE 1NDVYIDUAlS IMMEDIATELY RESPONSIBLE FOR
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{,. GDrdOD Paters OBTNNINO THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS
TRUE. ACCURATE MD OOMRETE. I AM AWME THAT THERE ME
SIGNIFICANT PENALTIES FOR 9ueMITDNG FN
SE INFORMATION
INCLUDING ~~ ~ 70-824-4401 98 4 28
President/General Ffana er
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THE POSSIBILITY OF FlNE MD IMPRISONMENT
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