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PERMITTEE NAMElADDRESSllndudr Farilitr A'an~/lanuon i/Different) <br />NAME <br />ADDRESS - <br />FACIL~iY <br />LOCATION ;_ ~ <br />e~N~ E <br />CO 8i <br />~IE rlarvA~E~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MT.NE ORNG <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX ALYSIS <br />A TYPE <br /> N <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE -~ ~ / 7 ~ ~~ 4 ~ j •~ <br />r <br />J I (.~,~ <br /> MEASUREMENT T <br /> - - : ~ _ _. <br /> PERMIT -~ -: - _ . <br /> REQUIREMENT .; r P' T ~. "•i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. ...: .I, • , ''' <br />''i <br /> REQUIREMENT '3rd :. - <br /> SAMPLE ~ • <br />~ <br />~~ <br />~'J ~ ~ <br /> MEASUREMENT <br /> PERMIT - , . ~ - _. _ - <br /> REQUIREMENT "' • <br /> SAMPLE <br />__ MEASUREMENT ~ <br />'~-' PERMIT ;. ,, .._~. ,- --~ . <br />'~j ~' <br />} , _ _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ... + . ... <br />- _ <br />• ~ ~ ~ • <br /> REQUIREMENT <br /> ' • <br /> SAMPLE ~~rJ <br /> MEASUREMENT <br /> <br /> PERMIT <br />_ - <br />t : '; . <br />. <br /> REQUIREMENT <br /> SAMPLE <br />~', , <br />~ Z <br /> MEASUREMENT - <br /> <br />PERMIT <br />~ <br /> <br />~ .. <br />~ -- • <br />;;'~, i _ <br /> REQWREMENT _ <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER 1 cvtiry under pemdq of law that thh ducumem and all uuiKhmenls xere TELEPHONE DATE <br /> prepared wnler m. dinatiun ur wperid+m in w.•curdancr wish a cyctrm detii~ntvl <br /> w ucure that qualified prrwmxl pruprrM ppthrr uml rcuhtntc the infwrmuthut - - ---} <br />_ . .. _ ---_ cuhmittrd. Huxd +M my inquln of the prrwm or prrw.nc xho mutwsr the c~etem. r <br />~ <br />•-~ -- or lhncc prn.m+dirreth mpmciMr fnr t;xthrrinK the inRtrmntiun. Ihr infnrmatiun `~---' ~ ~ ~+. - <br />- <br />~ ~ - <br />• kp• <br />I <br />~ <br />i <br />t <br />d ,`*~ ~~ i l.i <br />i , i ~ <br />I ~,, v- <br />~ . ~ e. an <br />nanp <br />. <br />u <br />l <br />rf, true, accura <br />+uhmitled i., tr. the IKtit of my knowirdgr and <br />SIGNATURE OF PRINCIPAL EXECUTIVE _ <br /> f um axurc that there are significaN prnal[iea for submitting ful~e infurmatian. AREA <br /> .iulaliunc <br />iwoment k.r knowin <br />( f <br />n <br />a <br />d i <br />l <br />di <br />th <br />ibilit OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED R PRINTED . <br />g <br />y n <br />i <br />e <br />n <br />mpr <br />lnr <br />u <br />ng <br />e p»c <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />I_"MiT AF'PL Irl? z'QR SOYRt 24Hk PFtFC7-' EVENT - ~iEl^ I. A. ~, <br />-,-;, PAGE OF <br />. _ , <br />