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PERMITTEE NAMEIAODRESS pi.eYr frWryJVwdLeer/ow Ijp(QG^wr) NATIOHAI iOLIUTANT DISCHARGE fIIMINATOhI 51'STpN NPDES/ <br />NAME DISCHARGE MONITORING REPORT /D Rl <br />ADDRESS _ , <br />[iDk l,: PERMIT NUMBER a3cHAR°E MUMeER <br />'' I ~'' MONITORING PERIOD <br />FACILITY E ND ~ ~ i I~IL YEAR MO DAY YEAR MO OAY <br />LOCATION IIA CO 814: FROM TO <br />r nnn n ncno to fvlrnlc hdn: <br />Form Approved <br />CMB No 2040-OOp4 <br />F - FINAL <br />SF.: Dr ER TRL f)TC 0R IJI~ <br />NOTE: R~~d {r>.trvcNtxetl b~lw~ complt+tMy thb Io(m. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO' wcr <br />FRE° SAMPLE <br /> EX of <br /> µ~V~3 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ', <br />.- ... <br />. ~ REQUIREMENT h ,, , [ ~ I ,.<. ~' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .~ <br />V.- . REQUIREMENT <br />1~ i SAMPLE <br /> MEASUREMENT <br /> PERMIT - ; ~ # ~ : ~~~ -• '.. <br /> REOUIREMENT <br />' 3l.:l~~i Fi <br />1 ~ ; , , r SAMPLE ~ <br /> MEASUREMENT <br /> PERMIT ~j. ~ # it ?s •~ -:r -:: ~ i~ ;c i•- ^.I G r= % R , ~ =; <br />:., ~ ,. <br />REOUIREMEN7 <br />I~lt]t`T!-# <br />_- SAMPLE <br /> MEASUREIv3ENT <br />~ ~ PERMIT ,-x~r #?>•~t##-~. ?r , •,*•~--:: ~fs~:rar•~•,r C)PJTIh: :... <br />:. `,._ . ,,~ REQUIREMENT _ .a ! t•~,': i GEN ~ <br />.i ~. C)i`aDU I f SAMPLE <br />1 +=-: ATMENT PL :. MEASUREMENT <br />. j r~ 'i PERMIT A1=POf~..l '[Nl~i? i 'r ;ti,~., ,, r =:r . -,'# ~#it _.~' <br />~__ ..-, <br />1. <br />iJF.' ;;~. I REQUIREMENT ?LY r•. #x.-r, <br />~~, SAMPLE <br />_, ,f, MEASUREMENT <br />PERMIT ,<~.~ ,~ria•I• :~#-~•?: ~_ -?,•~. ##ss-~t## _ ~,i_ .~ <br />REQUIREMENT ~ ;,:, ; <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER ' fe^"r " ' fK""r •' lhu IhN dofumenl !nd .N ellKhmenLS were TEIEPNONE DATE <br />pnp^rrd coder iu) dlretllon a wlprr.flow In Ofcord^nce r11A . s~slem daljntd <br />le tusure Ihel ~Il.Nned perwnnet prvpeir [^111et •nd teNu.le the InfOfm^/low <br />snbmltled. elwd on m~ Irpulry o/ the penal or prnorle rho nwlsr[r the s7slrrn, <br />Of thGwe penom dlrettlr reperolbk for ptheAn[ the InfonmUew. the In/onlrlbll <br />wbwdlltd ts• to Ihr bo1 of m7 twowkd[e .nd betlef, Irve, erfunte. ^nd aompkle. <br />- <br />- <br />I O.n.ren UI^l Ihen en sl[nlnunl pendlfee lac wbmllnn[ t^!se InforwuUow <br />61°NATURE OF MINCNAL EXECtlTrVE ' _ <br />TyPEp OR PRINTED , <br />Includl~ the palbltllf Or nwe.we I~npMowwwnl rnr Ann.l"[ .4d^unrK OfFICER OR AUTHORIZED AGENT CO E NUMBER YEAR MO OAY <br />COMMENTS AND EXPLANATION yr ANr vlv~A I IvNS IR~hrmci M •rncnmmrs n~r~i <br />EPA Form 3320-1 fRev 399) previous editlons maybe used <br />_AIMED. IF CLAIM APPi <br />A - <br />Thts is a d-part Corrr <br />?VED DY WdCD <br />.. ear elfll'1 /'9r <br />iE OF <br />