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PERMITTEE NAME/ADDRESS i/nrhuf~ Fac•ifity .~'amr//,ormion iJlh%frrcnp <br />NAME - <br />ADDRESS <br />kt)c~ <br />C(] 81 1 ~6 <br />FACILITY ^.iJ;iIjC)I: f <br />LOCATION i.~~N CU 80480 <br />-!=ORGE '! ~:4T'i EFt5CJN, GEN. MGrZ. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2C4C <br />f3NU T p I LL I NO I E ? 1 E'ER <br />X <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ... ., _ - -. - - _ .- _ . <br /> REQUIREMENT ' ~" ~ I f•"•}rv; <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT :. _ . .. - ~_ <br />- REQUIREMENT ~•~ ~~';- -. "'•'i. <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT ... .. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ; i-_ I~ . ~ ~ . -_ -.:, - - .. .. ,. <br /> REQUIREMENT ~i:),•, = . ~ :~; Ji . ; : ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ., r. __ ., .~ .. .. .... - .: .._ ~ _ <br /> REQUIREMENT F NS'C ?`r: ~ ~ ' ~~:::: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I certify under prnalte .,f mw mat mis e~KUment and au auaehment~ were <br />r <br />n•d und <br />r di <br />•ti <br />i <br />i <br />d <br />im <br />d <br />l _ _ TELEPHONE DATE <br /> pr <br />pa <br />er m <br />m <br />on nr wpcn <br />. <br />nn m airor <br />ann w <br />a o:Yrm <br />rey;tan _ - ~- <br /> <br />1. C ~~ ~ = <br />~ ~ - ~~ S.O rt <br />~ lo a voce that qunhfied personnel prnprriy gather and r•uluule the m(ormatinn <br />b <br />dt <br />f m <br />d <br />H <br />d <br />i <br />i <br />h <br />h i <br />) ~' <br />~ ~~ 1 <br />_ <br />- .n <br />m <br />e <br />un my <br />nyu <br />n o <br />e pen:m or prrwn. w <br />. <br />ar <br />o manaLe t <br />e .y arm. ~ <br />J <br />c t J ~ ` F, <br />t ur mine Ixnnn. d:reath ratifwm.ibtr fur katherinK the information, the infarnutiun - - / <br />- C <br />~. ~ {~ ~ .j.~l ~~ ~ •-, <br />I • ~ 7 C ~ , r, ~ ,. ~. r~ <br />,_ .. <br />, cubmitkvl i. <br />to the bed of uty knowledge and helieL true <br />xrutvtr <br />and «;mpkte •_ <br />- <br />- - ~ L ~ ~ <br /> , <br />, <br />. <br />. <br />1 um aware that thrre an• .igniftrunt penaltiati fur submitting falx information SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> . OFFICER OR AUTHORIZED AGENT A <br />TYPED OR PRINTED inc9uding the pwahilih of Iinr and imprtwnmem for knowing riolaGon. ~~E NUMBER YEAR MQ DAY <br />~.vmt~crv I a rarvv CArLMrvM I IVIr yr Htr r vtvLrt t tvrvo Ineterrtvt:e cu mtacnmrnls Here/ <br />'R <br />t <br />EPA Form 3320-t (Rev. 3199) Previous editions may be used. cQp3~~ This i~ <br />