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~ PERMITTEE NAME/ADDRESS ilnrlude F'urilin ~amr/LrKUrian iJUiJJrrrnU <br />NAME ,_, _~. <br />ADDRESS _ <br />y W L' J i i-~f~ 1 fJJ' ~ rC G fv T <br />~N3DA~i CO 810 <br />FACILITY ,E?E;yC' ~ T(J u~j~i'!'(ljt; !"llS~i~ <br />LOCATION T:-ji•.J G(~ ~ 1 ~ <br />:T T :: /+Tli1 T A7nTf'ih.l }~! T PdF MfkllfAt~FR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESJ <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 2040-0004 <br />t; ~ ~C; ia;~c~ T~ ~d~;=iuc <br />x <br />i <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION IUD, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT - <br /> <br /> <br /> REQUIREMENT hi i " ~ .- . ;'' <br /> SAMPLE <br /> MEASUREMENT <br /> ,.~ <br /> PERMIT ~ ~' ~ ~ ~ -" ' " <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ~ <br /> PERMIT . ,. -. ~.. ~ • _, <br /> REQUIREMENT '" _ ~ ~ ~~ X ~ • <br /> SAMPLE 1 \ J• <br /> MEASUREMENT I ~1 <br /> PERMIT .. -r ~/ - -. <br />~ <br />~ ~` _ .... <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT _ <br /> PERMIT ,• ~ .. _. :, -_ • . . , <br />; <br />; <br />4 i;' <br />•:= •-, <br />r=• <br />Y i`IX <br />' - ;.; <br />~QiU i `i <br /> REQUIREMENT , <br />~ <br />. ._ <br />_. <br />.. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ..- . ~ - _ . , _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT _.• . I~ ~ .. .. .. ,. <br />. ,_. _. , <br />Y <br />REQUIREMENT ' ' ; ~ ~' , ~ ' I f •: `-, <br />NAME/TITLE PRINCIPAL EXECUTIV OFFICER I.rrtif~ unrh•r q•nult~ ~dlaw Ih:d Ihi+d~svmenl and all altarhmrM+werr TELEPHONE <br />with a <br />te <br />trcd ~' <br />i <br />i <br />r <br />d <br />si <br />i <br />d <br />~ DATE <br />c <br />un <br />n wrar <br />an <br />r <br />+~-+ <br />m <br />e <br />>; <br />yrrpand wda•r m~ dira <br />tion ar v:pen <br />ualified penonnel prutw•rl+ ¢athrr and e+aluatr the informrtion i , /, <br />; ~ <br />. - ~• <br />i• <br />` d. a+.urr that <br />!% <br />~ <br />% <br />r <br />`,J <br />,., ,~ ~„ ~ _- <br />t <br />~ <br />• _i <br />q <br />G <br />, <br />~ <br />/_ +uhmiurd. Na+ad on m~ inyoir~ of the tx•rvm ..r perwmc who nonage thr y+tem. ~ ~ / <br />~ <br />'~ <br />r' v • <br />- %' /; ~l 'y ~i ~_= <br />~'~ ~-~- ~ ..r tho+e tter+an+din•rtl+ re+pimihle !or pathrring the infarnwtiun. tl:r infurmali~m <br />~ /~ ~- <br />T" <br />~' O / <br />wled <br />d I <br />lirf <br />ur <br />araur tr <br />and ram <br />drte <br />! <br />t <br />a <br />t <br />~~ <br />d <br />h <br />h <br />f <br />k / <br />~ <br />J <br />. <br />( <br />. <br />r <br />nn <br />no <br />ge <br />n <br />M <br />. <br />r <br />, <br />~ <br />~. •, <br />+ubmill+ <br />i+. to t <br />e+ <br />o <br />SIGNATURE OF PRINCIPAL EX CUTIVE <br />~ <br />` <br />~ <br />~ I am aware that tM•m arc +i¢nifarnt penalti:~ fur athmiuing ful+a• information. AREA <br />TYPED OR PRINTED inrhalinp the {rn+ibilit7 of fine and imprisonmrnt far Mmiwing+uAatinn.. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aff arracnmenrs nere~ <br />r <br /> <br />ECIP <br />n~ <br />"1'hi~ is a 4-pan ftn <br />