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PERMITTEE NAME'ADDRESS IlnaucleFacrlirv.Yumeilwxwr(nnijDljjrrenr/ <br />NAME r uiE`»IN~~ LLL <br />ADDRESS -- -i', hl1 i'Jt <br />' ?= L,Fi'r"AI'3 ST>-1TI'~N P,OAD <br />°:CTON l^.'~ 4J5 <br />FACILITY -(,E, ~liiLE: <br />LOCATION -,jy CO 8I0' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) FD(m Appfoved. <br />DISCHARGE MONITORING REPORT (DMR) ; - ~~~,- . OMB No. 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER - FINAL LAM <br />MONITORING PERIOD WET TL--:,T IN6 FRR OOIA ~~ <br />YEAR MO DAY YEAR MO DAY <br />FROM TO - - '~ ~- <br />NOTE: Read Instructions heforP cmm~lptlne this form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. I FREQUENCY SAMPLE <br /> <br />~ OF <br />TY <br /> ANALYSIS PE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE . " r ~ -. r - .. <br />f_ ~ - - - • MEASUREMENT <br /> PERMIT -, :T••>~'# sf- _ a ,J ~ .cst ~ -r-a •~-•:: ,.. r ~ v <br />- ' REQUIREMENT ~ t•;'3 `v' -', - • .... <br /> SAMPLE t _ <br /> MEASUREMENT <br />_ PERMIT ~ ~ yi a •~'a• ~l••a :, -r R ;; -;r z: # .l . V l.' ~ 3t st• # #• •rr - , <br />i - ~~'1_f•.- .-. ''.'~':Li-!' REQUIREMENT _ h1iV VALUI •I t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT '~- <br /> SAMPLE <br />/5 i . ~~ <br />(. <br /> MEASUREMENT ~ <br />f <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMErT1TLE PRINCIPAL EXECUTIVE OFFICER ~ , ~ ~~~' • ,irdcr penalty or law chat :ius dcn•umcnt and au .Irtaehntents were ~ <br />~ TELEPHONE DATE <br />r <br />.' % :r (~ ~ /(" , ' ^'~ C{ , ~- <br />~' c~ ~ i ' ~/ ~ prepared under my dlrccnon or ,open tsnm in ac.urdanee with a system designed <br />to assure that qualified personnel prupcriy gather and raaluate the inlurntatinn <br />uthmined. Ra.~cd on my myuiq• ni the per <br />;nn or persons who munn <br />e the s <br />stem ~ <br />/ / <br />/ // <br />f <br />/ <br />~ <br /> <br />__~ <br />. <br />g <br />y <br />, <br />d v <br />/ <br />~ ~.~, ~ _L~.., <br />` <br /> or <br />ross pertioru directly nsgm.4tMc for grthering the Informaticm. the tnfimtation ~ n <br /> <br />-' ~ ~ ~ <br />.uhrmtrtd ir., to the 1+ca of my know lalge and lxlicf, trot, accurate, nntl complete. <br />I <br />• <br />b <br />h <br />i <br />SIGNATURE OF PRINCIPAL ECUTIVE J / <br />~ <br />(~~ ~ /~ <br />G / <br /> <br />TYPED OR PRINTED _„ <br />. ,;; .•.i: i <br />.~i i <br />erc are s <br />gnificant penalties 6,r sul,muting false mforrnatioo. <br />d;r c d.. ;ys,rbdin nftine and tmpr.+onmcnt (n knowing vinlatioas. OFFICER OR AUTHORIZED AGENT A <br />NUMBER <br />YEAR <br />MO DAY <br />I+AaI as C~ITC ~\111 ['Vf]1 A\IATIf1\1 AC A\IV Illnl w CODE <br />' ;cPORT LC50 <br />- -JXICITY TE <br />EPA Form 3320-1 (Rev. 3-99) Previous editions may be used. <br />fSTICAL PDIPIT ESTIMATE WHICH IS <br />? i r~~RM l>_) <br />'I In; i~ ~t ~•pact'Porm aacE <br />