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pERMRTEE NAME/ADDRESS pwebJri~r/hryN...~t«aten ~/p~G,w,y <br />NAME "#"R~SPf'~t~ (~#Tfi~lfNG, ~I~iC. <br />ADDRESS T#3F~PP~~ M~:f~4~ <br />~'.O, fit'.ln 18~ <br />CF2Pt+~G CO 8~.~2~. <br />FACILITY 1"#~f~#'~"~F~ {"I~#!#)r <br />LOCATION C #~ a~ ~ G G O 13 ~. t32 ~ <br />~1'i"P.3: #~~i~fi~iOfi`li7 ~. F3U ~0~5, PR~Sl~fi°f <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES/ OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT ~OMR) ~ T #~OIZ <br />GOL~}G~~~~ ~. a 5 Q~® A { at.JB~ JC ) <br />PERMIT NUMBER wscNARDENUMeER ~" - F~fi~,~t~ fi~#Gf'wT <br />MONITORING PERIOD t3I.~G~Ar~t~#= TU F#r.l~ }~ lau#..tv#-# <br />FROM Y d0 DA ~ TO Y MO D1 YY ,d,#,~. P~#O L) I ~C#-#~i#~C~. # ~ # ~N i€~st• <br />NOTE: R~~d IrNtrucdtxa b~1w~ compl~tinp this form. <br />PARAMETER ~ QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSts TYPE <br />(a ~S <br />t,j I $16~L_ SAMPLE <br />MEASUREMENT ~'•Pt~~3f# <br />D ( `~~,"•) •~•##3t-y#•~ #~'k•Y••3z••~•# #•~•~3i•}~~'•~S• <br />~ <br />7 ...• <br />V~ ~~~ <br /> <br />8~{•C.)G6 1 (7 O ..PERMIT 3r#•#E•u~#~# Ft ~~,,,".- 1 :~ ~##-~-st- ~•3#~a-tt~~f :~:?f~3ti4~3k t•3t•~.;•~• ; .f_Y ~ ;JF§"#.. <br />L-°~F`f"l..U~f~T OIdOrS '~~t#.._U REnl11REMENY INGT fi~#r'~X #~iO=G+ ~•~t~~•~ <br /> SAMPLE <br /> MEASUREMENT <br /> <> PERMIT' <br /> _~EQUIHEMENT <br />_.. <br /> SAMPLE <br /> MEASUREMENT <br /> >tsERM1T <br /> RE<lUIREMENT <br /> <br />............................... <br />_. ___. <br />................................ <br /> SAMPLE <br /> MEASUREMENT <br /> PPERMIT <br /> REOUIREMEN7 <br /> SAMPLE <br /> MEASUREMENT <br /> '.PERMIT <br /> ::REt3UlitEMENT <br />::..:....:.............. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> aEiiua~MEN'r` <br />........... <br /> SAMPLE <br /> MEASUREMENT <br /> f±ERMIT <br /> AEClUIREMENT`` <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER ' nnny u er pens tr o I~w that fhb document and dl ~ttxhmenb veers <br />prepared under my direction or aupervblon In ~ceord~nce with ~ system desltnM <br />///J <br />TELEPHON <br />E <br />DATE <br /> <br />~~ I /p/~0/t (~ ~ • ,~b1 ~Ui S <br />1 <br />_ „ <br />/ to avrrre IhN quoNfled personnel properly plher n~ erNuete the Inforrrnlbn <br />wkmitted. liaxd on mf Inquiry of the person or penoro who nunase the system, <br />or thox penom dlrectl~ respomlbk for ptherl~ the Inronnalbn, the InrormHlon `A~\' E~ <br />J~ <br />Z~ ~~ _ Y <br /> <br />7/` <br />n <br />~~ <br /> <br />/~l <br /> <br />/ <br />~ ~~ / ` <br />/i <br />( / <br />~S . a G~ ~ //~ ~bnrlted Is, to the Desl of mr knowkd~e and betlef, true, ~ttvrate, end rnmplete. <br />1 ~m aware Ih~1 there ere slpilllunt pendtle~ ror fubmltlln~ bbe Inforrmflon <br />bIONATLRE OF PRINCIPAL EXECUTIVE (f ~ <br />~ <br />~/ <br />aS ~ <br />(f <br />TYPED OR PRINTED , <br />lndudlR the posibllttr or ene and Imprhonrnent ror knowlnc vidratlo~ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />C{JMMCIV 1 J AIVtJ [~rLnnn t furs yr ni.. .rva.r. r rvrw lntrrtrrmctr mi ~.ucnmmrs ntgtq <br />~"~I"sa Rc TG1TAt#,... ~RC3CJ L.~#`~~`~S W"Ll. 13;E ~zIr1TV~l3p ~c `i~°I`YI..~~Ii~~caCl}..~~5 ~..IN#~7 ~t~PL:[~~ ~'OR ;.='1(~Vt~:, ~~4~-{F2 C'~'d~t;z;=' ~~1~#~~"- <br />cs•`E~ bU#~D~1~ QF Pi~aD~= RE:Gl33R~t"iEtVT~a" Ui~;O~:Y~ I. ~1. ~?. TOS #"#O#~~~CIR3#VC° - I. ~. r. t_3:~L_ tis {~f~~~~~ - ~~E: I. fit. ~.. tI)). <br />, ~ L .~ i ... ~. <br />EPA Form 3320.1 (Rev. 3/99) Previous editions maybe used. ~a~~.~ Q~OT~a~4-Rf~rm. PAGE „gF~ <br />m <br /> <br />