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PERMITTEE NAME/ADDRESS pweWesoeWryN~/L«~now 1/DlQirrnq <br />NAME TF~t~F'F'}'R t`~ilf~;Tl~fG, If~aG. <br />ADDRESS T~dF~P~~€: f`~Y~fi~ <br />f''. Q. ?30~ ifa7 <br />GRr~ZG G+Ci B~f~~~ <br />FACILITY TF2F~~PEf~ f`~Ihfic <br />LocATIONCI3~,ZG CO 8~$2S <br />n-r•rns• t~,r~~trannsn ~ nt t soa-sv~ ~xa>=c rnnn <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPOES! <br />DISCHARGE MONITORING REPORT (OMRI <br />1" <br />PERMIT NUMBER DISCNAROE Nt1MeER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM G7' ~. G G ~. TO G7 ~. cam. °' 1 <br />Form APProved. <br />OMB No. 2040-0004 <br />'f~i s F~l(JE! <br />{ ~L1t3R ,JC i <br />I^ - 1" I E~4~€~ <br />~I^r TEST~d~tG FG?f~ G~~r~ <br />i"#OP'AT <br />NOTE: R~~d Irntructitxa b~for~ compl~tinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCr <br />OF SAMPLE <br /> <br />TYPE <br /> ANarsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />L_G 5G ~Ts~Tf~ fW X4131-If3 FAG SAMPLE #tit9. xiEi~ ii•#'r•~ #34# ~F##i`r `~tl~~lt '.f~zr#3fiC••s ( ~~ } <br />G ~€d T t31~A~' h4l•~.I I ~a MEASUREMENT <br />l'r~f~l3t~ ~. G Q PERMIT •~• ~•~••~-•~~ •sr :t~•~~t ~t- : ~•~,~•~ 1 !.~G. ~iOG' I •# ~• ~•sx•~•?r ~•~t~•~ ~ ~•it• ~~- ~Ti"~~ . Y ~r?F11;3 <br />~l^'F"f_(J~f~iT Gf~s~S ~ V~LU IiE4lIIREMENI' ~~;a# f"f~! jAL. tJE~ G~f`~"f <br />G SG ST~Tf~I^ 46NR t~GC SAMPLE ~x ~~t,~x• ;t•.~••~. ~.i~•3t• #3F3E#~•tt~ ~~#~x~tt~# ( ~3 Y <br />~ Zi~7~f'!-I~L~.$ MEASUREMENT <br />TA4~bG 1 0 G PERMIT -~~•~•~-~•~ ~•:~-~•~•~•~ ~ ~•~••~ ~.G{9. GCMG-~:-- - #~-~# ~#~r~~~ ~~-- 't"RG.Y ~'~~T~ <br />~1= ~"Ltl.l~l~fT GE=1Q~5 ~1t~E...l.l .REQUIREMENT •~•iP•#it• _t~ft'$" 1,/r~ I C~P~1T <br /> SAMPLE ~,i'"~ 1' <br /> MEASUREMENT <br /> >I'ERMIT <br /> RE4llIREMEN7;' <br />•:~:.;;: <br />::.;:.:...: <br /> SAMPLE / \ <br />V <br /> MEASUREMENT \ ~'1. I <br /> PERM11` .. ~ I <br /> RE~lUIREMENT <br /> SAMPLE i <br /> MEASUREMENT <br /> <br />PERMIT ,. <br />- <br /> I'#LilUlitEMEN'F' <br />.~ <br /> SAMPLE I <br /> <br />MEASUREMENT -' <br /> s~~RMIT ` <br /> ~tE~3UI~tEMEP1'I' ~ i <br /> SAMPLE `~--~~ <br /> MEASUREMENT ~ <br /> ?'>PERMIT „i <br /> AEt]t11REJUIfN'f': <br />• <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER t aru r u er pens ty o Yaw that. mh document and all altaehmenb were <br />ared under my dlreclbn or auperrMon In aarnrdartce with • system desi`ned <br />pre ~ TELEPHONE DATE <br /> <br /> <br />, j <br />~ G <br />s~I S <br />p <br />to aware that quaHlled personnel PruPe~y bather and evaluate tht Informanon <br />Baxd on m7 Inquiry of 1M pcrson or persoro who memee the system <br />submitted ~ <br />~~ <br />, <br />U <br />/' nn , <br />. <br />or those penoro directy rnpomlbk for plhcrlrtS the information, the Informenon <br />L.~1 <br />n ~ ~~r / <br />l <br />/ / <br />,,,pC ~'~ ~`/ L~i~i / / (~ r <br />submitted b. to the bent of my knowkd~e and be8ef, true, amrrate, and mmpkte. <br /> <br />b1ONATURE OF PRINCiPAI EXECUTIVE 0 <br />( ~ <br />~/ <br />OC f/ O~ /~ <br />l ~ 1 am aware that Ihene are slEnlflunt pendtle for submltHn~ 6lx Informadon, <br /> <br />TYPED OR PRINTED <br />IneludlnL the powslDlllty or ene and ImpAaonment for knowln` rldaUoln <br />OFFICER OR AUTHORIZED AGENT <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRS/~i~nc~ M/ att~cnm~nta n~~~/ <br />5i~~ :d. e"~. 5, dir. b-~, ~`1Jf~ T:r~i'A:[1..5 1~F T~,ST ~I,CIG~;JUR~. f~~POf,T ! G50 = STd~TiI~T~GAL F'1~T1~fT Ir~T:~€'fll~ITi~ 1rdHIG4-y I5 <br />1L..~~'MAf_ Tl7 ~dl 1~F TEST £3F;G~3i~1:tSf`3~, ~5i!!-} taT`F~GN !~GlJ`1'~ TflXG~T`~' TEST ~;EF'CIf~T ~'C3Rih TCI s`~Ml;. 1~I~I~=.fV t~~'i' T~ST~fUt3 fVCIT <br />,~ ~_- <br />~ ;r - <br />EPA Form 3320.1 (Rev. 3199) Previous edkions maybe used. G~'j 1 ~~~ ~j~~~~~r~iQTtil. PAGE ~OF / <br />