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PERMITTEE NAME/ADDRESS paV6i.rwryN..rLerrren yn(Q6.YnrJ <br />NAME ... <br />ADDRESS i :_ ..._,- L i'l l !' i <br />$OX ~~8.i <br />•iIA CO 81428 <br />FACIUfY _ ~ iyp - Y1 I i~lE <br />LOGS `YIA CO 81428 <br />~LIAM r-. BEAR JR. itiIN$ MGR <br />RATION AI POLLUTANT OiSCHAROE ELIMINATION SYSTEM /rNPDES/ <br />DISCHARGE MONITORING REPORT IOMRI <br />PERMIT NUMBER DISCHMOE NUMEFI9 <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />F - FINAL <br />5R ~ iJf=~~i TRL. I7TC uR (Ji+tMD <br />NOTE: Rra~d Inotructiorw D~1w~ compMth+p thlt form, <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FnEOUEf+cr SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX 'yIKY~s TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. ~, . . <br />r REQUIREMENT <br />, <br />,. , SAMPLE <br /> MEASUREMENT <br /> PERMIT .: .:-s-#tr•k ~-~>;-;:-;rt: <br />:,~ <br /> <br />_ _ <br />REQUIREMENT <br />.-~ ~ SAMPLE ,. , . <br /> MEASUREMENT <br />:; 5 _ PERMIT •~•~i•y ::.:, r; .k#•~•-- ~n;.T~ :_ r ): RI=ROR i ~~ Fi~~;. <br />IJj_i~lT REQUIREMENT - ~; C~;-1 f. i-.~Y ~`~ h9~JNT~' <br />-` _~,_~ SAMPLE . <br /> MEASUREMENT <br /> PERMIT ~=~ : :..• .~.#~ ,- ,. _ F ~ <br />- ,.-.... <br />v r• ;-, is <br />~L,: REQUIREMENT Y' I`l.~ ,•~;:~1+TH <br />cH`: ~ SAMPLE _ . <br /> MEASUREIv~ENT <br />~~ i 0 PERMIT e•ti•#i~ is , .- rF## 1* r , #K~ - -4-~•:_r: <br />~Y'~ <br />' i= <br />;;ZQc` REQUIREMENT _ ~ -i ; .. .. <br />.'~i.l { SAMPLE <br />• ,.jT ~-, ~ MEASUREMENT <br />_,~: .. '"` PERMIT _~r~.,UD '(-;'G(dT" ~# i, _ .. ,- ~.t-: .. `t r.l,} ~ fig <br />:_t~ENT ~=~ , - REQVIREMENT . A F-, -SILY MX •:. <br />... r^IPirr '::~; SAMPLE - .. - <br />c_,1 ~ , , MEASUREMENT <br />- <br />PERMIT -t; s: i' .-. ~ <br />rE ir•tt• :.. = •~ :. - .. .. - t: it <br />REQUIREMENT <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER + Krttl) Y r pen. !) b. IhH thh dorvrrrnt ^nd JI ^it^cnmrnte .ere <br />TELEPHONE <br />DATE <br />prtp^red Ynder rnt dirertfon a wprr++flow In ^ttordenK +Ith ^ f)rtem dof~ned <br />Io mYre th^t qu^Nned personne+ properly ~Ythef ^nd e•^fv^te the Infornutbn <br />eYb.ritted. srued on m) Inquiry d tM person a prrtorn -M trurt^~e tM totem. <br />or +ltt/ee penors dlrecty retpetMbk for ~^thtA tK the Infortn^tlow, the Infonrutbn <br />. svbmllttd b, to the best of m) tneviM~e ^nd belkf, true. YKV nte. ^nd tanpktr. -. <br />. 1 ^m ^.eK thu mere ^K tlpt111c.nt pen^It1v for tYbmllnn~ f^Lee Infonrrtlon <br />SIGNATURE OF E't11NC1-AL EXEEalT1VE - ~ ~ <br />TYPED OR PRINTED , <br />IrK+Yalni t1Yr potdblut) of nne ^nd Irttpr!^onment fa tno:ln~ r+d^tloras OFFICER OR AUTHORIZED AGENT '~ A NUMBER <br />COOE YEAR MO DAY <br />COMMENTS AND EXPLANATION yr Anr vwt.A r IUNS (R1/1/MLV Ni •tracnm~nfa Mrs/ <br />'J ont-,^' P _- ~ct.~- ~ c^^ ~'tC 1`!rfl T T- :'I /;j M ,'a~r~~t,t'(= r`, n~,: <br />' ~ ~ PAGE OF <br />EPA Form 3320-1 (Rev 3i99) Previous editions may be used rtt115 IS 3 4-P8R ('OrTt1. <br />