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PERMITTEE NAMElAODRESS ilnrfudr Facifity.Vawldlaalian iflhJJerrntl <br />NAME ; j , I I _ .. <br />ADDRESS ~ ; ; LL,~ <br />-. IIOX f~28 <br />' ~UGLA ~: iJ 8 i 434 <br />FACILITY _W NI?~ I Zt?N 1'i I N~ <br />LOCATION ~;ILLfa CO 81424 <br />~? f AAIf'F iwiATTF . I`1 T AEI= M{dhlsl ~>= Fr <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESJ <br />DISCHARGE MONITORING REPORT (D RJ <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 />M Y F•.i ~ ;'_: <br />SU3i~ t'1H i <br />F -- F I14AL I"IN <br />cPr~F~IT!11~ T1R;RIe-_- TP T *? Ti- Ti )TTI "~ nR <br />NnTF• RParf Inclrtirtinnc hafnrn rmm~lcfinn ihlC fnl'm <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> i AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />+~~ SAMPLE j <br />' ' MEASUREMENTI <br /> PERMIT E~'Cr~ t `f'i ., ,. ;.f ~yK~;-t <br /> REQUIREMENT ,' t~ I•i;t :. '._ f"h~'t•;T~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT } REP CRT F~: -; 1" „':,=`: <br /> REQUIREMENT ~;'~ R`l: DF :. 1. i "IX ' <br /> SAMPLE ' "' ' <br /> MEASUREMENT <br /> PERMIT ftEh~O€~T R <br />t ~~ <br />' <br /> ~ . <br />:- •y.tr;:-. <br /> REQUIREMENT ~.~:'~1?A f~ t; :~ i i ' N1 <br />• SAMPLE <br />" MEASUREMENT <br /> PERMIT ,; - R .: ~,....:. __, <br />- REQUIREMENT 1)io, AVC~ naILY MX `°' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crruf~ under penalH of law thal mlv d«vment ane all atlachmrnt. were TELEPHONE DATE <br /> prrpared under nn dlreetion or aupa•n iai~m in accordam•e wiN a syarm dreigaayl <br /> lu wcwrr fhal qualified prrwmnai prnpcrlr gather and r.aluatr IM inlurmaliaat = -- - ~ - J <br />i ._ _ submillad. ISuxd on ml inquiry of the prr7on or perums whu manage the sTstrm. JJ ~ <br /> or Ihnx~ pennas directly rarp~m~iMe for gathtring Ihr informntNm, the informaUou 1 <br />- --! <br />- <br />~ <br />- <br />- <br />l ~, .uhn6tt •d n, to the bni of my km~w ledge and belief, tear, wrurvtr, and compielr. <br />I am aware that Iherr are +i <br />nif <br />•ant <br />ee <br />ltia+ fo <br />b <br />iui <br />f <br />l <br />i <br />f <br />SIGNATURE OF PRINCIPAL EXECUTIVE ' > f ? -~ <br />~ - I ''f0 ~ <br />- ~ ' <br />~ ~ ' <br />.m ED OR PRIN <br />D g <br />w <br />p <br />a <br />r hu <br />m <br />ng <br />.e <br />a <br />n <br />ormalirnt, <br />K o <br />e pmcibiliq of fine and impriuatmrnt for Anowmg aNdatiotts. <br />,~ OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MQ DAY <br />nn^^urwtTC w <br />n. <br />nr w uv v~n~ n <br />w r~n. <br />n CODE <br />I Ali. t. a --hart icnlis <br />