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PERMITTEE NAMElADDRESS r/mlwk F~x•din .Y(unrt'LornrMn r'(D111arcrrq <br />NAME .. .-, j i••ICj <br />ADDRESS <br />~'iD 65 <br />G~~ F3i64 <br />FACILITY ~~•., , ~- <br />LOCATION: ,., ,~.;~{ •Y CO 8104• <br />..t ~~:r, r nt7n Mr~F t4Gh1dC_Fft <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />M I Nt1R oMS No. zoao-ooo4 <br />ISUHR UW) <br />F- F I NPtL R B LAN <br />55-1 SLUT STORAGE TO REO WA~Ii '~ <br />L <br />X <br />NOTE: Read Instructions before completing this form. <br /> Np FREDUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <br /> EX S <br />S TYPE <br /> ANALY <br />I <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />,,; PERMIT ~ { <br />~ .~ .-. <br />h. ,~.~ ~ ~-. c <br />_ <br />'F•.~t-1`i' ~ -- REQUIREMENT <br />~- SAMPLE <br />L;"' ~ '. MEASUREMENT <br />__ PERMIT ~ 4, - .. ~ - - <br />F ~ ~- t REQUIREMENT <br />i SAMPLE <br /> MEASUREMENT <br /> - ~~ ~ <br />~ <br />.. PERMIT ~ ~ ,. . <br />- <br />_r-- - ~ REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ~,. , ,: <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ '' - = ' - ..~, ;- . <br />'F ~ REQUIREMENT - <br /> SAMPLE "" _ ' <br />Y'y(~L; MEASUREMENT <br />- ,,, - PERMIT .. _ . , <br />_~~- ~): REQUIREMENT • <br /> SAMPLE 1 <br />,I•= MEASUREMENT <br /> <br />PERMIT <br />~ rata , -- , I" _ ~~n.~ <br /> <br />- <br />REQUIREMENT <br />~ <br />~ ' y ~ ~-'•~' _ _ <br />TITLP PRINCIPAL IXECUTIVE OFFICER <br />NAME { cen~f} under penalty of law that this J.xumcnt and all attachments were TELEPHONE DATE <br />/ enastun m accordance with a system J,.•.ignal <br />rnun or su <br />d <br />d <br />m <br />dir <br /> p <br />prepare <br />y <br />e <br />un <br />er _ <br />f^ <br />l <br />~ t !Jf - ~ ' ~ ~ to auur that yualificJ pcnonncl pmpcrl}' gather and evaluate the infnrttutinn <br />e the s <br />stem <br />h <br />h ~--- <br />_ - <br />~~ <br /> o manag <br />y <br />. <br />e pcnnn nr persons w <br />subminal. Baud on m}• mqutty of t <br />the infnrrrwtinn <br />the infomwtion <br />vbl <br />for <br />athcrin <br />a <br />di <br />l r~`~~ ~ `r ~E~ <br /> <br />(_, t t - <br />y rrspnn <br />~, <br />g <br />rose persons <br />rect <br />e <br />nr <br />submntnl rs, Iu dte ixst of my larow {edge and belief, we, a,: vrntc. and cump{etc. <br />SIGNATURE OF PRINCIPAL EXECUTIVE _ ~ _ <br />~- ~~ _ ~/ <br />~`' ~f <br />~ T <br /> I am aware that them arr sigrtrticani pt:nalties for submntintt false information. OFFICER OR AUTHORIZED AGENT AREA <br /> <br />l <br />ti <br />k <br />i <br />i <br />F <br />i <br />J <br />f NUMBER <br />CODE YEAR MO DAY <br />TYPED OR PRINTED now <br />ons. <br />imprtsorun,~u <br />ur <br />ng v <br />o <br />a <br />t <br />ne an <br />irtshnlm!, the p~sibiliry o <br />COMMENTS AND EXPLANAI IVrv yr f+trvT vwl..ial Ivrva tnereronct: an nrrnw nnrnw nm c~ <br />;-1R PREG <br />SAMPl.. T <br />EPA Form 3320.1 (Rev. 3.199) Previous editions may be used. <br />11Ft\i ~' - 5EE I <br />~TF'UCTIDNS - <br />l h:~ i, ii ~-{`art t:~nn ~~'. <br />