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PERMITTtiF NAMf1ApDRESS(/wd.f.frtl~ryM../Lor.rron~~Dlei.+~r) <br />NAME ' .! ' i' ~ , ~ ~. ~ f' <br />ADDRESS 1 -- -,~~ <br />.•,CEKER 4;G si16 <br />fACILm ~;: QL E?WYO ht : i`. _~ <br />LocAnoN;•~=_~K~~ CO 814 <br />.. ^i. 11ELLY D. SAI+iUEr~S~ 4'P O~ OPS <br />NATIONAL -OLLUTANT d4CNM0E ELIMINATION 4Y3?EM /INPOES/ <br />DISCHARGE MONITORING REPORT (OMRI <br />' Ja., f <br />PERMIT NUMBER rrscHAnoE NuMeEn <br />MONITORING PERIOD <br />Y A ~ D Y Y •AR 0-: D Y <br />FROM J" _ TO <br />Form Approvcd <br />w z PduR OMB No 'L040-0004 <br />BURR vt; ) <br />~ - Fzt~aL - ~- . <br />WABI-! $AY TO WQf'ii AgEA rGitiiD ' <br />NOTE: Read Inatn~ctior+a baiora complatlny tfils /wm. <br />PARAMETER QUANTITY OP. LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX F1lEOVENCY <br />of SAMPLE <br /> <br />TYPE <br /> ANAtrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />EM <br />U <br />T <br />- /~ <br />+ ~9r nf~ <br />_I r/~ <br />I~ <br />0 <br />~li~;'::~' <br />DISSOLVE ` R <br />EN <br />MEAS <br />I •- - - <br /> <br />IO~S'ri ~. <br />PERMIT <br />- <br />.. , . .... --,~-r--.., . <br /> <br />" <br />!-E r LUEN I' ~~RO:`- ~'r~Lt i> REQUIREMENT ~-=C)DA :~'~'u IiC <br />DAI! Y h [ ,(~:: - <br /> SAMPIE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />_~ <br />~ <br />` <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT' <br />`~ _ <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRI CIPAL EXECUTIVE OFFlCER r R/111Y Y .. o.e, q e h. ~A.1 Ihb AorveKnl .nd .11 .n.rnmenu ~~ <br />.~e TELEPHONE <br />.r.l <br />l«~Ie <br />R«a.~...un <br />i <br />..e.~ <br />~ <br />el...ale. <br />< <br />r <br />e <br />l <br />DATE <br />p <br />p. <br />r <br />r <br />o <br />Hr <br />. <br />. <br />..r. <br />~ <br />~ <br />te <br />. ~ • : ;` / <br />e / <br />le ~.. Ihu <br />.nnrd <br />ersonnel <br />uAer .nd ...I.i.~ <br />the I.re. <br />ul <br />~ <br />~+ <br />/ <br />f <br />w <br />p <br />~~, <br />r c <br />e <br />,e <br />o <br />v <br />w <br />F/ ~~ ; sf'.~ ~ +.enrnee. area on ~. lrpwer o! u~ prnon a p..,e.e .ho m.n,te .M >.n,een. ~.. ~ , <br />~7 <br />1 <br />' " <br />~ <br />er ll~ose perm dlrMl~ respenlMe ror [.1Aer1 w[ the Inronrullow <br />rye Inrornrllon - - <br />~ <br />~ ~. r <br />. <br />, <br />~v ~~ ~ ~ ' !U <br />G k ' /~' IG /" L ; ~ ~/" :: `r ; ~•." /L-~ .ub~lld h. b IAe be+t o< ~ knonled[e .nd Dener, irve..rcursre..nd eornpk4. <br />{IONATLME OF MINCI-Al EXECUTEVE <br />H U <br />d <br />nln <br />.wl <br />b r <br />1 <br />l <br />b <br />l <br />I : 1 ~ l <br />. _ <br />/ <br /> ere .n <br />[ <br />r <br />prn. <br />nr ru <br />m <br />.nw ti.R U <br />r <br />lnn[ febe <br />nlorm.[low. A A <br />TYPED ~ ~~~ Ineludin[ lAe pereluir M nne.na i~npn,oemenl rnr Aneoln[ .Id.ua., Off1CfR OR AUTHORIZED AGENT CODE fVUME1ER YEAR MO DAY <br />COMMENTS AND EXPLANATION ur nnT vwL~ I Tuna /nna/anti an irracnmanr~ narar <br />_. 4HR PREt:7P EVENT IS CLAIMED. I>= CLAIM AF'PRCiVFD IiY ki4GD• <br />_ _ <br />~- ,• ~•. • SEE i. A. ~:'- t <br />,: .: - <br />EPA Form 3320-1 (Rev. 3)99) Previous editions may tx used v,~ ~ ' LIS i5 a 4-paR~ Torm PAGE - pF ' • <br />