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rERMITTEE NAMEJADDRESSp~.r.~wryrv../t~.,ra~n~,.~..t1 <br />NAME L. <br />ADDRESS <br />DER CU <br />FAaurv JtdYC3 M I NF <br />L~,~ CEP. CO <br />NATIONAL /OILLrTANT Ot5CNM0E ELIMtNAT10N SY3TFlA (/NPDES) <br />DISCHARGE MONITORING REPORT (DAIIRI <br />PERMIT NUMBER otSCHMOE MUMEER <br />MONITORING PERIOD <br />YEA MO GAY. YEAR MO ' DAYS <br />FROM TO <br />Form Approved <br />'~ j ~ ~(•~ OMB No. 2040-0004 <br />(SVDi~ JC: i <br />F -- FTNAL <br />~V1..Ct-- A 3~DT PUND!GOOI` SF'GS <br />NOTE: R..d k»tructlor» b.ttx. eompbtk+p thl. tam. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOt/ENCY <br />of SAMPLE <br /> <br />TYPE <br /> AHALys+s <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT " <br />. _ ~~- <br />. _ REQUIREMENT <br /> SAMPLE <br />•` ;P>=Nr} ' MEASUREMENT <br /> <br />` PERMIT <br /> REQUIREMENT ... - t•, •, , i„ ~ - <br /> SAMPLE <br /> MEASUREMENT <br />. <br /> , , <br />. <br /> <br />- <br />-' PERMIT <br />REOUIREMENT - iZ:ar- ~ ;'`.'V'_ - .... ''1 T; 1.; <br /> SAMPLE <br />- - ' MEASUREMENT _ <br />- <br />~ <br /> <br />` - PERMIT <br />REQUIREMENT <br /> <br />1 <br />C~'),', ti':V'~ <br />r1.. -1.- <br />::~,"~• ~:_-.T `~' <br />- SAMPLE <br /> MEASUREMENT <br /> PERMIT :c,- <br />~ =' ~ <br />• <br />• ~ REQUIREMENT _ <br />- SAMPLE <br />•'' MEASUREMENT <br /> <br /> <br />- <br />-c~tT - <br />'" <br />~'' PERMIT <br />T <br />' ,, _ _ <br />,. . - - <br />_ <br />, <br />- REQUIREMEN <br />i <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />IPAL EXECUTIVE OFFICER ' Ce"'tJ " a"•'r •~ ln^t Ub dorumrnt .nd .il ^nrnwrnt~ ..en <br />i , TELEPHONE <br />ME/TITLE PRIN <br />~ DATE <br />r <br />C <br />NA <br />pnp.rtd coder rn) dlmrtbn a fuyrrH/on In ^eeord.nee wlln ^ f)•fem dd~ned / ~ ~, <br />/ <br />~ <br />L .~ / I" own Ih^1 ~u^MnW personnel VnMA7 [^Inee •nd e•da^te tM Informalo" ~ ~ <br />l ;i ~ ~ / ~ ~/ <br />~/ ~/ ~ I 1 ~ ~ <br />^eemtttee. s..e ^..~~ t~~tr, o! the penoet a persoro .no ~.n.te the e}~tetn. ~ / ~ ~ <br />, <br />~ <br />' <br />' <br />~ ~ <br />~ <br />., <br />,~ <br />. <br />. <br />~ <br />/ ( / <br />~ <br />JI .., - <br />L <br />~~ Z _r,.. <br />y o< mote peesoee dirKn~ re•peblbk ro. i.tnen"~ lne lnfornuuon, the fnr"en..tton ~ •~j <br />_ I. „ , , <br /> <br />• <br />L <br />~ - fubenttted b, to the eetrt or m~ tnew4dEe nd seller. troe. ^ccunte..rd compMe. ~ / L~ ~ / -' ~ U <br />~t ~- / , ~ ~ F f ..' ~.^• ~ <br />t tn <br />y <br />nln <br />l <br />i <br />s <br />tIONATVRE OF -RINCMAL EXECUTIVE <br />t" ~ ~`- ~ `" ~ t <br />A <br />Po <br />r <br />n <br />r <br />b /. <br />- <br /> E <br />e.n <br />pen. <br />.~ ^.^n t <br />• <br />err .n <br />tle <br />r w, <br />m <br />t <br />n~ <br />• <br />e lnrornutbn, <br />TYPED ~ PRINTt~ t~+wt"~tn^~tetuy.rn.~..et",pn..,,~"tra-~-t"~.+a,u~ OFFICEII OII AIIfHORIZED AGENT ~ppE NuMeER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fR./.r.nc• wM.rMchm.nr~ h.r•J ~4HR pREC I R ~ VEl~IT I5 C;_A IMED. I F CLAIM ~f'PRClV1`D Ey LlQC?~. <br />; ;.,F _ ;rr - _ _ .-~ ~ ~ 3 - - -.fir,.; -•- t: ,r.. <br />EPA Form 3320-1 (Rev. 31991 Previous edidons maybe used. - '~'js~=a =~'n (p{Ip, PAGE bF <br />