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PERMITTEE NAME/ADDRESSp~.rL/rirrbgN../terwrenl/D~r..ty) <br />NAME .~ , <br />ADDRESS _ ._ `~i _~ . .... <br />;. BOX 4f~~ '.f <br />~INIA CO 81428 <br />FACarTY i I E NO . _' Pi I NE <br />LocAraN ",NIA C d X11428 <br />- I f ANI A R FAR . 1R M T tVF Mr~R <br />NATiONA1 POIItJTANT dSCMAROE ELIMINATION SYSTEM /rNPDESI <br />DISCHARGE MONITORING REPORT fOMR) <br />PERMIT NUMBER dscr+AnoE NuMeEn <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. 2040-0004 <br />M z tv ._. ~; <br />c suer .. <br />F - FINAL ~-- I A <br />5R; n~ER TRL DTC L1R UIVt~!!~ -iRip;~~ t <br />.' . <br />NOTE: Reed k»ttuedoer b./otrr. eompMtlnq thb fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FnEOUEtrcr <br />of SAMPLE <br /> <br />TYPE <br /> ,yr~Y~s <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />• .. AN ~~ SAMPLE ' <br />AL MEASUREMENT - <br /> , <br />;~ 1 C~ PERMIT :~ !t#?t~,. ° ~,.. r <br />. <br />r- ~UFt~JY ~RQS REQUIREMENT ~ ,.,..•, T <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 /> MEASUREIv7ENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br /> <br />NAME/TITIE PRINCIPAL EXECUTIVE OFFICER ' ""'" " " a""r ° 1.. IAN Ub dar°mem •nd •Y Nt•chmenb .ere <br />TELEPHONE <br />DATE <br />prepared under tnr dlrettbn a wprMflow In •cc°rd•nce trltA • sfstrm ddEned <br />le •>dure I1tN qu•Mned perwnnel properl7 (Nher ^nd r•Je•le 1M In(ernulbn <br />wrErrdtted. S•wd en mr Inqulrr or ute perwn a persdu wAo tmn•te tM r(s(ern, <br />a I~e•e penanf dlrertir respeMEk ra EatAer/n~ tAe Infornullow, IAe Infaem•lbn ~ - <br />7tlEmllled la. to the Eeft N m7 Lnewledp and AtMe(, tr.e, •ccvrsle. and complete. - <br />iIONATVRE OF MINCI-AL EXECUTIVE ~,. <br /> 1 •m •.•re YtN tAere are flEdnont pen•ItMs for wAmltnn~ r•1+e In(entutlen, <br />TYPED ~ PRIPITED IndudlrK tAe podDlNtr e(flne and ImprNenmenl fa knoulnE •IN•Uott- OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRS/~r~nctr ~N •tt~chmtrnts h~r~l <br />.: {;~- -. ~'~, c ~ T.,,cn rr tit ATM r.!»~iQVnErD LiY 1.,!~^.^)7. <br />_ ,. PAGE OF <br />I=PA Form 3320-1 ~ Rev 3/99) Previous editions may tre used TIIIS.IS a 4-peR COfITI. <br />