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PERMITTEE NAME/ADDRESS flnclude Farilur NameAncafian if Diffrrenn <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />CO 8I42e <br />vTrF PRFC; <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DA R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />M I PAUK <br />(SUBR MK) <br />F - F I (qAL- <br />MW TO UNNEID TRIO TO <br />Form Approved- <br />OMB No. 2040.0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> 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 /> MEASUREMENT <br /> PERMIT c- +: r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t certify under penulth of law that this document and all atuehments were TELEPHONE DATE <br /> prepared under my direction or supersisiun in Aa•ardaoce with a -leak designed <br /> to unsure that yualifkd persrmnel pr.perlf gather and evaluate the information <br /> submitted. Barad rm me inyuin of the pe"m or perwns who manage the %%stem. <br /> or tb,- pro- dira+li? respmvihie for gathering the information. the information -- - <br /> suhmitted h, to the hest of m) knowledge and belief. Irue. accuraw and aanpiete. SIGNATURE OF PRINCIPAL EXECUTIVE - - <br />- <br />TYPED OR PRINTED <br />I t am aware thus tlmrr am significant penuttiv% for vuhmitting false inrormation. <br />including the p,sihdit. of fine And imprtsrnmtent for knowing violations. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />GUMMtN I S ANU tANLANA I IUN Ur AN T VIULA I IUN2) (reference all auaeumenta ner e/ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This i5 a 4-part form.