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PERMITTEE NAME/ADDRESS andnde Foriuly ,Yamdiaeatinn iJDif(erenr, NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME 111„,r,; , DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS .,-4L C iJMP L <br />670 PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY L ;V A L, : COPIPL,.Ey MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />LOCATION DEN CO L 1 i FROM TO <br />-Y, v-,%P 1. Prri &MATTnN MANAO-F <br />Form Approved. <br />OMB No. 3P40,0004. <br />MINOR <br />(SUBR •JC <br />F - FINAL. FtOU <br />DISCHAR'-' i(t ' LlDD?r' : l:•.i "'. ! ti1N.t <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 /> <br /> MEASUREMENT r <br /> PERMIT <br /> REQUIREMENT <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif. andyr I rn,,u .d tae that Ihis document and all attachments were <br />i <br />i <br />d <br />h <br />d <br />i <br />d <br />o TELEPHONE DATE <br /> prepared muter nn dimcu <br />rte or superv <br />sion <br />n uccor <br />anco ott <br />a ystem <br />es <br />gne t <br /> to aswre that qualified pemtrinel properly gather and erah,ate the information <br /> submitted. Rased on m? inqui" of the person or prrsons who manage the y?strm. - <br /> or tho.c persons directli responsible rot gathering the inrormafion. the inrormation , <br /> whmllled is. to the "of m% knowledge and holier, true. avrurate. and compleles SIG TUBE OF PRINCIPAL EXECUTIVE .? " - <br /> I am a%jem that there arc significant penalties For submitting falu Information. <br />I <br />NT <br />FI <br />AU <br />H <br />G AREA <br />TYPED OR PRINTED including the po..ibilio of fine and impri onment for kn-ing violations. <br />CER OR <br />T <br />OR <br />ZED A <br />E <br />2t <br />NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />GUMMtN I b ANU tAI'LANA I IUN OF ANT VIULA I IUIVD (etererence an aftacnmenls nere/ <br />P EVENTi -fSS, <br />PROOF" IN I. A. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 4 5`15- ' Thi%! k4 d. 4-part form.