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PERMITTEE NAME/ADDRESS iinciudo, F•ariHn•.Naw1bicarion if fhfferent) <br />NAME <br />ADDRESS - <br />,X 670 <br />`0 81639 <br />FACILITY L-; ri F}jpi. t ii 1f') ?} <br />LOCATION _•D EN CO 81639 <br />,w v.ARn. RFC7L AMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR O DAY <br />FROM TO <br />Form Approved <br />OMB No. ?liao• € 1+ <br />E,oLrT-T , <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br /> <br />OF <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT J <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT x' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ry <br /> REQUIREMENT <br /> SAMPLE <br />;n _ MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMENITLE PRINCIPAL EXECUTIVE OFFICER I n•rtir? under prnatq of Is% that this durument and all attachments were <br />i <br />d <br />h <br />d <br />i <br />d TELEPHONE DATE <br /> I porW under m} direction ur supershion <br />n occor <br />ance wit <br />a system <br />es <br />gne <br /> to assure that qualified personttel properly Rather and evaluate the information <br /> submitted. Hand an my inquin of the person or persona who manage the system, C_ r <br /> or Ihosr persons direcll) responsible for gathering the information, the information <br /> submitted is. to the best of my knowledge and brlief. rate, accurate. and complete. SIGNATUR F PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I nth aware that there are significant prnallin for suhmilting raise informatmn. <br />imiuding the Ixrssibillfp of fine and impri onment for knowing %NAatione. <br />OFFICE OR AUTHORIZED AGENT AREA <br />NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />COMMEN15 ANU LAYL.ANAIIVN Ur ANT VIVLAIIUNZo Irfererence au artacnmenfs nerep <br /> <br />A DERIVATIONS AS "TOXICITY". RPT LM <br />4S OBSERVED USING TEST CODE "So' RPT <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. ?C This is a 4-part?fdrm.