Laserfiche WebLink
PERMITTEE NAMEIADDRESS dnclude Facility vame/lucatian if Diffmnp <br />NAME <br />ADDRESS I'+1 - <br />br tj <br />CO X163` <br />FACILITY M I rl F ° , . F. X \ <br />LOCATION r:N co e. 1 <br />63e <br />anon ctrl n"ATTr7rV MAf1ILtr_'Icq <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. ZgAO-O 4- <br />DISCHARGE MONITORING REPORT (DMR) p <br />PERMIT NUMBER DISCHARGE NUMBER F I VIAL L <br />iR01NC wE T FOR 016- A/G;17A : <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO AY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br /> <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION N0 <br /> <br />. <br />FREQUENCY <br /> <br />of <br /> <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS - <br /> SAMPLE <br /> <br />MEASUREMENT ) <br /> PERMIT J <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ,T <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I crrtif,undrr pcnulty urlaw that Ibis d•wunent and all attachments were TELEPHONE DATE <br />prepared undrr n" direction or wprnision in accordance with a %%%tem designed <br />t•i assure that qualified personnel properly gather and eealuate the information <br />suhmittrd. Nosed on nn inquire of the person or persons who manage the system. <br />or those persons directly respor sihle for gathering Utr informatiop, the informatim <br />d b <br />let <br />h <br />b <br />f <br />k <br />l <br />d <br />li <br />f <br />t <br />hi <br />d <br />r, an <br />comp <br />%uhmltttd is, to t <br />rsl o <br />my <br />ni- <br />e <br />ge an <br />e <br />e <br />. <br />rue. acco <br />e <br />e. SIGNATURE, F PRINCIPAL EXECUTIVE <br /> I am aware that there are significant penalties for subrailling false Infornuttion. AREA <br />TYPED OR PRINTED including the I-ibility of fine and imprivmmem for knowing siolations. OFFICER OR AUTHORIZED AGENT E NUMBER <br />COD YEAR MO DAY <br />COMMENTS AND EXPLANATION VF ANY VIULAI IUNJ (Heference an arracnmenrs nere) <br />ZD DERIVATIONS AS "TOXICITY". RPT LOWEE <br />4AS OBSERVED USING TEST CODE "S". RP1 <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. t }