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PERMITTEE NAME/ADDRESS rlnclude Facility Namell oration if Dtffeanf) <br />NAME <br />ADDRESS r <br />BOX 670 <br />DEN . O 81639 <br />FACILITY F'--A hJjr.%E COMPLEX <br />LOCATION DEN CO 87.639 <br />Y KARO. RECLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No.4040-0004A <br />MINOR <br />(SUBR Jr-) <br />F FINAL ROU <br />DSCHC TO TRIB/DRY CREEK <br />NOTE: Read Instructions before comoletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />( <br /> MEASUREMENT - `• ( 7 <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT {^-A <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of 1- that thi%document and all altachmenh were TELEPHONE DATE <br /> prepared under my direction or sup r%ision in accordame with a system designed <br /> to assure that qualified personnel properly gather and esaluate the information <br /> submitted. Based on my inquiry of the pemm or persons who manage the system, <br />or those perwny dirndl resporssibie for gathering the Information, the information _ <br /> submitted is, to the best of my knowledge and belief. true, accurate. and complete. <br />I am aware that there are signifIcant penalties for submitting false mfnrnuuion <br />SIGNATURE OF PRINCIPAL EXECUTIVE i <br />•1 - I <br />TYPED OR PRINTED . <br />including the Possibility of fine and imprisonment for knowing siolrtiun, OF CER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />%,UMMC1q 10 AIYV CAr'lA1gA I IU1Y Ur A1gT v1ULAa 1Uriz frieferenre air arracnments norW <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ?IDS ',` INS is a 4-Part form.