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PERMITTEE NAME/ADDRESS ?Incwr Facx6y.'1•amelLocatian iJDIJJaratl <br />NAME <br />ADDRESS c. <br />bux. 670 <br />DEN 8163 <br />FACILITY 1ECA Ml!-JE COMPLEX <br />LOCATION DEN CO 8163 <br />{ KARO, RECLAMATION 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 MO DAY <br />FROM TO <br />1 <br />Form Approves <br />OMB No. 2040-0r4 , <br />M I NOR <br />(SUSR <br />IF - FINAL ROU i'7 <br />D5CHG TO TRID/GRASSY CREEK( <br />NOTE: Read Instructions before comoletina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT 1 j r.\ <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEAS <br /> UREMENT l <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ` <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT I` 1 <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br /> SAMPLE <br />I <br /> MEASUREMENT y ' tti, <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalt.t of law that tbi+document and all attachments were <br />d <br />d <br />di <br />ti <br />i <br />i <br />i <br />h TELEPHONE DATE <br />?r1f? Jones <br />e prepare <br />un <br />er m% <br />rec <br />on or superv <br />on <br />s <br />n accordance wit <br />a system designed - <br />t N nv to acwre that qualified personnel proper1% gather and esWuate the information <br />/ <br />I <br />(? <br />Ha>yr?N logi l I <br />lTtt s?++^^?a <br />)? submitted. Based on ms inquiry of the pe-n or perams who munaW the sy+lem. ?` <br />? <br />/ <br />\ <br />?0 <br />. or those loom. dirtcd% responsible for Katherina; the information, the Information ? (?- 7 <br />(970)27C)-S? 09 submitted is, to the bw•sl of nuts knowledge and belief. true, accurate. and aumplete. <br /> <br />I am aware that there are significant penalties for submitting false Information SIGNATURE OF PRIN IPAL EXECUTIVE <br /> <br />TYPED OR PRINTED . <br />ncluding the possibility or fine and imprisonment for knowing+iobaiiuns. <br />OFFICER OR AU ORIZED AGENT <br />AREA NUMBER <br />YEAR <br />MO <br />DAY <br />t,UMMCpr b J ANN r-ArLArIA I IUrv Ur Alv T V IULA I FUIVa Inererence air airacnmenrs nere/ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used 11his is d 4-patY form. PAGE OF