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PERMITTEE NAME/ADDRESS rlnchak Facilirr .'Yamo11-arion if'Npr1•ier1 NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />LL. y MONITORING PERIOD <br />FACILITY C F1 I.' , ?I-; 1= `r r YEAR MO DAY YEAR MO. I DAY <br />LOCATION ZIE.N CO 13I f: FROM TO <br />u.A;?n. RPCt.AMATTCIN MANAC <br />Form Approved <br />OMB No. &2WOAA <br />MI NI-';R <br />(SUBR _ <br />F - FINAL ROU <br />[?SCHG TO TRIB/GRASSY CR EK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT , L/ <br /> PERMIT .. , <br /> REQUIREMENT A <br /> SAMPLE <br /> MEASUREMENT l C <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />, <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br />i <br /> <br /> PERMIT <br /> REQUIREMENT I <br /> SAMPLE <br />I <br />I <br /> <br />i <br /> <br />I <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />n " <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT F. <br /> SAMPLE <br />V <br />, <br /> MEASUREMENT I I., <br /> PERMIT _ _.. <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 -mfg under penalts orlaw that Chit document and all attachment, were <br />prepared under m) direction or su <br />ervisirm in accordance with a system desi <br />ned TELEPHONE DATE <br /> p <br />g <br />to assure Ihat qualifled personnel properit gather and evaluate [be information <br /> submitted. Based on mt inquin of the person or persons who manage the %% stem. <br /> or these persons direclll resportsible fnr gathering the information, the Information I <br /> submitted Is, to the best of ms knowledge and belief. true, accurate. and complete. <br />I am aware that there are si <br />nificant <br />naltie <br />for submittin <br />ls <br />f <br />inf <br />rmati SIGNAT RE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED g <br />pe <br />s <br />g <br />a <br />e <br />o <br />on. <br />including the poWbilitl of fine and imprisonment for knowing tidadoms. <br />OFF ER OR AUTHORIZED AGENT AREA <br />D NUMBER <br />YEAR <br />MO <br />DAY <br />UUMML141 D ANIJ CArLANA I Ivn Ur' AN T <br />Irrewence an anacnmenfs nere/ <br />EPA Form 3320-1 (Rev. 31N) Previous edtiotu may be used. - `- ' •' TIt15 is a 4-pail fOi1Tt.