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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different)
<br />NAME 1, r-- -'El.! t,...,._t ;r
<br />ADDRESS ED'1:? M I Wl'
<br />? Ni'<tE-RN1ESS DR I VE 1~, ST'S' 207
<br />ENOLZE-1100D CO 60112
<br />FACILITY iZ- E' NA :`i 1`, NI
<br />LOCATION £i;'F : CREEK CO 60467
<br />ATTH: EiR ENV ENGINEER
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO_, DAY Y R MO_ DAY
<br />FROM TO 1 s
<br />Form Approved.
<br />$ na£1 OMB No. 2040-0004
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<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were
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<br />TELEPHON
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<br />DATE
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<br />er my direction or supervision in accordance with a system designed
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<br />. submitted. Based on my inquiry of the person or persons who manage the system,
<br /> or those persons directly responsible for gathering the information, the information
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<br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. ^?
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<br />I am aware that there are si
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<br />false information SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />OFFICER OR AUTHORIZED AGENT
<br />AREA
<br />ODE
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<br />NUMBER
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<br />YEAR
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<br />5E ; I 'L FA 31, SC11_ I DS I --i.f. T 1~4.1. L-L Bf-' WAIVED FOR 24HR PREC I P EYEjN, ? - EE I. A. 3, PG. 4) 'FOR REQUIRE-:ME QT'S
<br />OR"1RL :' Ns""'sF'L..%1t1G s1?'ST•RUu`1 IONS - I. G. ltd, P'c,. .
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.
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