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NAME <br />ADDRESS OF <br />FACILITY <br />LOCATION_ <br />cif <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> NO FREQU SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <br /> TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />s F --j l- REQUIREMENT <br /> <br />,, `,. SAMPLE <br />`? <br />15p <br />r MEASUREMENT <br />L <br />; <br />E <br /> PERMIT :. <br />r , ; yt ,• - :-. REQUIREMENT <br /> SAMPLE = <br /> MEASUREMENT <br /> PERMIT - i t'ht <br />• -: - i REQUIREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />i PERMIT ' . <br />.-I t ,.: r I , r • REQUIREMENT ?.:. _ <br /> SAMPLE J <br /> MEASUREMENT <br /> PERMIT - 1j': ( -?a =iir.'•,? <br />• REQUIREMENT <br />r t <br /> SAMPLE <br />. <br />- <br />:; 1_ _ MEASUREMENT <br />F <br />• PERMIT <br />_-T- - REQUIREMENT <br />NA!YlifiTLE PRINCIPAL EXECUTIVE OFFICER I ccnifv under penalty of law that this document and all attachment, were A I/ <br />K TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a system designed Gj t S? <br />O <br /> to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Based on my inquiry of the person or per oms who manage the system. <br />the information <br />onmblc for gathering the information <br />erstms directl <br />o <br />those <br />rt? 1 t _ <br /> , <br />p <br />r <br />p <br />y <br />nd <br />m <br />lete <br />d <br />d b <br />li <br />f* <br />w <br />t <br />b <br />f <br />l 7 p <br />970 929-5855 <br />2008 <br />07 <br />07 <br />AMES T COOPER PRESIDENT e, a <br />co <br />p <br />my know <br />ge an <br />e <br />e <br />. <br />e.accura <br />submitted is. to the <br />ast o <br />e SIGNATURE OFPRINC AL EXECUTIVE <br /> I am aware that there arc significant penalties for submitting false information, OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED mcluding the pcres;Wity e•f tine and empnsonment for knowing violations. CODE <br />GUMMtNIJ ANU r-AMLArvAIIVM Vr mill, •ow- <br />_TPt.'Ti: <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. <br />-24-HP. PRI <br />Form Approved. <br />OMB No. 2040-0004 <br />I NOR <br />?I_I[3R NH i <br />- FINk" DEL ifs <br />UCZID'-t?' P CiN'T i W! N l !7sR i i;UNN 150IN <br />xxxx <br />NOTE: Read Instructions before completing this form. <br />ENCY <br />J" is a 4 -pas form. PAGE OF <br />tGCr i i _