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PERMITTEE NAME/ADDRESS rlncludr Facility.V'ameflaation if Diffnentl <br />NAME : T tVr3 <br />ADDRESS <br />?tRl`iESS DR;.VE E-, STE 207 <br />_v,IOC1D CO 801 12 <br />FACILITY Fill I NE <br />LOCATION CREEK r-'O 80467 <br />_',/E LEACH, SR ENV ENGINEER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />M 11-1[) <br />( SIIB I,: <br />F -- F I NAL_ ROW <br />L5(,-HG TO KOLL DTGH#3%TRCliT CRK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REPORT <br /> REQUIREMENT DA I L1' MX ANN giA <br /> SAMPLE <br />?' <br />, / <br />?` <br />?` ` <br />f?'?P <br />( <br /> MEASUREMENT •- -r <br /> PERMIT H. A <br /> REQUIREMENT 1A <br /> SAMPLE <br />REMENT <br />ME <br />S <br />- <br />Z <br />J i <br />!I <br />` <br />=nA <br /> A <br />U . <br />• . <br /> PERMIT ' <br /> REQUIREMENT DF: T. t- Y N a: : Jt; <br /> SAMPLE I J < 1 <br /> MEASUREMENT <br /> PERMIT 4,1 *it i1- <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif. under penalh of law that thiv document and all atlachmenls were <br />ti <br />with <br />. <br />d <br />si <br />d <br />d <br />d <br />di <br />Wo <br />i <br />d <br />t r TELEPHONE DATE <br /> prepare <br />un <br />er my <br />rec <br />on or supe" <br />n <br />n accor <br />ance <br />a <br />s <br />em <br />e <br />gne <br />to assure that grulified per.,mnet pr„ perh gather and evaluate the information ?- <br />L <br />? h <br />i <br />l <br />l <br />N <br />d <br />i <br />i <br />d th <br />h <br />th <br />.- vu <br />e person or perwnv w <br />e system, <br />m <br />t <br />ee <br />. <br />wse <br />on m} <br />nqu <br />re , <br />o menage <br /> or thow• persom dirrcth r-p,mvlMe for gathering the information, the inforenalMn 7 <br /> submitted is, to the best ,.f in knowledge and belief, true. uccurale. and complete - <br /> th <br />t th <br />i <br />t <br />h <br />ilti <br />ls <br />i <br />ti <br />I <br />ifi <br />lti <br />f <br />f <br />f SIGNATURE OF PRINCIPAL EXECUTIVE " <br /> <br />TYPED OR PRINTED am aware <br />ere are s <br />can <br />pena <br />es <br />or u <br />m <br />ng <br />e <br />n <br />orma <br />on. <br />a <br />gn <br />a <br />including the pn.sibilio of rue and impris,mnu•nt for knowing •h,latiom <br />OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />?arE firm. <br />EPA Form 3320-1 (Rev. 3to) Previous edi ions may be used. ._` 10'14 ! {?°i % is a4-