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PEHMIIIEE NAME;ADDRESS <br />NAME <br />14'. <br />ADDRESS _i "I I NE <br />t ! i"'f ROAD 65 <br />. O 8164e <br />FACILITY Dial i'1II'4E <br />LOCATION , Y co 81648 <br />--i Ti i F:?3n. i41 i it1- MANAf=F14 <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 /> <br />- FINAL ROL.AN <br />5-1 SLUT STORAGE TO RED WASH <br />K! <br />NOTE: Read Instructions before comoletina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - w I C F_ r' 1 r4S I T! <br />Tr t .• -. ,.JI- REQUIREMENT ;., - i^!=`?ITF! <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT n <br /> REQUIREMENT i lUh•l i i` <br />R, !' SAMPLE <br />-- MEASUREMENT <br /> PERMIT :ri' t. t? s: <br /> REQUIREMENT :?[ (., r: c? <br />i SAMPLE <br /> MEASUREMENT <br />_ PERMIT 0F: i rv? -zN AT' <br />F REQUIREMENT :, IN T <br /> SAMPLE LID <br /> MEASUREMENT <br /> PERMIT r ;l`;'.. <br /> REQUIREMENT Mt. t , i <br /> SAMPLE <br />+F;- MEASUREMENT <br /> PERMIT ; .- 7 EFORT REPORT <br /> REQUIREMENT GRTR AVG U+,iLY . <br />NAMEJTITLE PRINCIPAL EXECUTIVE OFFICER ertify under penalty of lase that this document and all attachments were TELEPHONE DATE <br /> prepared under my direction or supers tston to accordance with a system designed <br />to assure that qualified potwrtnel properly gather and evaluate the information <br />- <br /> ?j <br /> submitted Based on my inquiry of the person or persons who manage the system. <br /> or those persona diractfy responsible for gathering the information, the information <br />?I { t j W the best of my knowledge and belief <br />and complclc <br />submiUed is <br />true <br />acettrme w <br />= ' '- f ' ^ ` ` ± t <br /> . <br />, <br />, <br />, <br />n a <br />a <br />e th <br />t th <br />r <br />are <br />n <br />fica <br />ln <br />f <br />r <br />bmitt <br />ls <br />i <br />t,,m <br />t! <br />I <br />i <br />t <br />f SIGNATURE OF PRINCIPAL EXECUTIVE f <br />/ <br /> <br />TYPED I* PRINTED w <br />e <br />g <br />ing <br />a <br />ta <br />,m. <br />at <br />r <br />a <br />e <br />s <br />i <br />n <br />pena <br />es <br />o <br />su <br />e <br />n <br />b <br />t <br />f fi <br />i <br />I <br />l <br />di <br />th <br />l <br />d <br />t fo <br />k <br />l OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> ng <br />e possi <br />i <br />y o <br />sonmen <br />nowing %- <br />ion, <br />inc <br />u <br />i <br />ne an <br />impr <br />r <br />a CODE <br />I..UMMtN IJ ANtJ MAVLANAI IUN Ur ANT vIVLAI IVrVA Irreverence art <br />menrs nere/ <br />,R PREC IF <br />SAMPLINC <br />)R R1 <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. _)01 712 This is a 4 -part form.