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PERMITTEE NAMEIADDRESS 0.. b&ForWryNawa/Locedon(/DdWv-# <br />NAME <br />ADDRESS Dl--AN 1"Y2. 3 i i.S )EKE. <br />P. 23. EI Vii, '!:`, Is <br />FACILITY EF.-t , I'IC. w> 11 EdL <br />LOCATXNdC;O 'IER9F- T CO 01434 <br />ATTN: LO*IILL.. E. BEAR, PRY=S11DE-1 T <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPDESI <br />DISCHARGE MONITORING REPORT IDMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM k0til v1 v TO c-rw•t V -Ntj <br />Form Approved. <br />OMB No. 2040-0004 <br />SUBR rH ) <br />F -- FINAL GuN i s <br />t NO DISCHARGE I I <br />NOTE: Read Instructlom before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> ANALYSIS <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ft,- #k{3c xi fE4# ##?ftk#if l ,'fir ) <br />I <br />? <br /> MEASUREMENT ?, 3 I ll iy1 <br />'; ='•!YkJ t O O PERMIT <br />F 3E 'i GROSS tvlS°IL 1 itEnuIREMENT SU <br />?_. I 1-155.a TOTa ;L- SAMPLE ?•;; .;; ;: w :. ::?F _ ..i::..... 4 1 ? i <br />L=PEis3))E; MEASUREMENT <br /> ERMI1.' i s t <br />- <br />- <br />?:E FL GJEPTi?G?? 4??t1_LI R EQUIREMENT @8$:•## - <br />_ _. - <br />r. •.#?'._ '.` ??. ?n <br />1 tL9i n - <br />-:fig <br />i ;) i 3 i rf L SAMPLE fi t a' ? ti ti :: t<?,' le i I: i ?2tj ? <br />FE) MEASUREMENT o u 2 <br />6- <br /> 7 <br /> <br />EFFLUENT GROSS VALUE R..4QUIREMENT- <br />' ## ±dc ?_ ? _., ??.' VG/L 1r-ir . <br />I l bPiN .) i-, E-AtSE SAMPLE {: tii#r i ii tft?ii c k i b'.k «: =tic tie i, ! I <br /> MEASUREMENT <br />?. <br />"?;n d ' • <br />PERMIT <br />. , t ; ?: a <br />-?. ?.. f;- ?- <br /># ,•: <br />_ .._ <br />a, . ,. , •,<• <br />w <br />_, ... , <br />EFFLUENT taRC3S ti' ;L $De RE?lUIREMENT< tr# i°r# its./ ? _6; <br />-17LOW? IN ;.OUNrI,,1? ( OR SAMPLE ?: O'er 3 ? a?5#ii r f+9 ?#i a# # Ys Pesr? #i <br />`7NRQ TREATMENT PL_APTI MEASUREMENT //7 <br />3 ] O O PERMIT -'- i=mot C _ J l <br />wFFLI_JENT GROSS VAL Uff REOUIREMENF i #ti1QD IrK#i_ ii <br />J%Ii LT11Sr TOTAL SAMPLE k i ifYi#i ti :;•?;i i? I f: {r• # v <br />0I SSOL VED MEASUREMENT <br />?'O2 9-55 _ 0 5 PERMIT 4,? ? ?? o-7: -'?:? } ? s •?•?_ ti `r".'f: f ?};tit_. ? a?. <br />; F) GJ ?i'T GROSS VAL Ul REOUIREMEN7 <br />s=}3t.#i' . i-?i`} <br />,31L SAMPLE i• r ?: i k b v2 I. 1z i :E 3i 6: 3r •_; r x : is sx <br />. <br />V I S UAL MEASUREMENT <br />?R;} 5 {} r PERMIT •< <br />7 " y=:I ?.. - :?t _ ,. <br />+`=!` L JENTRCS i! AI_GJk REQUIREMENT <br />-7 <br />PdO=t°1 <br />### <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER t cenny u ar pena q o law that this document and all altaehmenU were TELEPHONE DATE <br /> prepared under my direction or supervlslon in accordance with a system designed <br /> to assure that qualified personnel properly gather and evaluate the Information <br /> submitted. Based on my inquiry of the person or persons who manage the system, <br /> or those person directly responsible for gathering the Information, the information <br />?/ <br />8 Pa <br />submNted 1% to the best of my knowledge and belief, true, accurate, and complete. <br />1 am aware that there are significant penalties for submittin <br />false Information <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />V <br /> <br />V <br /> <br />f <br /> g <br />, <br />TYPED OR PRINTED Including the possibility of fine and Imprisonment for knowing vidaUons. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EArl-AIvA I Ivn yr An v --pt 1 lvr m pfarsrencs sit errounmenra nerei <br />D F i W EA S E yyttREF ]D 7 I. f1 ?- EE 3. `L . A, 30 CA Y AVERAGE IS P I I ?`I?i? 'SY I`?[i`?.lTt 'L-W AVERAGE DURING FR I DD RE1='OIRI"`? D, <br />,S SEE 1. EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. (Ji' `'. /y=; '' ,This;;is'8:4-pAR form. PAGE OF <br />