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PERMITTEE NAME/ADDRESS (Include Fac(Grr .Nana/Locarion ijD(ffrrartl <br />NAME <br />ADDRESS <br />J. BCIX 673 <br />.•'{DFN CO 8263 <br />FACILITY -"JEC.A rv!INE COMPLEX <br />LOCATION . rrDEN CO 8163 <br />')Y KARL, RECI..AMATTT]N MANAGER <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 Y R MO DAY <br />FROM TO <br />Form Appyved. 0 <br />MINOR OMB No. 2040-0004 <br />(SUBR .JC ) <br />F - FINAL RLJU <br />USCHO TU TRID/GRASSY CREEK <br />NOTE; Read Instructions before comoletina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />X OF <br />TYPE <br /> E ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />L <br /> MEASUREMENT w <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />1 /`. <br /> MEASUREMENT ?) <br /> PERMIT <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ccrtif., undo penult) of law that IN, d.a,tment and all attachment. were <br />ar <br />d undrr mt di <br />f <br />ti <br />i <br />i <br />i <br />d <br />ith <br />d <br />i <br />d TELEPHONE DATE <br /> s <br />prrp <br />a <br />rec <br />n acrof <br />ance w <br />on., wpen <br />wn <br />a c,, <br />em <br />rs <br />goe <br /> to assure that qualiricd per> mna properly gatber and esaluate the information % <br /> submitted. Ruled on my inyuin of the lxrwn ar rwr,ms who manage thr %?%trm. <br />" <br /> ur lh,wr wmons dir <br />i rmp,nsiblr fur gathering the intinmatim. the inr'u-mation <br />L <br /> submintd I,., d, the be t or m? knowledge and belief, true, accurate, and vrmplete. 1 ? <br /> I am aware that there arc significant prnalties for wbmitting false information SIGNATU E OF PRINCIPAL EXECUTIVE . <br />TYPED OR PRINTED , <br />including the possihilits a nne and impri nnment for knowing sialation., OFFICAR OR AUTHORIZED AGENT AREE NUMBER YEAR MO DAY <br />Vvnmre t• r.a e+nv ear ertnn r Iva s?r s?. ? .wer. r w,w lnerer erwe au auat,rwnenw nme/ <br />:OFD Tn REOIJEST A REASONABLE POTENTIAL ANALYSTS BE <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used This is a 4+aff6mi. PAGE OF