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PERMITTEE NAME/ADDRESS'Include Far&f-y Namdlocation if Uifferem) <br />NAME <br />ADDRESS , . _ . .. . _ ... <br />BOX o70 <br />i?1~N CO 81639 <br />FACILITY E CA MT NE COMPLEX <br />LOCATION ,_ I_ N 170 81 639 <br />? KARR. RFrI AMATTnN MANAnFR <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 AppAved. • <br />OMB No. 20400004 <br />F - FII <br />D15CHA1 <br />NOTF• Rtaart Inctritrtinnc hafnrn rmmrlatinn Hsic form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT ( / <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEAS <br />T <br /> UREMEN <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE / <br /> MEASUREMENT I Cr <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 /> <br /> PERMIT - .. t - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT , i <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of taw that this document and all attachments were r TELEPHONE <br /> <br />prepared under m% direction or super%Nion In accordance with a sygem deeigned DATE <br /> to msvre that quaiified pemnnel properly gather and esaluate the Information <br /> submitted. Based on m} inquire of the per on or per,o s who manage the system, 1 <br /> or those persons dimctl% responsible for gathering the information. the information , <br /> submitted is, to the hot of my knowledge and belief, true,,wvurate, and complete. <br />I am awar <br />that th <br />are si <br />r <br />nirw <br />l <br />lti <br />f <br />b <br />i <br />i <br />r <br />i <br />i <br />h <br />SIGNATU E OF PRINCIPAL EXECUTIVE I <br />1 J <br />TYPED OR PRINTED <br />rsniaaaCA1TC Akin CYDI ANATInN nC ArJV Vint g <br />e <br />e <br />" <br />pena <br />e <br />es <br />or su <br />m <br />tt <br />a <br />,rmatlnn. <br />ng <br />n <br />n <br />including the possibility of rine and imprisonment for knowing siolations. <br />A r r%&10 /O s r1 _ OFFIC R OR AUTHORIZED AGENT <br />, AREA NUMBER <br />C l <br />DE YEAR MO DAY <br />AFTER COLLECTION OF 12 SAMPL: <br />PERFORMED. <br />EPA Form 33201 (Rev. 3199) Previous editions may be used. )0205?