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PERMITTEE NAME/ADDRESS !include £aei&jr A'amelLocadon if Differenn <br />NAME <br />ADDRESS _ <br />)? ?2 <br />C0 474 <br />FACILITY e1GR ZOT?1 { i 7 fF <br />LOCATION i_A co 314214 <br />1 Al.lr-L" 1.1Ar. MTNIC MAAIAr-11=f7 <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 />Form Approved. <br />OMB No. 2040.0004 <br />M I P40R <br />(S(JBR MH <br />F - FINAL. MNTR5 <br />SR":J1Tl\IF ;.?...I' ! R T8 Tr-1 F" i. .; 1 .._ OR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO FREQUENCY <br />OF SAMPLE <br /> EX YSIS <br />NA TYPE <br /> A <br />L <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />i <br /> <br /> MEASUREMENT <br /> PERMIT ..:?T <br /> REQUIREMENT AV.-7 L_Y 1.1 <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT x ;f :... ;=1 PC`i s <br /> REQUIREMENT ; U;a I L_Y M <br /> <br /> SAMPLE <br /> MEASUREMENT I <br /> PERMIT R i ' - S., <br /> REQUIREMENT ?tvLr ` F <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />J <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penally or law that lhi• dmument and all attachments were TELEPHONE DATE <br />Prepared under my dira•tiun or supervision in accurdaue with a system designed <br />n, assure that qualified pononnel properly Rather and evaluate the information - <br />_ submitted. Ila," on my inquin of live person or Persons who manage the sy%tem. <br />or those persons directly responsihla for gathering the information, the information <br />_ suhm;tled K. to the best of my knowledge and belief. true. uccurale. and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that there are significant penalties for submitting false information. <br />AGENT <br />TH <br />I AREA <br /> ri onment for knowing violations <br />nd im <br />ibilit <br />rri <br />l <br />di <br />th OR <br />ZED <br />OFFICER OR AU D NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />p <br />y o <br />oe a <br />inc <br />u <br />e poss <br />ng <br />GUMMtN I A ANU tAMLANA I RJIY vr• ~4w v1vLM u uv- Incrc.c....c on w.-..... c...- ......y <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. i i i s is a 4-1): trt 101!1;