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PERMITTEENAME%ADDRESS,b::iud Fw•ilin•.VwteJLlKarluniJUif)in•nlo <br />NAME - <br />ADDRESS ss• L C LaADOUT <br />t40 BI-)wAE ROAD <br />- 71VIA <br />FACILITY R`1R r --?I_EK LC}: D01 IT <br />LOCATION ^ NIA <br />} <br />Co <br />,MP4,; ? rnflPF R. i,R1=S7 >7FP <br />Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) form 20400.- <br />OMB N Noo. . 200004 <br />DISCHARGE MONITORING REPORT (DMR) '40R <br />ti <br />_iOR 111H, <br />PERMIT NUMBER DISCHARGE NUMBER -- FINAL DELTA <br />MONITORING PERIOD IsUGOLIT POND TO N FORK GUNNISON <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ; <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE -s _ -. <br /> MEASUREMENT <br /> PERMIT r47,? -r ;i k ##iE#iFsE REPCr>? REF" i>- ITRLY rRAi, <br /> REQUIREMENT r . 30DF+ :, DAILY L. <br /> SAMPLE r t 94) <br /> MEASUREMENT <br />'• + PERMIT it# ### REPORT Y _S=1 ###It#k -?####?t ###IE? r x try ? r EKLY IS ! . <br />r. REQUIREMENT I NST MAX J= C ?ry •r <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 certify under penally of la, that tius Jrwtunenl :utd all ata. hments were <br />' <br />-i <br />i <br />d <br />d <br />d TELEPHONE DATE <br /> direetimi or supra <br />slon <br />n accor <br />ance with a system <br />esibme <br />Prepared under nn <br /> to assure that qualified perwnnei properly gather and evaltute the informmton <br /> submitted Based on my tnquiry of the perwn or pawns who manage the system, <br /> or those persons directly responsible for gathenng the intormanon, the information <br />r. _ ! l j <br />/?? ^ T submnr d is, to the hat of my know Wge and brhef, true. accurate, and am,plete <br /> <br />ubmittin <br />I am aw <br />r <br />that th <br />w <br />re <br />nific <br />nt <br />naltie <br />f <br />r <br />f <br />lse informati <br />n <br />SMGNATURE OF PRINCIPAL ECUTIVE } 7 <br /> <br />TYPED OR PRINTED a <br />e <br />e <br />a <br />sig <br />a <br />pe <br />s <br />o <br />s <br />g <br />a <br />o <br />. <br />includin <br />the <br />of tine and tm <br />nmtcnt for know me einlations <br />os <br />,b,ht <br />ris ` <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER I <br />YEAR <br />MO <br />DAY <br /> g <br />y <br />p <br />s <br />p <br />s CODE <br />I.UIVIMCrv IJ MIYU 1-Ar LM11M 11 V11 Vr M19T V I UlM 111.!1-4.7 In Olaf at 1L.W all al la t: II II ICI Ira, I1wral <br />rr 24-'riR PRECIP E%1FNT IS CLAIMED. EXEMPTIONS FROM <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used.OIII1. PAGE OF <br />r .a.4• aq