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PERMITTEE NAMElADDRESS,lrr, Lair l a, ilia Nama•tocurion it Ui//emntr <br />NAME <br />ADDRESS DOU T <br />+i•'?T SPR I NG-i tJ <br />FACILITY GIA-C•rq (. UAD-1,JIJT <br />LOCATION J C <br />i3F T!•;i'AN, OPERATOR <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 />Farm Approved. b <br />OMB No. 2040.0004 <br />1 ' <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQOUFENCY SAMPLE <br /> -- EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE a::} ) <br /> MEASUREMENT <br /> PERMIT R t P C: (? T t . = 1 1, y> ;. ; -j:" r iz r. c { i: <br /> REQUIREMENT 1 :T G lr?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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE P NCIPgL ECUTIVE OFFICER I certify under penalty of law that tht+diKument and all attachment were <br />' TELEPHONE DATE <br /> prepared under ntv dmt•tion .a <br />super. i,wn to ucrunlancc atth a system designed <br />t <br />i <br />t to assure that qualified personnel propctly gather and c.nluate the infumation <br />Hydrolog <br />O9tb <br />s submitted. Based on my utquirs of the person or prams who manage the system, J <br />5209 or those pemins directly responsible for gathering the mtormnnon. the information <br />(970) 276- submitted is <br />to the hest of m <br />knowledge and belief <br />true <br />accurate. and complete f v <br />I <br /> . <br />. <br />. <br />y <br />I um aware that there are si <br />nificant <br />enalties for subnnttmc false mfomranon SIGNAT RE OF PRINCIPAL EXECUTIVE ?r <br /> <br />TYPED OR PRINTED p <br />' <br />g <br />mcludrng the ptmsihilm of tine and impnarmrncni for knnwine vtolanons OFFI ER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />D <br /> CODE <br />GUMMtNI, ANU tAF1LAr4AI IV N yr AIYT vtvuar rvrva Iriererence au anacnrrrents nere/ <br />PREC IF EVENT SUL• <?? Tit BURDEN OF PROOF* PEQI.IIREMENTS IN <br />_D TO THE DIVISION WIT?'it•I 48 !?i1llF<-. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. _! 02/C'PisliS $ 4-part form.