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PERMITTEE NAMEIADDRESS ilndudr £acifur.Name/Location if DiJJerentJ <br />NAME <br />ADDRESS 1I <br />co 6163 <br />FACILITY E x <br />LOCATION CO E3163 <br />AAT•ION' 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 YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MiNUR <br />(SUBR •JC ) <br />F - FINAL <br />DISCHARGE <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE i <br /> MEASUREMENT - ` ?- <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT t` t <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 oeruf, under penalh of law that this document and all attachment. were <br />prrpurecl under nto din tion or .uprn ision in accordance with a -icm dmigmd TELEPHONE DATE <br /> lu,-ure that yualiried pemonnal properii gather and evaluate the information <br /> .ohm0led. Based on m" inyuir) of the pervm or permn% %ho manage the %vstrm. <br /> or lh- prr ams direclh responsihle Gor gathering the information. the information -' -" J <br /> suhmittod is, to the he,1 or mN kri-ledur and M.licr. true, accurate, and complete. <br />I <br /> 1 am aware that them are signirieani Imnalun for suhmitting false information SIGNATOE OF PRINCIPAL EXECUTIVE - ? <br />TYPED OR PRINTED . <br />winding the po+dhiliv, of rime and imprisonment ror kmowing %iodations. OFFI R OR AUTHORIZED AGENT A <br /> <br />REA NUMBER <br />CODE <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />COMMENTS AND EXPLANA I FUN OF ANY VIOLA I IUNS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. N") Previous edtions may be used. )(, 1 4 -: `-This. i5 a 4-piul4brin.