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PERMITTEE NAME/ADDRESS 17-diw4 FaeMrylVa-WLee•vfeo tfD(ffvwvnt) <br />NAME <br />r <br />ADDRESS <br />.... 6Ui 14JU <br />ISADE CC big. <br />FACILITY U -'' 1DL• ?NUATh t; SCUTH Iiv LS <br />LOCATION t'ALi:iAulr CO di ?. <br />Form Approved. <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM NPDESI OMB No. 204040004 <br />DISCHARGE MONITORING REPORT (D R/ <br />PERMIT NUMBER DISCHARGE NUMBER _ F I h A L t". i `. <br />MONITORING PERIOD ?? L C F Fr a <br />YEAR MO DAY YEAR MO DAY <br />FROM TO C- <br />NOTE: Reed Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX J <br />ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - .. ;t L Y i <br /> REQUIREMENT <br /> r. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <br /> REQUIREMENT <br /> <br />'Alli ?1A 7 L :4 <br /> <br />C <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT s : u ;. r <br />:. r t <br />. v <br />"1 1 I• <br />^. J, t <br />y REQUIREMENT <br />- ly y L1? <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> L Y I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :. i C Ft l y : <br />- <br />(L t <br />. :• <br /> REQUIREMENT _. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I feniq " r an• t1 ° I•w that thh document end all attachments were <br />TELEPHONE <br />DATE <br />prpered undtr my dlrxt{on d suptn-h{on In accorderare with . System d.Aln,4 <br />- to assrsr that 9-1,111,ed prronnel pro"Hy gather and evaluate the Inforsrutlon <br /> submllted. Based on my I"ulry of the person or perdu who manage the system, <br /> or those prroru directly respomlbie foc gathering the infor icon, the Infornrtion <br />^ <br /> submitted is, to the best .(my knowledge and better, trove, ace -Ir. and complete. <br /> I am tors that them are significant ptnaldea for mbmllting felt Information SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED , <br />Including the posetbl111y of nne and imprisonment ror knowing viotsiiort>. OFFICER OR AUTHORIZED AGENT AREA NUMBER CODE YEAR MO DAY <br />I-VMMC1'1 10 AMU Cnr ??ret•s r rv.. ... ..... .... ?,-...v.w rn wr wr ?nc? mr wuwa.nrn?nra nw.w/ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used ThIS:IS a 4-Part fOrin. PAGE OF