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PERMITTEE NAME/ADDRESSnaeiriisiMryNa.sa/Lor«ronl/D?.rwre) <br />NAIL <br />ADDRESS <br />INIA CO 81411 <br />FACILITY R NO. y M11`4E <br />LOCATION IFRSET u 814L, <br />•N I FL_ E BEAR. PRFS T OFNT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDESI <br />DISCHARGE MONITORING REPORT IDMR/ <br />PERMIT NUMBER DISCHARGE NUMeDI <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />!9 1 <br />FI - F I NAL i 6 <br />1 NE DRAINAGE TO N F1•( GUNN I SON <br />NOTE: Read Inetructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br /> <br />E F"OUENCr <br /> <br />OF <br />SAMPLE <br /> <br />YPE <br /> X ANALYSIS T <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # k ;. f•, 5 3i k#ii ,- i'- t? <br /> REQUIREMENT M I ; '.., , ''• tAX i hiltt`t <br /> SAMPLE <br /> MEASUREMENT ?. , <br /> PERMIT ti t * : __ vC E i r r = <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # spit :, C} <br /> REQUIREMENT DAILY 13 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT r i iA k v T <br /> SAMPLE <br /> MEASUREMENT <br />-, 7 PERMIT <br /> REQUIREMENT h f}:,: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r ORT <br /> REQUIREMENT T MAX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I nruly w d,, pen' lr o Iaw that thH 6o umenl and it .ttachm enU were TELEPHONE DATE <br /> prepared under my dlr tlon or wper.lyon In wvord- with ¦ system deigned <br /> to care th« qualified personnel is opq Hy gather and eeaNate the information <br /> wrbmllled. Band on my Inquiry of the person or persoem who manage the system, <br /> or how persoms directly mporrlble for gathering the Informatim the Information - <br /> wbmllled I& to the bet of my knowledge and belief, true. accurate, and complete. <br />1 am aware that then art sl <br />.IM-t <br />enaltle for <br />bmitdn <br />w. Inrerm <br />ts <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />y ?. i- <br />`- <br />TYPED OR PRINTED g <br />p <br />w <br />g <br />a <br />on, <br />Irwiudint the peslbllitr,J fine and imprisonment ror knowing iNatlum OFFICER OR AUTHORIZED AGENT A A <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND LAVLANA I IVN Ur ArtT VIVA I Weis rrfererence off errecnmenn nerd <br />,AGE <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />GHEST MONTHLY AVERAGE DURING PERIOD REPORTED. <br />This is a 4-part form.