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PfRMfTTEE NAME/ADDRESSR+4.rFor&yMmm(L«.tAan(/D(,%-i) <br />NAME <br />ADDRESS <br />13 J X 48:3 <br />. ! I A CO 8142a <br />FACILITY NO. 2 M IN E <br />LOCATION ,IA CO 81426 <br />..LIAM A. BEAR JR., NINE MGR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPDESI <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY Y AR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MINUR <br />(SUBR MH) <br />F - FINAL DELTA <br />CHRO(• IC WET TESTING FOR 006A <br />x ran DTRr.HARr1-F 171 *## <br />NOTE: Read Ir»tructlorn blifore completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCr <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REPORT Y7177y <br /> REQUIREMENT S I NGSAMP <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER t rertrty under pen' 1) o law that thk document and all attachments were TELEPHONE <br />with <br />d <br />dir <br />ti <br />r <br />ee+h <br />l <br />n In <br />rd <br />t <br />m d <br />eW <br />d <br />d DATE <br />prepare <br />un <br />er my <br />ec <br />on o <br />wp <br />t <br />o <br />acco <br />ann <br />• sys <br />grw <br />e <br />i <br />to swan chats quaMfkd personnel properly gather and eeduate the Information <br />I <br />i <br />f <br />h <br />sobmitied. she'd on my <br />nqu <br />ry o <br />the Person or person w <br />o manage the system, <br />it <br />oedble f <br />athe <br />th <br />di <br />- <br />r <br />in <br />I <br />r <br />tl <br />the I <br />f <br />rwtati <br />- /? <br />th <br />or <br />ose persons <br />m <br />y <br />p <br />o <br />g <br />g <br />e <br />n <br />orna <br />oek <br />n <br />o <br />on <br />r <br />submitted Is, to the bat of .y knowledge and bel ef. Itve, aavnte. and complete. - <br />SIGNATURE OF ?RINCNAL EXECUTIVE <br />ln <br />t <br />i - <br />J <br /> I am aware that then an slgn <br />un <br />Ismail <br />a for mbmlltfng false Informallon, AREA <br />TYPED OR PRINTED Including the poalblMte of flee and Imprisotemettt for knowing vlasooees. OFFICER OR AUTHORIZED AGENT ODE HUMBER <br />C YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erenc• aN ettechments here/ <br />='T PESULTS Of LETHALITY DERIVS AS "/EFFECT", CP711.IT1.1 AND <br />i -T <br />ATISTICALL CPJ';. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used , Tws-m 1 4-P fpcirm. PAGE OF