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PERMITTEE NAME/ADDRESS QwrYV ForojyNewdLxal/on l/D(0;.-r) <br />NAME <br />ADDRESS <br />. ..tlGw iti.ill <br />I..ISAUL Cv biti <br />FACILITY :. V, j U c h G h i p L S t; U T tl f1 I :r L ;: <br />LOCATION ?. R P f1 L l h L .: CO b i ti <br />Form Approved <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM //NPDESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT WMRI <br />PERMIT NUMBER DISCHARGE NUMBER r 1 A A L M h A <br />MONITORING PERIOD IC C C A L M E E K <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Inotructlons baford'comolatlna this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />t PERMIT ._ r - ... _ :; .. , <br /> REQUIREMENT <br />1 V ?1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> <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 /> <br />PERMIT <br />REQUIREMENT <br />NAMEf"TLE PRINCIPAL EXECUTIVE OFFICER I mrtlt• under penalty o law that thh document and au attachrnenu a era <br />TELEPHONE <br />DATE <br />Prepared under my direction or wyen lon in accordance with • system eefi[ned <br />_ to aware that qualified penonnei propeAy [alhee and e•Nu Ne the Infrxsn atlon <br /> submitted. Bond on my Inquiry of the Perron or prrmm who manage the srstem. <br /> or those pence directly responsible for gathering the Inionnatlon. the Information <br />l <br />su bmltted b <br />to the bet o (my knawkd <br />e red be",( <br />tr <br />lr <br />tr <br />and <br />t <br /> <br />- - e <br />, <br />g <br />. <br />ue. am <br />a <br />• <br />comp <br />e. <br /> 1 am aware that theca are dgnllkant Penaltle for submitting raise Information, SIGNATURE OF PRINCWAL EXECUTIVE '- <br />TYPED OR PRINTED Inducting The Possibility of line and lmpmlsonmeni for knowing Aolatle ma OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />trvmmcre m a nnv ?nr a..mmar. t ..e.. ... t,..... ....,...................? nwr .r <br />._, CIr. _Iic I trC;L1. L:?_C3 C E'(;FC.`. CF FFC_F <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is a 4-Part forth. PAGE OF