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PERMITTEE NA WJADDRESS pmA h Iatybry No.WLxarraw (/D(06wu) <br />NAME <br />ADDRESS <br />Box 9 <br />J I A CC 8142,E <br />FACILITY T E NO. 0 1 N <br />LOCATION Q I F, CO 8142E <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDES) <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER DISCHARGE NUMSER <br />MONITORING PERIOD <br />YEAR MO OAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MINOR <br />(SUER MH) , <br />F - FINAL DEL'T <br />?R: 17)t"'4R T P I ','Tr- OR 1-'NMD TRIB <br />NOTE: Read Iflstructione before completing this fofm. <br /> NO ptEOUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . <br />EX DF <br />A <br />YSIS <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS AN <br />L <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT tt •k zs t x <br /> r <br /> REQUIREMENT <br /> .a k <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/ fTLE PRINCIPAL EXECUTIVE OFFICER I Certtly u neler penalty o low that this documenl and all attachments were TELEPHONE <br />prepared vender my direction or super.hlon in amordanre with a systern designed DATE <br />to mute Choi quohned personnel property Salk" and eraluale the Information <br />th <br />e system, . <br />rbmllted. bred on my Inquiry of the person or personal who monate <br />or Chow person directly realpotdbk for gathering the Information, the Information <br />wife filled h, to the besC of my knowledge and better, true, arcvrste. and complete. ' <br /> Nllcant <br />enalties for mbrNttlng fakes Information <br />are sl <br />r <br />th <br />t th <br />1 SIONATURE OF PRINCIPAL EXECUTIVE AREA <br />_ , <br />g <br />p <br />am awa <br />e <br />a <br />ere <br />lstl <br />f 11 <br />nt f <br />r k <br />owin <br />A <br />l <br />d I <br />t OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />TYPED OR PRINTED n an <br />mpr <br />sonme <br />o <br />n <br />g <br />a <br />mm <br />Inrkeding the poodb <br />llty o <br />COMMENTS AND EXPLANATION OF ANY vlvlnllvnalnnsrsncson .++.crrr,r.r++?+r.r.r rub FaRECIP Fk.IFi`.I"f ; CLATMFD. IF CLAIM APPROVED BY WGCD, <br />-- - 1 - _ _ _.. - -- :::: ? •t. This IS a 4-part form PAS[ of <br />EPA Farm 3320-1 (Rev 3199) Previous editions may be used Thu