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PERMITTEE NAME. ADDRESS -I6rrlwk• I aciltn Aamr L.x•ution irD!tferent) <br />NAME <br />ADDRESS _ H L_OADOUT <br />'76 <br />T SPRING- CIO <br />FACILITY ;,,UL.CH <br />LOCATION ?U N CO <br />-1•: L•1} T'•ii?!'?I?I, i7r= r=f7ATnR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form ApprroveU <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER ?. _ F GUTI <br />MONITORING PERIOD i lip <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions befor completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREDUENCY SAMPLE <br /> <br />? OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />SAMPLE t: s » t t 9 <br />MEASUREMENT <br /> PERMIT l: ti 3r#ii REPORT ?_1 #it## is -#t4?irz cr ;!.rr 15LirL1 <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this docurnem and all attahment% were <br />ared und <br />re <br />r m <br />di <br />ti <br />n o <br />i <br />io <br />t <br />ith <br />d <br />t <br />d <br />d TELEPHONE DATE <br /> P <br />p <br />e <br />y <br />rec <br />r superv <br />n si <br />ance w <br />o <br />s <br />accor <br />a sys <br />em <br />esigne .? <br /> to assure that qualified pcrscmnel properly gather and valuate the information <br />submitted. Rased on my inquiry of the person or persons who manage the system. <br />' I i <br /> <br />iii <br /> or tlxtse Persons dirraiy resPonsible for gathering the information, the into <br />tntation C <br /> <br />suhmmed is. to the best of my knowialge and Weld. uuc, accurate. and complete <br />1 am aware that th <br />r <br />r <br />s <br />nifi <br />nt <br />n <br />ltie <br />for <br />b <br />ittin <br />ls <br />mi <br />i <br />f <br />ai <br />SIG TURE OF PRINCIPAL EXECUTIVE ? <br />_ <br /> <br />TYPED OR PRINTED e <br />e a <br />e <br />ig <br />ca <br />pe <br />a <br />s <br />su <br />m <br />g <br />a <br />e <br />t <br />rm <br />on' <br />mni, ng t, r pcnsibility of fine and rmpr-onn;ent for knowing violation` O FICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE <br />Maw Lnr LIV ?MarVa? W. Mafia raV 1--1-V- <br />t.c eu asaaw nnenaa net c/ <br />F , - ?ECIP EVENT E <br />TV THE UIVIE <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ,T 1S 'a 3-part form.