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PERMITTEE NAME:ADDRESS rtnidu,!•F4wilgv,%amr L,urlrinnifj)j&rcnrl <br />NAME Vii?,^IINALr INC. <br />ADDRESS LOADOUI' <br />?MUOA T SPRINGS CO 6047 <br />FACILITY .'F.PS .': (71 L t:ATr`:I rr <br />LOCATION <br />i-) E N C 7 F. ; i 6 <br />..i-.} i rr. ?r, c.,tnr.: na cus•.rno <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approlled- . .. <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER ?! c: i:r1.1T1 <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE = t} ) c? <br /> MEASUREMENT <br /> PERMIT RF.PUR' `''].1 <br />ii 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 />NAMEITtTLE PRINCIPAL EXECUTIVE OFFICER I wish under penalty of law that thu docuawnt and all attachments we"- TELEPHONE DATE <br /> 1-acparcd under my direction or supervision in accordance with a system designed <br /> :. assure that qualified peronnd properly gather and evahtate the informaton <br />th <br />t <br />m <br />f <br />h <br />B <br />d <br />h <br /> e pennn or persons w <br />o manage <br />e sYs <br />on my inquiryo <br />t <br />c <br />. <br />,uhnutted <br />asc <br />or Chow persore, directly responsthle liar gathering the information. the infotrnation <br />r <br />1 <br />?? <br /> submitted ts, to the hest of my knowledge and belief. true, accurate. and complete <br />fo SIGNA RE OF PRINCIPAL EXECUTIVE 1 <br /> rnianun. <br />1 am aware that there are +igmfcant penalties for suhatining Paige in <br />vi <br />ti <br />b <br />f <br />i <br />d <br />i <br />f <br />k <br />i <br />l <br />h OF CER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED now <br />ty o <br />n: an <br />snnn;cnt <br />or <br />ng <br />o <br />a <br />ons: <br />ncludmg the pus,t <br />i <br />f <br />rnpr CODE <br />GUMMtN 15 ANU tAYLANAI IUN Ur ANT VIULAI tUtva Incrararrcc an auacnnrcnta mere/ <br />PRECIP VENT ^UL-JECT TO BURDEN OF PROOF REQUIREMENTS IN <br />FD 1 HE DIVISION WITHIN 40 HOUR'2' <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. : ' .'? ??S'15 g 4-part fomi.