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._4300 Cherry Creek Drive South <br />De_nver, Coloradd-80246:1530 <br />Make enough copies of form for each reporting year. <br />i' . <br />Permittee (Company Name) <br />Facility Name: <br />Mailing Address <br />Facility Phone t <br />Permit Certification No. COG-50e.02 <br />Reporting Period: Jan. I-Dec. 31, 20 ;Form is due by Feb. 15 of the following year) <br />**Each section must be completed. Please print or type.** <br />Check box if this is a <br />new name, address, etc. <br />12A-U D N Ik e PA z z ? <br /> <br /> <br />A. A report on the facility's overall compliance with the SWMP. (Include here a summary of any measures taken <br />to comply with your Stormwater Management Plan (SWMP), to fully implement it; changes or improvements <br />made in any of your Best Management Practices (BMPs), employee training, spills, other problems <br />encountered, etc. How is <br />`7Jio,p.? your plan working?) <br />ha v0. UPP - <br />A 9 A16 IAI V-AA _ G-t-?? <br />Were changes made to your SWMP? XNO ? Yes - Describe changes on a separate sheet. <br />B. A summary of each comprehensive storm water facility inspection made, including date, findings, and action <br />taken. (The permit requires at least two comprehensive facility inspections per year - see page 8 of the <br />permit. Include here a summary of those inspections, plus any other comprehensive inspections made. It is <br />not necessary to summarize day-to-day inspections, unless significant problems were noted.) <br />First Inspection - Date Findings, and action taken: <br />tj:!5- <br />?TT/ i c-5 YII\A <br />Notea// may be reprod <br /> <br />>?S ar9/o2sg <br />'KA; W Z- P/ <br />r T <br />Pew 671? Lk /.a