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PERMITTEE NAME/ADDRESS a•cla& Fa MtyN wWL w1-(/Dfp...nr) <br />NAME <br />ADDRESS _ .,- <br />BC1X 483 <br />14IA (;0 81428 <br />FACILITY 1E 1.40. 2 M I I•,IE <br />LOCATION AIA CO 81428 <br />. t - A elr"'Arl Im MTAtC MnO <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTENI (rNPDES/ <br />DISCHARGE MONITORING REPORT (DMR) <br />FROM Form Approved <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY <br />YEAR P9?TOJ <br />OMB No. 2040-0004 <br />(SU <br />F <br />SR; <br />NOTE: Read InMtmedom befwe completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, HIEOVENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###.? >fi?3tiP•v a ;: F ! .f .:. =? ii::' <br /> REQUIREMENT ^i?lld 1 H <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 4$- ; .' + ._; ) 1= / a t3 <br /> REQUIREMENT ;DA r- k) T t . I. I''iCJP3TFi <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT 'Ale I I`j T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 14?1';?}r -. ;; f< ## a?s# ?.r__KLt <br /> REQUIREMENT (.'.' 'H r T <br /> SAMPLE <br /> MEASUREMENT <br />- <br />- <br /> <br />I <br />PERMIT i_ =a .: = z T.,; # It <br />Tr <br />r_ -71 <br />757 <br />:. 77 777 <br />REQUIREMENT <br />NAME/17TLE PRINCIPAL EXECUTIVE OFFICER t;Wuly " er p"n• ty . law that this docwmmt and de .Itorhmenu were TELEPHONE <br />prepared under my direction or supeM/on In accordance with ¦ system designed DATE <br />to nature that qualified personnel properly gather and evaluate the Into-lion <br />submitted. Band on my inquiry of the person or perm who man?gr the system. <br />ti <br />th <br />Inf <br />r <br />n <br />f <br />f <br />ti <br />on, <br />e <br />o <br />ma <br />o <br />or gathering the In <br />orma <br />- or those persons directly responsible <br />d <br />complete. <br />• submitted Ise to the best of my knowledge and ballet. trve. accurate, an <br />EXECUTIVE <br />RE OF PRINCIPA <br />SIGNA <br />" <br /> I am a..- Ibat there are IgnIfIcant penaltks for wtbmltttng raise Information. TU <br />L AREA <br />NUMBER Y <br />TYPED OR PRINTED InckWing the posdb1111y of floc and Impr/senresent for knowing Aolstfas. OFFICER OR AUTHORIZED AGENT CODE EAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /RdSrSnce sat •ftscilments herel <br />PP crTf 7MF') t? CLA?M A FRt"?','L D 9 '.,;QCf) <br />PAGE OF <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used Thins 1S a 4-pan form.