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PERMITTEE NAME)ADDRESS (7m"Fardlsy NamWLar¦r/ar (/D($6v s) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPOESf <br />NAME DISCHARGE MONITORING REPORT IDMR) <br />ADDRESS _ <br />BOX ;I PERMIT NUMBER DISCHARGE NUMBER <br />d IA MONITORING PERIOD <br />FACILITY T E NO. 2 M I NF YEAR MO DAY YEAR MO DAY <br />LOCATION . !y I A CO 81-' FROM TO <br />i, I TAM n y]CA= am MThiC Ml?G <br />Form Approved <br />OMB No 2040-0004 <br />w <br />I f I NCII <br />F - FINAL DELTA <br />SR; DEER "rRL D TC OR UNMD TR IS <br />NOTE: Read Imtructione before completing this form. <br /> <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 <br /> MEASUREMENT <br /> PERMIT I:#??# il-•:tT•: t ,:. ..-r:. _ i ' 'SLY {?N"IT,r <br />?.T ?` . REQUIREMENT r.: .. , ; ..;.. ' -, NA X i M IN <br />i SAMPLE <br /> MEASUREMENT <br /> PERMIT #??#Ira ### use;*ait ?, -., <br />V :C ... <rs: <br />IF_ REQUIREMENT SODA AV G 15 i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #####3E lXs?sr#I` z3zs? hi REPORT <br />REPORT <br />N ?i <br />aR' a% <br />- REQUIREMENT 3ODA AVG DAILY SIX I-IONTM <br />rIlIV. T?j'r; L SAMPLE <br />AS i MEASUREMENT <br /> PERMIT # A' F' # 3f # s? : dt## .t _>r,;??,,? IS000 Nh :; :RF;f <br /> REQUIREMENT GI?A r.' DAILY 11X I`tOt'uTt-! <br />j SAMPLE ;.:- . . <br /> MEASUREMENT <br /> PERMIT <br /> <br />t <br />?IW <br />YRA <br />B <br /> REQUIREMENT NST NA Q, ENT <br />t'Iaid SAMPLE <br />ATI _ MEASUREMENT <br />O PERMIT REPORT <br />=Rf?SS REQUIREMENT _OI)A A4"' I _ <br />-? ;l SAMPLE ; <br /> MEASUREMENT <br />PERMIT m.-._ .k- r• _ .. r: LjR' <br />REQUIREMENT •.::? TR M,:. ; <br />PRINCIPAL EXECUTIVE OFFICER I antte ¦ er pens ty o bw that Ub document and all eiuchments werr TELEPHONE <br />L DATE <br />NAME/TTT <br />E <br />Prep¦md under my dt reclbn a superwWm In attord¦n with ¦ system designed <br />to aasun that qualified personnel Property gather ¦nd evaluate the Inrnrrn¦tlon <br />tabmllted. Baled on my Inquiry or the Pearson or pa mortal who manste the system, <br />or loot, penes dlrectly repondble for gathering the Inrorm¦Uon., the Inrormatlon <br />, <br />submitted hi, to the best ¦r my knowledge and beW, am.. acc mw ¦nd aomp4le. <br />I <br />RfN <br />EXE <br />R <br />O <br />WA <br />tlT <br />E ! <br /> I.. ¦m ¦.¦n U¦t there on sgnlncanl pen¦Itle for lrtbml¦dng r¦law Inforno¦tlon. E <br />F P <br />C <br />L <br />C <br />IV <br />SIGNATU NuMBfa <br />TYPED OR PRINTED Inebdlnt the pnalblllty of Ilm end Irnprteanment for knowing vtdadors>. OFFICER OR AUTHORIZED AGENT cooE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (RSforence a# •rrecnmenrs nore) T? <br />IR ,:.OT=r"Tr Ft?l t:. T? rL-Ail`1F'?. Tr' 71_AII"! APPP•,OVED BY 1,irIC n. <br />EPA Form 3320-1 (Rev 3/99) Previous edrbons may be used This IS a 4-Pert form PAGE OF