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PERMITTEE NAMEIADDRESS (Include Facility Name/Location if Different) <br />NAME t1^a'? ?ff <br />J Wtt?•? :A? ?. Ir. 4r"w"¢ GS'?i'SClG S Jr«.. M. C <br />ADDRESS )30'Pj.CE JVC). I C''j.r14E:S <br />F. t-J. q83 <br />PF'CA-414, CO 814227) <br />FACILITY 1-40101E. NU. <br />LOCATION P A01,ve ` fit (110 8 1c U <br />G7 ^'? d <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D, R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ) C`} I TO Cc'? <br />Form Approved. <br />OMB No. 2040-0004 <br />NH) <br />FINIAL J) E, L T <br />;:S vi"? ?L) iv'. +g'i•?I?i !"» 07ULtitNIti014 Rt'b <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 />Z SAMPLE i1 ??•s s3yr"i S??k?? '3'r i ?: IS ?1 :; ( F. 7 <br /> MEASUREMENT <br />Or`f 00 3 C 0 PERMIT tea °t f Y f ?" s? I 10,F. <br />1FI Ql ti t:±?? € c^sr 4KaS t! REQUIREMENT :}c y nTS.t"hS? `; T t.'Tt""_Ji1 ?itj 'illi43tt <br />"...`O L ' S.S) T t " tial _ SAMPLE <br />r <br />U:iv?!~f?ii MEASUREMENT s? <br />0055'V 0 1 la 0 PERMIT =i:ks r c it.. ,.. .. :e ::° r "vv;? ?.., ??•v?? ?aj uv?1; <br />?" ;a'T r313i trr. I j; REQUIREMENT s; •#? :r$ a sy ss <br /> <br />v <br />ED s+f. d <br /> <br />i 7 <br />7# lya? <br />so, SAMPLE •%9.4i•3.•:;?i••;° ?k•:t•}§?•rr nt?:•t•?k ? 25) <br /> MEASUREMENT <br />0054 f? 41 PERMIT z .k i 'r s1 w ?r3 z; 3?s?: % -T ?i"? <br />,rl f _ 'r r,f 7 <br />t?. REQUIREMENT <br />. '.> <br /> <br />=: a . _ 141 <br />24 <br /> <br />31 ," . <br />t 1w Atlr) :r:IF.: S SAMPLE 9 k2?3# ##r 't:i?:r ?#?+ t# 3 it?4:Wi:'. { ? ?: <br /> MEASUREMENT <br /> PERMIT ref,". i :r'i <br />r:'1? S .^ °;. ?r? r?Y"°` • ! 4 °..? r; :REQUIREMENT :r•S <br /> SAMPLE <br />"J? <br /> MEASUREMENT <br />0 ".air' f C PERMIT <br />?•..t ,l xr•} ?, • a a y?.,1 : , REQUIREMENT <br /> SAMPLE <br />V X Uec r MEASUREMENT <br />_ <br />% f PERMIT :; ,• ,. 'i< . ... ' :: +1 .... : ?:. ..., .. +.. ? r r : ,'r <br />r. ;) :o :• z ^ c REQUIREMENT ?tlsg? y..,., <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a system designed <br />0 , p <br />' I /I to assure that qualified personnel properly gather and evaluate the information <br />d <br />d <br />(!LA` r!/ submitted. Based on my inquiry of the person or persons who manage the system, <br />' <br />or those persons directly responsible for gathering the information, the information y <br />?'1 ?(• submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />SIG ATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that there are significant penalties for submitting false information, ORIZ <br />D AGENT 'AREA <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTH <br />E CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference an arracnmenrs nere/ <br />% <br /><$J...... <br />)7:?: ^y. ,, . _.. », r t .?.? .:f.3'?. .. r?l ,.-t?. .}.J. >?. ?: _r.._?'?.... ., .?... ..A t •}'t'_ r ,,.- t? .: a.? .r,...» ., G^, 1 ?..? .., ... ? ..... ,s t??< ?_"i <br />-. e = PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. tIS`1S ?'4 part_grm.