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PERMITTEE NAME/ADDRESS (7nclwleFaciliryName/%ocation ifDijferrnt) <br />NAME <br />LI? t / NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />u Form Approved. <br />t <br />' DISCHARGE MONITORING REPORT (DIMR) <br />ADD OMB No. 2040-0004 <br />RESS i c.L !?J'r i 2 GU O rv ' (? <br />GrJ? G? CO PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY ??a??, r' U S MONITORING PERIOD <br />LOCATION r/c,?C1 K YEAR MO DAY YEAR MO DAY <br />2? Cc> 8 iC9? FROM ? ! ? " TO 0 9 ! Z 3 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER I <br />QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY S MALE <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br />SAMPLE 1 <br />12 <br />MEASUREMENT <br />' /&C).33 ICJ Q ?U <br />/ PERMIT . / <br />Ro Sa-?Jl ??lG. p.N/ IREI?IT. ' jQ?? ? <br />? '? <br />L f ll <br />S ? r <br />? <br />9 <br />lt <br />SAMPLE <br />MEASUREMENT <br /> <br />I <br />' ( <br />/rye <br />?I???G??*a Viz?? REWIREVENt j ?A <br /> <br />SAMPLE <br />MEASUREMENT <br />i <br />PERMIT. <br />EMENT <br />SAMPLE , <br />MEASUREMENT <br />P):RMIT <br />? <br />NIEMENT <br />- <br />_.,. <br /> <br />SAMPLE % <br />MEASUREMENT <br />PERMR k <br />AiMM <br />MEW k <br />• <br />. , ... ,. ... .....E v ... :.. _, .... .. <br />SAMPLE <br />MEASUREMENT <br />n <br />RED <br />REMENT <br />t .v. ... ..... ... n, a .. .. - . <br />- .. ....'T <br />. <br />SAMPLE <br />MEASUREMENT <br />_AA <br />[ <br />FAM UtREMENT y <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHONE <br />d <br />d <br />DATE <br />prepare <br />un <br />er my dire or supervision in accordance with a system designed <br />t?° e B qualified P6wanel properly <br />gather and evaluate the information <br />. <br />my mgmry of the person or persons who manage the system, <br />I or those persons.directly 'reaponsrble for gathering the infonmtion, the information <br />F/2 Ll;? 'U72 <br />h <br />b <br />itt <br />d i <br />su <br />m <br />e <br />s, to t <br />e best of my Imowledge and belief, true; aczwate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE 9;V1675-4322 <br />I am aware that them are 6ignificant penalties for submitting false information .10 O a(o <br />f' <br />TYPED OR PRINTED including the possibility 6f fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT NUMBER <br />OMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attaclrmer?ts here) YEAR MO DAY <br /> <br />Goa 9:-'219r1_1 roan, '1X201 D.n.dn,.e a.iHinnn '. w tie ..red