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PERMITTEE NAME/ADDRESS (Include Fatuity Name/Location if Different) <br />NAME ! T i = i ' is }? t`t 1 E?)'' I?# I ICI i <br />ADDRESS r $' ',' i .I 1?# + <br />CO Sol 12 <br />FACILITY ?. i ;; r# ; (,i <br />LOCATION <br />'M 804f).7 <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) MINOR <br />PERMIT NUMBER DISCHARGE NUMBER F -- F IF I A- i , OUT T <br />3URI'd`CIE RU!"40 i TO MiRn-.tvT CvoC:I:-k <br />MONITORING PERIOD <br />FROM YEAR MO- DAY TO YEAR MO_. DAY_ N-10. 4 # NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />'xs"3) l*,: r 1:l_: SAMPLE ##yk?? 4i 3i?it i= rr 'rte: •?k! ?? 5920 <br />t x R <br />f?9Q <br />?7 <br />a. Is S0 1 1:' MEASUREMENT <br /> PERMIT #r.<:X t:,?#tl # .t n? l?tr t1E atf°s.Jtt! <br />L 5 i^Cs_ `e <br />'.h!.i <br />E t # i1L1?#T' :r( (3 fit',#..?3i. REQUIREMENT t n 3( `. r AV MAX VIG/L <br />111i.... ?-Zf`vh" ta'":9' ?°?.._ SAMPLE =d• •X•??x• •.z_?} 3f ,.;•t•.:: #?•nt3tKi•# <br />) t 14 -,115A <br />•,> I SF.; AI... MEASUREMENT <br /> PERMIT g.k'k vt=+w>: W;.=1t Ft <br />trFD,.1,..3 Vf?WJE REQUIREMENT <br /> SAMPLE a <br /> MEASUREMENT <br /> PERMIT h <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ; <br /> REQUIREMENT' r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penalty or;law that this document and all attachments were . ' <br />ith <br />d <br />d <br />i <br />i <br />i <br />d <br />t <br />m d <br />i <br />d <br />di <br /> <br />` TELEPHON E' DATE <br />•, <br />\-O ance w <br />prepare <br />un <br />er my <br />rection or superv <br />s <br />on <br />n accor <br />a sys <br />e <br />es <br />gne <br />to assure that qualified personnel properly gather and evaluate the information <br />[[[ submitted. Based on my inquiry of the person or persons who manage the system, <br />or those persons directly responsible for gathering the information, the information <br />1 <br /> <br />to the best of my y knowledge and belief <br />accurate <br />and complete. <br />submitted is <br />true f 0 o <br />i <br /> , <br />, <br />, <br />, <br />r <br />lti <br />ti <br />f <br />l <br />i <br />f <br />ti <br />I <br />h <br />h <br />i <br />f <br />b <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />D OR PRINTED pena <br />ng <br />a <br />se <br />n <br />orma <br />on, <br />am aware t <br />at t <br />es <br />or su <br />m <br />t <br />ere arysfi nne and <br />including the <br />offind imprisonment for knowing violation's <br />ossibilit OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER r <br />YEAR <br />MO <br />DAY <br />TYPE . . <br />p <br />y CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATION5 (Reference all attachments here) <br />,:ri.?..l t..i-`i_2.»??.:'?- _i-: #+t"???tr'x' .=_L BE WAIVED F=OR _-" 101'i•?,. 2?,H.R PRE"( F, ?:V-Ei\ SEE 1. A. 2r PC. 4 FOR 3-1?G i?:i*'~•'«f"1S`i T-S. <br />G)Rt,.6i .: ?"7F?. •'i c..l ,13ti . IF+J Ea d Ili ?-? '"" 1.. C. i1 VJ P197. -i. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may: be used. ?Qdl rhtS7i 4- SCC??bim.' PAGE ;OF