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. 4300 Cherry Creek Drive South <br />Denver, Colorado 80246-1530 <br />Make enough copies of form for each reportin yetir. <br />Permittee (Company Name): . <br />Facility Name: <br />Mailing Address <br />Facility Phone t <br />Permit Certification No. COG-5042 <br />Reporting Period: Jan. 1-Dec. 31, 20 _/0 ;Form is due by Feb. 15 of the following year) <br />**Each section must be completed. Please print or type.** <br /> <br />A. A report on the facility's overall compliance with the SWMP. (Include here a summary of any measures taken <br />to comply with your Stormwater Management Plan (SWMP), to fully implement it, changes or improvements <br />made in any of your Best Management Practices (BMPs), employee training, spills, other problems <br />encountered, etc. How is your plan working?) "` -- _ <br />h4 v_, bee-c) /V-O )'V <br /> <br />Were changes made to your SWMP? XNO ? Yes - Describe changes on a separate sheet. <br />B. A summary of each comprehensive stormwater facility inspection made, including date, findings, and action <br />taken. (The permit requires at least two comprehensive facility inspections per year see page 8 of the <br />permit. Include here a summary of those inspections, plus any other comprehensive inspections made. It is <br />not necessary to summarize day-to-day inspections, unless significant problems were noted.) <br />First Inspection - Date Findings, and action taken: <br />Note ffprm may e reproduced <br />oft IV.D V41< 4F <br />Q Check box if this is a <br />Hrfew name, address, etc. <br />19-S 7'a r9i02sg <br /> <br />AD a- Lk