Laserfiche WebLink
PERMITTEE I NATIONAL POLLUTANT DI ARGE ELIMINATION SYSTEM (,VFDES) For pproved <br /> Facility Name, DISCHARGE h ORING REPORT (DMR) 0 ), 2000-0015 <br /> i <br /> NAME-- _ 12161 /17J91 <br /> ADDRESS— P.lI{{LIO. L'U." L,Jj:iJ -------- ( 1 1 <br /> 80215 -______— PERMIT NUMBER DISCHARGE NUMBER <br /> ———— S, ✓ f, -------- MONITORING PERIOD <br /> Fe�My-— GOldcm Eagle Merle -------- YEAR MO DAV MO DAY <br /> LOCATION FROM .( 1 TO *, 1 <br /> ---- -------- (2021) 12221) r24-21) (2e-27) (2x-29) (.loa)) NOTE: Read instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> PARAMETER (46-33) (54-61) (3843) (46-33) (3461) OF <br /> (32 37) >< EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63) (64-68) (69-70) <br /> SAMPLE <br /> MEASUREMENT q y 1. r. A f +. A <br /> PERMIT I <br /> ./ REQUIREMENT ;,, 1.4 <br /> SAMPLE <br /> ;31.11 I y [ I)T - i MEASUREMENT <br /> I <br /> PERMIT <br /> REQUIREMENT a n i 1l, 4 <br /> SAMPLE <br /> f I I i MEASUREMENT <br /> P�RidIT' �t <br /> j REQUIREMENTik s 'r <br /> SAMPLE <br /> t�f 1 I I MEASUREMENT <br /> 4 <br /> PERMIT Q 1 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT .0 <br /> PERMIT {I <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AND BASED <br /> ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 7� <br /> it a'I.l i Ll� JI.C:i1L IS TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG <br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 4 1001 AND -0 969- 5(.t i,,� �,� .�1 -> <br /> 33 U WS C.S 1319. (penalties under these statutes may include fines up to $10,O SIGNATURE OF PRINCIPAL EXECUTIVE <br /> TYPED OR PRINTED and/or maximum imprisonment of between 6 months and 5 years.) OFFICER OR AUTHORIZED AGENT A A NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> lF ., � ; .rr .. � t;1. ( „+,h11) i ll>� � :l. jtil:. it!' t"'I►{ ( � i.t7 r ti J {jL >1E 7°I I,• ( i i: i ,.(.iS::h.:'t <br />:PA Form 3320-1 (Rev. 10-79) PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br /> UNTIL SUPPLY IS EXHAUSTED <br />