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PERMITTEE NAME/ADDRESS(!nclude Facility Name/Lomuan gDi/(erend NATIQNAL;¢ <br />NAME 5c'NcC^ CCAL CCFIANY '' I <br />ADDRESSDk AYB$ ~ CO <br />RAYDEN t CO 81639 P~ <br />FACILITY ~" - <br />IACATIp - - YEAR <br />N1kYUEN CO 81670 FAZiM xy <br />0.,TN: G. BUL is :~t;YN~ Cl11 l1ANA(.!5 *~ ~ (zo-zp <br />E EDMINATION SYSTEM (NPDES) Form Approved. <br />31NG REPORT (OMR; <br />rn- el <br />N I Y C tl OMB No. 2040-0004 <br />' <br /> <br />] 017 G <br />(SUBR <br />YY) Approval expires 0531-98 <br />~ <br />i <br />J DISCHARGE NUMBER F- FI N ! 1 F C (~ Y <br />ZING PERIOD ACUTE YEI TESTI-6 FCIr. Cl}A. <br />R MO DAY <br />7p .. x <br />'~~`~ NG <br />[I~CNAFCE ~y <br />)~~ Co>Z <br />;.f 7ze-zl) (zs~z9l (so-31) NOTE: Read Instructions befor ompleting this form. <br /> (3 Card Ony) OUA 1 OR LOADING Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (e6-53) (54-61) '. (38-45) (46.53) l5a-st) EX of TYPE <br />(32.37) ,•AVERAGE MAXIMUM UNITS INIMUM AVERAGE MAXIMUM UNITS <br />(62631 ANALYSIS <br />(6a~ss) <br />69-70 <br />'~ SAMPLE ~~:. ,. ;} A:t4X~ 169G•4 4 ;49 ( i~) <br />CEBIOUAPNRIA MEASUREMENT -` '`:~.; <br />f6713ii 1 U U PERMIT r.>rr: <br />~ } $ EF- 6II fAk <br />'FYLUE:iT GRO55 YALLE REQUIREMENT. . :~~ 1!Y i} t's~ CE-i r <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> ~MEN'~ . t.~ Y .vta i ~ <br /> ~MPLE <br /> M NT <br /> ~ ~ ~~•' <br />' <br />- ~ ~ ~~ <br /> REOUIREM szx< `,.L* <br />, - ~ - <br /> - <br /> SAMPLE <br /> MEASUREMENT - <br /> AERMI'Fi <br />' ,. a <br /> ~EQUIkIEMELaT~ ...! <br />>~, ~" <br />~ . '",. y.. <br /> . F , <br />- - : I <br /> <br /> SAMPLE <br /> MEASUREMENT .. <br /> , <br /> ~60iJI,gEM~NT ~ <br />~ x n <br /> <br /> SAMPLE <br /> M <br />E <br />ASUREME <br />NT <br /> <br /> '.$ <br />y <br />y <br />+ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />. ~ <br />~ <br />'-~ <br />' <br />g" } ', <br />,, <br />~ <br />. <br /> 1ENT'." <br />RE'QUIFi~( „ ;. ~. y <br />"4 I : <br />~, <br />»~~ . fi' ._ <br /> w <br />NAME(iITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E~fAMINED AND TELEPHONE DATE <br /> AM FAMILIAR WfiH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MV <br /> INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEVE THE SUBMITTEO INFORMATION IS TRUE, <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICAM ~ O' I <br /> PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING THE <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE tB U.S.C. § I W1 AND 33 U S C. <br />SIGNATURE OF PR191EIPAL EXECUTIVE <br /> <br />OR PRINTED § 1319. IPerretties under these sletules may include lures up to Et6,000 end or <br />h <br />i <br />d <br />f b <br />6 <br />tl5 OFFICER OR A HORIZED AGENT A <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED monl <br />s en <br />mum tmp <br />sonmenl o <br />efween <br />yaers.) <br />max <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Helerence en ettacnments nereJ <br />:, 5r' PAi:7 I. A.4 F'ON LE7AIL5 OP TEST PROCEDURF. FELCAT LCIiEST DILUTION (n EFFLUE-T) YflICP IS 1i9EA1 'IC `-G: <br />OF TEST ORGpYI5N5 ~LC`_0) AMU ATTACH ACUT° TCIICI7~1 TEST FEFCYT FCYt TC CNN. <br />EPA Form 3320-1 (OB-95) Previous editions may.not be"used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 00199/ 9 9 C t i 7 - I,b 5 7 PAGE 1 OF <br />