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PERMITTEE NAMEIADDRE55 (IrrW6 FrWryNsJlecanm IJDrBi..nrl <br />NAME SLNLL'A COdL COdHAaY <br />ADDRESS DRA'dF:R D <br />HAiDEN <br />CO 61639 <br />FACILITY <br />LocnnoNNAYUcN CO 81GjU FROM <br />ATTN: G. UUD e:tOMN, GENERAL "IAHAGER <br />DISCHARGE NUMBER <br />l10-T 11 !1T-T31 l14T51 lT6T71 <br />Form Approved. - <br />I` C H A F L: ' T ~ : `i I 99MaFNP- zo40-o0r0a `~ <br />(SUFF. F fl) ApproveLeijp~r4e 705-31-98 <br />r r.eiiAL 1 ,~, <br />!LhO~ <br />~~~'~ DISCHARGE ~ ~~ ''~'•' <br />NOTE: Reed inetructitxle befwe~completlnp this form. <br />PARAMETER !3 6rd Onlp QUANTITY OR LOADING !e Grd Ontyl GUANTITY OR CONCENTRATION 'NO. FREGUENCr SAMPLE <br /> 146-53 /5461/ l3B-15J f4653 /54671 E <br />(.~ DF <br />l31-371 J <br />MALrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS I6T-a91 !64661 !6'1701 <br />AN alt ('A$E: SAMPLE -t:J:#:G'1,- ~ 9({~ OIt E'AAO aCJfi(:f ~}{r) : ~• <br />VISUAL MEASUREMENT VL <br />54005 1 0 0 PERMIT ~ +'~Ot>:%•'.t RppORT 2~=j' $~41411A~ oE~~## OOtfi%.r #4 .tt#i~ ~EERLi IS7AI <br /> <br />tiFFLUENT GROSS VALU REQl11REMENT~ o-~ <br />I95T <br />AY <br />NC=D '~<~~~~~~~ <br />• • <br />:r <br />oor <br /> , <br />. ~; :. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ~ ~ ~' "Y" <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />. <br /> REQUIREMENT ..;;. <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT ~ .I .~~ <br /> .fEQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> .REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> 'REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERnFr UNDER PENALTr of uw THAT I HAVE PERSONALLr EXAMINED MD <br />AM FAMILIM WITH THE INFORMATION aUBMITTED HEREIN <br />MD 8ASE0 ON TELEPHONE DATE <br /> : <br />Mr INQUIRY OF THOSE INDIVIDUALa IMMEDIAT0.r RESPONSIBLE FOR <br /> OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE, ACCUMTE MD COMFLETE. I AM AWME THAT THERE ME <br /> BIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br /> , <br />THE PoSSIBIUTY OF RNE MD IMPRISONMENT. SEE 18 U.S.C. ! 1001 MD 37 <br /> <br />U.B.C.1 t31e. 111rrWeFFUWr eww m~mslnFF lIKAMr hMaW roSIO,pOD SIGNATURE OFi INCIPAL EXECUTNE <br />AREA <br /> <br />TYPED OR PRINTED <br />w a muinun hyvLamFnt of bltrwn a manara rM 6 EvFrA/ <br />OFFICER OA' LRNOf11ZED AGENT <br />CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell ettschmsnts here! <br />TSS F~ IdUN LI9ITS MILL BE MAIMED eN~ SETTLEAULt: SOLIDS LINT AF@LIEL FCq <=10Y5,24NR PRF.CIP F.YF.9T; 1S; <br />IHJN LIt7ITS MAIVEO FCR >lUYh,24HH PdECIY EVENT $U5,]ECT T7 FUFC°_N CF pFC~F IN I.A.2. OIL & GREASE-5fd <br />i. d.1.D. Tf1S Mf)N TTf1NTNf:-SCV T.4-T- <br />EPA Fwm 3320.1 108-95) Previous editions mey be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USED.( p 0 C 7 2 / 9 7 10 31-1513 PAGE 20F <br />