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w <br />PERMITTEE NAME/ADDRE66 p~Y6 Frr57Nar//ovmm VD~.nwr1 rv,,i •,,, ~~~~ <br />NAME. _POLi1SBf10BM COAL CJMPAYX <br />-~_--- <br />ADDRESS 90AUS IDE NINE, K v 5 PORTALS <br />P.U. BOX 1430 <br />PALISADE CU 41526 <br />FAaurv <br />LocnnoN <br />Af'fN: JU4h A. M~NABE P4ESIDENT <br />DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM TO <br />lIO-III 11I-331 111-751 176-77I 128-19/ /30-311 <br />(SUBR iC) <br />F - FIiAL <br />RINOR <br />Form Apprsonv4eOd. <br />i4 To a ~~~0531-98 e <br />~i~`~u~ <br />NOTE: Reed Inetruetlorr before cornpletln0 this loan <br />- <br />P <br />-- - - -- -- - - - !3_CerdA~y1~UP~IT ¢UANTITY OR CON <br />!l rro o"!vi <br />-. - <br />- = <br />ARAMETER _ <br />le6-531 ~ 15Y5 - -- - - - ~ - , <br />l38-s51 '- -! 3 <br />137-371 AVERY,GE-' J, .:~ MAXIL~U~af - _l1NF}3 'MINIMUM- AVERAGE- ! <br />L STA.THE 4BNR 'AC SAMPLE #i##4# 903### ##tRtRO# ###### ( 23) <br />CckIUDAPHNIA MEASUREMENT <br />1'AHJd 1 U U ~RERMIT:~. ,:5. <br />:.. ##~!»tA.lBr~ :.~ <br />:'::: 4#~IiO.~M"+OI~ .. <br />.~-- <br />: ##X ~ <br />QD~ <br />UI. <br />~O <br />~ ~ ##~.70~~ ~ ~:.'':#?R.~:~$~:~~ EH- :~ .. <br />.j -~ •~I..RX..~ . +.~8. j . <br /> <br />EPFLUErlT GHO$S 9AL0 .. <br />:REDUIREMENT.~ <br />... .... , <br />: . <br />. <br />,;•.: '-~ ~ ' <br />Id##g _ <br />. <br />. <br />. <br />~k•'.i.1[LiiE. <br />>; ': ~• <br />..< <br />.; <br />a~~.. ": <br />LCSJ ti 1'A'iBE 96HR A SAMPLE. 3##4V# ROitOO9 k##t0## OgtG#II# (, j~ fn° <br />P19EP.:4..ES MEASUREMENT _ : <br />" ~~,,'I <br />1'ANbC 1 0 0 ~ rPE MIT:::;`,.. <br />. : _' ...... ::. <br />. ::°: f3t}ti!..,. ##p A ',?N?/`~?~I~l??;r: ' g,; . <br />~~~,. <br />,.~: <br /> <br />;" <br /> <br />L t <br />a: r <br />oFF U bROSS A~ <br />Q . <br />~. <br />EQU <br />LREMENT: . <br />, <br />:. . <br />.. :'i:• : ..: .. <br />.. .. ..: <br />: <br />" <br />' <br />' <br /> <br />~#a# <br /> <br />i <br />i <br /> <br />. •. <br />s . <br /> <br /> <br />.. <br />S.;Z:'.":::;: "': <br />. <br />; <br /> <br /> <br /> <br />. <br />.:.. <br /> <br /> <br /> <br /> <br />.. <br /> <br /> <br /> <br /> <br />. <br />. <br />:.. <br />. i. <br />. <br />. . ... <br />. : <br />:': <br />: <br />, <br />.i X <br />: x;... . <br />. <br />,.. ..: ~ <br />a <br />' ~~ SAMPLE : ~ - ' <br /> MEASUREMENT <br /> PERMIT :~: ~ ~ <br />~ .. .. ~;`::..,:. :_~.:~~~ ~ ~ ~ .. ': <br /> REQUIREMENT , <br />~. I` - "~" ' ~ ~ <br />t/ . <br />~ ~ - <br /> ~ ~ Y` <br /> <br />I ! SAMPLE •i - <br />~% <br />y : -, n, MEASUREMENT <br />,.. }.: <br /> <br />,., <br />s,?I~ <br />:~ ::.P~R,~YII7:::~". r <br /> <br />.. <br />~ ~ <br />.. , <br />. <br />~ , <br /> 5 <br /> MEASURE ENT <br /> ~:':~'PERMIT" ~~ '~ ~ <br />,.. . <br />~ ~~ <br /> tREQULRENIENY ::':::: .. .: :P':'°~:':a%:: ... <br />.;r: .. <br />: <br />S i <br />f':" <br /> , <br />., <br />:..: . . <br /> SAMPLE - ~ <br /> MEASUREMENT ~ ~ ~ '~° '' <br /> PERMIT.:.;..: . ~:. .. .... .. ........: ~ ~ , <br /> .REOUIRENIEN'f. ~ ~ ~~ ~ ~~ ~ ~ ~~ <br />... <br /> <br />~ : <br />~ <br />r t... -~ ~ SAMPLE-' .. .. ., .:. - <br />~ ~ <br />~ <br />- ~ <br />f z r - . <br />-' ~ - -- °- ~, ~ --. <br /> MEASUREMENT <br />_ ;,_..PERMIT'.:::- ..._,~._.,~:~ .:..:..:...: :::....: ~~.._,_:..: <br />~ ___.. .. .._ <br />~ <br />:~ _ __ .. ~ - - .. ,... .. ~ ._ <br /> .REQUI.REMENT' ~~~. .: .: .. .. <br />.. .. . <br />NAME/TITIE PRINCIPAL EXECUTIVE OFFICER I cERDFV UNDER PENN.Tr GF LAW THAT I NAVE PERSOSULr ExAMINED MD <br />AM FAMILIM WITH THE INFORMATON SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br />II <br />T ~ S T q ~ f t" MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE, ACCUMTE MD COM0.ETE. I AM AWARE THAT TNERE ME <br />SIGNIFICANT PENALTIES FOR 6UBMITTING FALSE INFORMATION <br />INCLUDING - <br /> <br />~ F r -+ , <br />THE POSSIBILITY OF NNE AND IMPRISONMENT. SEE 18 U.S.C. f 1001 MD 3] <br />SIGNATURE OF PRINpPAL EXECUTNE /7[) ~/S y~U~ ~~eC C) 1 ~~ <br /> <br />' u.s.e. f rate. IPeWbr uN.r n.ro mnm• elrr i°eAN~ AneF w ro rr0.P00 AREA <br />TYPED OR PRMITED rw or m.r:...n irw+dle+er eran.«n eeronrA, rtlsrera/ oFFlCER OR AUTHORQED AGENT CODE NUMBER YEAR MO DAV <br />~I <br />i <br />COMMENDS AND EXPLANATION OF ANY VIOLATIONS !Reference sl/ sttschmenrs hers) ' <br />:iEG PAST I.B.q POH UFTAILS OF TEST PROCEDURE. REPORT COYEST DILUTION (~ 1~FFLUEYT) NHICH IS LETHAL TO 50X' <br />OF TEST U$GANLSRS {LC50) 9YD ATTACH ACUTE TULICITY TEST REPORT PO R!! TC D1+R• COFZES OF ALL INPORf7ATI0Y <br />htt~:T NP Ci'YT Trl cOB_ <br />EPA Fam 3320.1 108-95) Previous editions mey bs used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) 0 O 3 9 2 / 9 R C 2 2 3-125 6 PAGE 1 OF <br />CENTRATION ~ rREDUErICr SAID <br />I5I-511 ~ - ' - ~ - OF ,~ <br />Ex ,MALY96 TYPE <br />~~MAXIMUM .UN)TS' B:-6m .'s~-s91 !e&701 <br />