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PERMITTEE NAME/ADDRESS (Include Facihp~ Namrlloconon i/'Di/ferenp <br />NAME SEMFCA CCAL CCCFAMY <br />ADDRESSDR$IPEA D <br />HAYDEN CO 81639 <br />FACILITY <br />LOCATION A Y U E a <br />ATTlI: G. 8UD <br />CO b1E30 FRC <br />dRUYN, GFNE~:hL AARAi;FB <br />Form Approved. ' <br />n I a G x OMB No. 2040-0004 ~~ .. <br />A?grovel expires OS-31-98; <br />__1SU88 d1) ~; <br />F - FIAlI ACUTT <br />GISCaAEGE TQ'_j6! CAEEN <br />aaa YG~]slr~6E '~iaa <br />NOTE: Read Instructions belor, completing this form. <br /> (3 Card Ony) QUANTITY OR LOADING' f<Card Only) QUANTITY OR CONCENTRATION NO. RREOUENC SAMPLE <br />PARAMETER (<s-53) (54-s /) (3B-<s) (4s-53) (sa-st) 'EX of TYPE <br />(32J7) AVERAGE .MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANacysls <br />70 <br />69 <br /> , f6as3) (6<-68) - <br />( <br />Ytf SAMPLE ;ramFart •.cgaaz~ vanaaa ( lJ} . <br /> MEASUREMENT "-- ~ ~~ <br /> <br />UUUUU 1 U D PERMIT. iV q i ><a» ,, ;>a IC; t =:- - ~ ~ .. ~~ /5 U <br />EFFLUENT GR05S YlLGF REQUIREMENT - <br /> <br />~ i~+ail l1jz,~fli'Jt.;' SU { <br />v. B- - <br />~UL U5, 'CU AL SAMPLE '`~'~~`"`` `~~ aac ~~ :'` agaa>c~ ~,, ) <br />SUSPENUEU MEASUREMENT i " ' <br /> <br />UUS30 1 0 U PERMIT ~. ~ +~- '-1 ~` iA16 '-. rF ~. fi~*`.L" # >' ~ ~~ t#~~- <br />EFFLUENT GHO55 YALUE REQUIREMENT t n~ .-~ <br />~.~~~~~~a _ <br />L!I#~..lj.~- <br />rG/i <br />~ <br />~~j~ <br />SULiUS, :;E:TTLEAki E SAMPLE ~ "'"'a r77ari+G,: aq>•gq.q ( ~- <br /> MEASUREMENT <br /> <br />OUS45 1 U 0 ~ ~ PERMIT ?9agta4 a >!a7 i '0# iF3 <br />~ '~'~ ~ `_ „- #b-F,~C#7 j" ~l i.{I. . <br />EFFLUHhT GROSS YALUF .REQUIREMENT X;%Y. ~ a <br />IRON, TU7AL SAMPLE ;~aaan: nrar~a aaoaM ( ]S) ? <br />(AS P£) MEASUREMENT <br />UlUt1S 1 U C °PERMIT. aagig~ - gg4+P. i t0 ~ Aa -Q{ a-: IIiM '"" I>L~~z ~~~~-' <br />EFF'LU$NT GRO55 9$LUE FiEbUIREt•AENT [:4: „j.~ ~ r !4G! L ~:~~ -` <br />OIL AaU GtiE$SE SAMPLE 'J "'P r~'r" `~n ~'`~ a4AOL~ ::aaatC :.~~: <br />~ ( 9) ' <br /> <br />~ MEASUREMENT : <br />~~ N_. <br />U35U1 I U 0 .~. PERMIT pq~ 4a a <br />~ SL-} qaa. ~ sil~is <br />~' -{' ~ <br />~ <br />~ I.' _ ~ # )~#'~ <br />EFFLUENT GROSS YALUE ,REOt1wEMENT '<..^~~t~ "~ `~ ~~ <br />, 6/I * `.~. <br />F LUi, IN IUIIDU UY SAMPLE I U~ q aax,a A+ 8 as 7vgq <br />TAHU TKEAT tiE#T FLA II MEASUREMENT <br />~OOSO 1 0 0 PERMIT. • + 8©A4 #8FC#2 vgaaa qqq= a 4, ati ~ ~j~~~ ;;,A4A <br />EFFLUENT G&055 TALUF REQUIREMENT` :.tQF)~ jr(i $jlbT tIX YGU <br />~ aaii ; <br />R_- ' <br />SULLGS, TOTAL SAMPLE agars as a=.a aavnva ( 5/ <br />DISSOLYEll MEASUREMENT <br />7UZ9S 1 0 0 `PERMIT .- :: ~~~4 <br />( ,-+i~gg4 <br />~ >; C>i q•Yaa OFaIC~.~AL A ~~-C6.. - ~ ~ -l j~r~.~.;". <br />f:FfLUENT GHOS$ YALUE REQUIREMENTf ; < <br />- <br />-~. ,. CQh4 ~~I+jj- AY p~jT~ ~(I'T~ GG~j = : ,g. `"' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN <br />AND BASED ON MY TELEPHON E DATE <br /> ; <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION. 1 BELIEVE THE SUBMITTED INFORMATION IS TRUE. ' <br /> ACCURATE AND COMPLETE. I AM AWARE TNAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITPNG FALSE INFORMATION <br />INCLUDING THE ~~ <br /> <br />. <br />POSSIBILfTV OF FINE AND IMPRISONMEM. SEE 1B U.S.C. § 1001 AND 33 U.S.C. <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ D~ <br /> <br />TYPED OR PR 4 13t R. (Penekies untler Ihese sterules mey inclutle lines up to Et0,000 end or OFFICER OR ALIT ORIZED AGENT <br />A <br />INTED manmum tmpnsonmenr of betweenfimanths entl5 years.) Op NUMBER YEAR MO DA <br />V VMMtN I J ANU tXYLANA I IUN OF ANY VIVLA I IUN5 (Reference e7/ adachmenl5 heref ' ' - <br />T55 F IROY LI11IT5 Y3LI BE YAIYED S 58TTL£ABL° SOL]GS LICIT AF~f~ED FOA <=10Y8,24FE F(iFCIF FYFIT; 75E b <br />IAOY LIRITS NAIYED !CF ~1UYR,24HA FR£CIP EYFaT SUFJECT TO BUADEE Of FECCP IK I.A.i. CIL E GEFA!5 - °_Ff <br />T u 1 n mnc rnor Trc Tyr ~ u i u <br />EPA Form 3320.1 (08-95) Previous editions may not be used. (REPLACES EPA~FORM T-40 WFIICH,MAY~NOS BE•USED. ~ P,AGE OF. <br />.:. >~ > ~ Q0261It99Ci.T7-3853 1.:. .. <br />