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PERMITTEE NAME/ADDRESS (Include Faciliry Name~Cocatran jOrBrreny <br />NAME SiC.NcCA CGAL CCl:FAAY <br />ADDRESSD R A y r~ D <br />NAYUEN CO Filc s'~ <br />FACiuTv <br />LOCATIOI~AY UCN ~Y, CO 8L63U <br />FRD <br />e n•~±. :enn eenuu •eri~IL.e <br />FGrm Approved. <br />OMB No. 2040-00 4`- , <br />1 4 u h Approval expires 06- ~ Y ~ <br />- FidFL I.. NDU7T <br />.:,ChAFGE TC GFAY81 GfiEEH <br />~= tie IiscrAncE ~_-~ cr+c <br />~NOTE: Re2d instructions before, completing this form. <br /> (3 Cerd On/y) pUANTITY OR LOADING '~ Onty) QUANTITY OR CONCEN~ fON <br />' NO. FNEOUENC SAMPLE <br />TYPE <br />PARAMETER (4653) . (54-61) M 54-67) <br />(3H-45) l46-53) EX DF <br />(32 ~~) AVERAGE MAXIMUM UNI ~ MINIMUM AVERAGE MAXIMUM UNITS arvat.vsls <br />JO I 'S, 7' <br />~ SAMPLE ~=s... 1 ;t ~ ~ ~ r-~ ( 1 {/ /3 C~ C7~~t0 <br />, U S P F h L) E Ct <br />. MEASUREMENT .J <br />f>GSIO i U Q ..A MIT O ! ,r• y0r <br />~ _-.• :.C,,..: .: . <br />~ ~ .. E~ ,. <br />b'FFLUh~1<T GNOSS ~ALUE #iH•~ ANT _ <br />- ~ <br />• ~f44s} ~~}1~ Aq6 Ok~ir ,*'--. G/I r <br />~" -t1~ ' <br />;i0LIG5, SETT ABLE SAMPLE '`"~'~ ~a x~a a a `,^ 11 ~O~L ~~) i\ <br />U 1/ <br />J3 J <br />~vr. Iq <br /> MEASF~REMENT . ` <br />On~4~ 1 u U ~ ~ -r o0 ~;.: to aaaa ; ~~ rf! <br />eFE'LUENT GROSS YALGt RED' <br />~ <br />` ~* ~~::'~- ~ ~ tAb3 . <br />Iii. <br />~~ '~~~;~~ !-*, rlll ~~~~. <br />~ L~Y+~II <br />I NUd, :'GTAL <br />(A ti FE) ~ <br />SAMPLE <br />MEASUREMENT faaus 4~ •.~vi•'v +r c^it•.-: , <br />~- • U 1 <br />O' O ~ ~ ) `, <br />CJ ~{/~ <br />(-~ V Iy~ <br />~6 `c <br />UlU4S 1 U U PERMIT a0 9 :; r, '. 3. +0 ~ '.''~ <br />~' ~~ <br />t,fFLCL•tIT DROSS YALUE .AEf,1UIpEMSN7 `; <br />~ X>)4.'.. 3UCA AY6 O~YI• •~_` dC/I "" CX~6 <br />'ZL ANi1 LiiEA SAMPLE :~ C O a C+ rK>:~-.: /,-~ <br />lV ) <br />v <br /> MEASUREMENT <br /> <br />U 1Jtl1 1 U G ~ PERMIT aOAB ,ROm Lb%.< d ~1#. •~ i1 - <br />cF'PLUd:~7 t:f1055 YALG! RE=QUIREMENT '" tt;r~ ,j~~•~• EF#X EG/I •- 6Eff <br /> SAMPLE <br /> MEASUREMENT <br /> _ <br /> * ~~.pERMIT- r~a, ~ <br />~ 'I t ~' - .- <br /> a~Ef1~UIREMENT ="":~ -~.- = ,. <br /> SAMPLE <br /> MEASUREMENT <br /> ~4 <br /> ~RERMIT~ - d 'Ca~ <br /> RE41lIRPMENT .~ a <br /> SAMPLE <br /> MEASUREMENT <br />~ - <br />~i~.~'bRMYT ~ ~ <br />~FIEQUii~EMENT ~ ~ ?~-, ~ . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I~HAVE PERSONALLY E%AMINED AND ~ TELEPHONE <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY DATE <br />INQUIRY OF THOSE INDMDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING { ~ <br />/ <br />` J <br />THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br />ACCURATE AND COMPLETE. .I AM AWARE THAT THERE ARE SIGNIFICANT ~/' .J~L.~ - 1- <br />INCLUDING THE <br />ITTING FALSE INFORMATION <br />S <br />S <br />B <br />~ /, ~ ~ ~I <br />V <br />/ <br />. <br />PENALTIE <br />FOR <br />U <br />M <br />POSSIBILITY OF FINE AND IMPri1SONMENi. SEE 18 U.S.C. 4 1001 AND 33 U.S C. SIGNATURE OF PRyINCIPAL EXECUTIVE 1 (r <br />1 <br /> aoa end or <br />(PeneN'es ands. rnese swrures mey include tines up ro sro <br />4 1319 GENT <br />U AREA <br /> , <br />. THORIZED A <br />OFFICER OR A <br />O NUMBER YEAR MO DAY <br />TYPED OR PRINTED marimum imprisonment o/ Oelween a montrts end 5 years.) D <br />C <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all atlacnmenrs Here) <br />TS5 t. L5UN LIRITS 41II BI'. 4AIflEO E 3ETTLEA6IE SOL1I5 LICIT AYFLIEL FGi+ <=IOTB,I4EF FEECIF EYE~7: 7+_5, <br />IFON E SETTLEABLE SCI1D5 LIMITS 11ALYSD FOR ~1QY.A,:YBN PF.ECIF EYEN4 ~UkJECi TO BLFLEK CF FFC,CE I1 1.1.1. <br />1 C .C _ O <br />aae cr,.r.. aa~o.T rnR-9sl Previms editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ~ n nn v a nn.n ~ w ~..+s ~.d -~. PAGE . + O.F <br />