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PERMITTEE NAME/ADDRESS prYdr F,cd~ryNae/Loeaaen UDg...,,q <br />NAME POYDEBHORN COAL CO;IpAM1' <br />ADDRESS ROADSIDE t!~IN)r, N 8 S PORTALS <br />P.O. BOY Il13i1 <br />PALISADE CO b1526 <br />FACILITY <br />LOCATION <br />nTTN: JOHN A. Y~h.16, P~f;SIDENT <br />NAn'6RALCb[LTITANTTSISEHMGE EOMINA bja'4YSiEM INPDESI <br />DISCI(? 96 E MONITORIy4 RER9~1Y IOM! <br />a <br />PERMIT NUMBER DISCNMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY . <br />FROM TO <br />126T Il l12-131 !II-751 II6-271 178-291 /36311 <br />-~ ~ - ~ ~- ~ ~ . ~ ~~ - form-APProvad. <br />11CII~1=' ~R4 lESSIYC°"~~P~ ~-App4 <br />(SURE ,YC] APProveLesA14405-31-93 <br />F - FI IAL lLL'' ]] <br />I!I9CR <br />a.a HO DISCHARGE ( ~ ~~`~ <br />NOTE: Reed Ins[ructlaru before eompletinq thy form. <br />PARAMETER 13 Grd OnlYl QUANTITY OR LOADING !4 Grd On/Yl QUANTITY OR CONCENTRATION ND- FREQUENCY SAMPLE <br /> (46.53) (50-61 t38-461 !4653 l5L611 <br />EX DF <br />TYPE <br />l32-371 MN.YSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !s2-sal I6q-66) 163701 <br />1, I_j0 S'TATEtE 4f3HE AC SAMPLE r~aoau Y+;Yfiaa;11 <br />~ ~r,>nfiA6 ~ fi>ZfififiO ( Z3] /~~' <br />C6RIUDAPHIiIA MEASUREMENT ~ ~(,J Ins7++ <br />TAM3ts 1 C U PERMIT Ofiltt>gp# 'IGFOlk9rY <br />- a9C idQ9.pQ1... +ao41d~0. ..:+RpA?AIkE . IER- <br />~ TiiLY iRA6 <br /> <br /> <br />AFFLUENT GROSS YALU! <br />REQUIREMENT. <br />.. <br /> <br />fiwac <br />~ <br />i~k[..~: LltB <br />: ~, ~ .. ~ <br />, <br />: <br />`..~~. <br /> <br />...:. . <br />L L:SU STAT k>± 96Hk AC SAMPLE 44pait4 RCrtOOA ~ aaa>afa rY 44p O+p ( 2»' <br />F' I h E P H A L h S MEASUREMENT ~ ~ J <br />f AtioC j U U ~ PERMIT;' ~~ ts4A!Ol~rir •. ~rk$>DI##O :- 1ppR <br />~~~t900I . <br />. ^:MK?O+t±a~T1.. <br />:'~-!M>!A?f9~R:': <br />IER- <br />~ <br />T14L7( :. <br />.R~a~ <br />c:FFLUEST G80S5 YALU. .REQUIREMEN7 04GC "'•` k <br /> SAMPLE ~ - : ,~f <br /> MEASUREMENT ~ ;{I~3-'-'~. . <br /> :. PERMIT. ~ ~ .. -,:,_ ~:~ <br />'~ <br />~ <br />-l <br /> ~REQUIRE <br />MENT ~ ~ ~ .:~: ~:: r, :.,. . <br />. .. - <br />r <br />t. <br /> . k <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT:.:. ::. :;.,.. <br />. <br />. ~ ~.,.. <br />.: ,... <br /> <br />.REOUIRENIENI':: <br />............. . <br />. <br />... t.:3: <br />:: ~: :...:, ~.: ~. <br />..:....:.:. .. . . .. <br />.. .,.,., <br />...: ~ -.:.:o~.:. ~ .... ... <br />... <br />~:..::... , ~... <br /> <br />. . <br /> SAMPLE ~ ~ ~ - <br />- - <br /> MEASUREMENT <br />' r .~PERMIT'::..:~ : :: .: .~~: ~~.-~ .. :. <br />~ <br /> :REQUIREMENT <br />.... ~ ~ ~ :. ... .. ~ .. . . <br /> SAMPLE ~ ~ - <br /> MEASUREMENT <br />~ ' <br /> ~~ PERMIT ~'~ ~~ ~ ~~ ~ ~ ~ <br /> .REQUIREMENT ~ ~ ~ ~ ~ ~ ~ .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~ ~ <br />~ <br />~ _ <br />~~ <br />~ ~~ <br /> ~RE.QUIREMENT •~ ~~ ~ ~~ ~ <br />- <br />~ <br />... <br />NAME/TRLE PRINCIPAL EXECUTNE OFFICER I cERTI <br />AM FA FV UNDER vET+N.TV of LAw THAT I NAVE PensoNN.Lr ExAMINEO MD <br />MIUM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br />`, ^ I ,{ ` <br />~A//L` //T~ ELF S -~ <br />~ OBTNN NGRTNE MFORMATIONDIIRaEL1EVE THE ~SU9MITTED EINFPoORMATION~a J <br />r" / <br />/7..,, <br />/' d I ~~ ~` ~ <br />! <br />TI'?O TRUE. ACCURATE MD COMPLETE. I AM AWME THAT THERE ME <br />SIGNIFICMT PENALTIES FOR SUBMITTING FN.aE INFORMATION, INCLUDING <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 15 U.S.C. / 1001 MD ]] <br />-r <br /> <br />810NATURE OF PRINCIPAL EXE E <br />9 6y ~~ <br />/~ <br />J <br />' ~ u.s,c. E I ]1s. larr/a, up,r rA.~ ,ann., rner hrAN, rw, w ro sro,ooo <br />TYPED OR PRINTED .red or m,rmvn L~np/snrnNre ereerweenemonN, rgsFwa! OFFN~R OR AUTHORgED AGENT CODE NUMBER YEAR MO DAY <br />~;~ <br />,'4 <br />s <br />f <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRdersnce s!l effechmenfs here/ <br />SEE PART I.Be4 F06 DETAILS OF TEST PROCEDURE. AEFORT LOHEST DILUTION (R EPFLUfYT] YHICH IS LETHAL TO SOw <br />JF TEST OkGANISRS (LC50) AND ATTACH ACUTE TOYICITS LEST REPCRT FOAH TC CMA. COPIES Ot ALL INFORMATION <br />MUST RP r'ltYT TTl 44s. ~ ' <br />EPA Form 3320-7 108.961 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) D C 369 / 9 8 G 2 2 3-12 5 6 PAGE IOF <br />