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PERMITTEE NAME/ADDRESS /l+dre.vxwy N../t«.na. //D~arnn <br />NAME ~,ifi:;l:n C::)AL COM6'A,.'Y <br />ADDRESS DftAa L.`. U <br />NAYU~N <br />CO B1b33 <br />FACILITY <br />LocATION }, A Y ,~ c N CO B 16 3 J FRI <br />ATTN: G. ol1U BROWN, E!~E:tAL ^IA8A~t8 <br />Fotm Approved. <br />,• C '. C N A F 0 4: T G G S A yoke luoft2o~oooa ~~ <br />I$ U F fl h W) Approvelafp~r~ ~OS-31198. <br />F - FTfAL I <br />4[Nr,F <br />~~~ Nc DTSCeAPC~ 1.~1 ~;~ <br />NOTE: Raed Inetructiam before completing this form. <br />PARAMETER l3 Grd On)yl QUANTITY OR LOADING Grd Onlyl QUANTITY OR CONCENTRATION ND, FREQUENCY SAMPLE <br /> 146-531 /50-611 135-151 146-531 I5t67/ <br />EX of <br />TYPE <br />l31-371 ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !s:-sal l6a651 158-701 <br />L A\J ., n. f. i[. SAMPLE ~i'. r~3:r'~% 1 yq~ 'Y;.h~OC 9;fJ J'::'+ 5;:~^*: +'' /~ 1 <br />Y I r U A L MEASUREMENT O <br />~ V' , U I S <br />t3Y000 1 0 G PERMIT ~:Lt~;=~:9 L' REPbRT ~~~ Elea C AA4*frt >xq;>r z>ro #3Y4-,:: :~:+"~ ~ <br />E~FLY ' <br />YISLki <br />E'F-LJk:NT JFOSS VALU: REQUIREMENT .- <br />IN~'F K-Y NC=D n~~'°'~' <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> .REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UNDER PENALTY OF UW THAT I NAVE PERSONALLY EXAMINED N!D <br />AND BASED ON <br />FORMAT <br />N SUBM <br />TTED HEREIN <br />M <br />LI <br />R <br />TH T <br />E TELEPHONE DATE <br /> <br />~p V\ V` \S Oke~ ; <br />AM FA <br />I <br />A <br />WI <br />H <br />IN <br />IO <br />I <br />MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />'^~ <br /> <br /> <br />/ <br />~ TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE <br /> <br />INLLUOING <br />ANT PENALTIES FOR SUBMITTING FALSF INFORMATION <br />SIONIH <br />I <br />1 <br />~ <br />/ <br />(/L_ l/() (Q ~ I J ~ ~ , <br />C <br />THE P955161UTY OF FINE N1D IMPRISONMENT. SEE 18 U.S.C. 1 1001 )J1D 3] 1 <br />E ~~ ~~ ~~ O ' 2 <br /> <br />~ U.S.C.11]1e. lPrrb'.A UrK~r MrAbruha mFY hcMd/r.r+4ero SIO,OpO 4NATUR <br />OF NCIPAL E7EECUTNE <br />6 AREA <br />PRINTED <br />TYPED ua ar nva.rwni~plarmanr el ern..n e,nwlN,.vsy..Al OFFlCER OR HORIZED AGENT CODE HUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell eftechments here/ <br />SS.; & IAN LIY.1T5 GILL 3E GAIV2D E S°TTLE.AFL.°, S')LICS LI°I7 AFFLI°C Ftf <=10YF,7.4tiF YRFCIP EYF.y7; 2`_~~-~, <br />i itJh 6 ScTTLLA3LF. ~OLZDS LI1IT5 tiAIVED FOR >lOC:t, 217Hi: PNdC IF fVfN7 SG FJFCT TO ELuL--°,N OP PROOF IN I. A. 2. <br />I,il. i. GFLr'FSF.-`:PF T.R.T- ~. Tn~ Nflti TTfiGTNG i 7_T -~_ <br />EPA Fwm 3320.1 108-96) Previous editions mey be used. ~ (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.1 0 0 C 0 6 / 5 7 ] 0 .'~ 1-1513 PAGE ,OF <br />