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PERMiTiEE NAME/ADDRESS (/neiib FrYtryNaw/laranan!/D1~nm) TAVD[es`SBiSE1RYd /° <br />I !~]. <br />~-^ <br />~ <br />___NAME. D/l L'7G.Q N.r1 Rk C9AL ll)!1 P~t~{~--# ___ .._.__ , <br />~+_ <br />~ IT ING~ .~ f _ _ <br />-~~ -~ <br />-.ADDRESS ~~II~-D E~ %IHE, h ~ PORT-ALS C Z'~ 4 <br />P • U . NO X 14 3 0 PERMIT NUMBER DISCMMGE NUMBER <br />PALISADE CO d15Zfi <br />FACILrrr MONITORING PERIOD <br />LOCATION YEAR MO DAV YEAR MO DAY <br /> FROM TO <br />ATfN: JOHn A. N.CK AE, F:LESI DENT n61r1 rz1-131 n4151 116171 l18-19I !363/1 <br />_ _ _ -~~agEr_ roved. -. .. <br />F - FINAL L.1 <br />MINOR <br />~+~~ NO DISCHARGE ~~ ~~'+ <br />NOTE: Reed Inetruetlorr before completlnp this loan. <br />-PARAMETER !3u/d On[vl OUAN'NTY OR-LOADINCr - -,. N-GrdQnNl---4UANTIT-Y-OR-GONCENTFWTION----- _ -- _ -NO., FpEOUENCr SAMPLE <br /> 146-531 154-51 l38-~51 !1653 151-6/ GF . <br />l31-371 EX MALras TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !et-6.11 154681 15&701 <br />'IL AND .;REASr: SAMPLE GYiVaa4 ( 9b) 40441Y4 4E44>!b 4C~p>ti tA4 <br />Y ISUAL MEASUREMENT ' <br />B406b I U U PERMIT .:: 0041-4tt . .: 88Y33RT ES=1 4014t71R?F. . . <br />: OO~A~i±6 :': 4:fsq:tP:Oq'.:; '444 LIC~Y ISUAI <br />BFFLUL'NT GHO55 YALU ;REQUIREMENT.. ..~ .::, ' .'. sY N SP~.NfA% NOaO i:: :.'.:?' '.:: :: . ;" 0404' <br />.,: <br />.:. , . <br /> .` SAMPLE - - ~ - <br /> MEASUREMENT " .~ ~ - <br /> .,.., <br />~ <br />. <br /> <br /> ~~ <br /> ~ <br />S WIPLE ~ . <br /> MEASUREMENT - ~ . <br /> ~~ . <br /> .PERMIT ~, .... ... .. .. <br /> REQUIREMENT <br /> SAMPLE <br />. n <br />?'% - <br />! MEASUREMENT ~ ~ ~' <br />fi>.f.. <br />~~ <br />' PERMIT <br />~ <br />K ~;' <br />~:. <br />. REQUIREMENT <br /> ~~ <br />'~ SAMPLE ~ <br />~'~ ~ MEASUREMENT ~ }e <br /> <br /> ~REQclIR~111~~NT.;: r .~ <br /> , <br /> SA <br />PLE - <br /> MEASUREMENT ~ ~ - <br /> ~: ~'~PERNII r <br />::... <br />~~~ - .. ~ <br /> <br />~ <br /> <br />~ ~ . <br /> :;REQUIREMENT ~ .. ~ ~ ~ ~ ~ ~ ~ ~ ~ <br />,. ~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> ;:::.PERMIT ~.. .: ~ .. <br />~ <br /> ::"HEQULREMEM~: ~. :.. ~ ... ..: - .. . <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI <br />AM FA Fr l1ND[R PENALTY OF LAW THAT I HAVE PERSONALLY E%AMIMED MD <br />MILIM WITH TIE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br />C y O V P ~ <br />T L <br />J T~ MY INQUIRY OF THOSE INDINDUN.S IMMEDIATELr RESPON98LE FOR <br />OBTNNING THE INFORMATION <br />I BELIEVE THE SUBMITTED INFORMATION IS _ <br />. <br />G , <br />TRUE <br />ACCUMTE MD COMPLETE <br />I AIA AWME THAT THERE ME ~ ~ D <br /> , <br />. <br />SIGNIFICMT PENALTIES FOR sUBMITTING FN <br />sE INFORMATION <br />INCLUDING <br /> <br />~ . <br />, <br />THE POSSIBILITY OF RNE MD IMPRISONMENT <br />SEE to U <br />S <br />C <br />E 1001 MD 37 <br />~70 '/ [ <br />~ y~°~ <br />° ~ <br />Q <br />(t Y\ . <br />. <br />. <br />. <br />E rat 610NATURE OF PRINCIPAL EXECUTNE YJ <br /> u.s.D. <br />e. IPNWniI utMr err •6nm• m•r behnl• M.r w ro s IO,000 AREA <br />TYPED OR PRINTED •ns ar nr..Ym•niwd~a+Pn•'rr O/brwrnemoney rw6r••ral OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />GVMMCN I5 ANU CAI'LANF I I Vrv vT nn T Ylvl-n t n+na Inoarmce en enscnmon rs neref <br />51rYTLEAbLL SOLIDS LIMITS AF•PLIt:S ONLY IP C=lOYR,Z4Hk PRECIPITATION EVENT IS CLAItlED. PEHNITTEE iiAS <br />bU6UEN OF PROOF ViHEB P,a,~UESTING t2ELIEP FROM SETTLEABLE SOLIDS PRIMARY LIMITATIONS. <br /> <br />j:; <br />44m <br />t yr <br />) <br />I! <br />EPA Form 3320.7 108-961 Previous editions mey be used. (REPLACES EPA FORM TaLO WHICH MAY NOT BE USED.) 0 04; 4/ 9 R C 2 2 3-124 6 PAGE ~OF <br />