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PERMITTEE NAME/ADDRESS R+eYO fru~ryNew/la,nr dDlO.uq -_ _ _-z <br />NAME-__R.(jj(j1E~µ(l~( caAL sa~PA-i~r - -- __ __ ___ <br />ADDRESS gC~A11~IDE !!INF., N !; S PORTALS - <br />P.O. BUY 1430 <br />PALISAD? CO 81526 <br />FACILITY <br />LOCATION <br />AT'[N: JOHN A. C.LNAB, P96:iIDENT <br />DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />170-I11 111-731 !II-751 !16171 138-191 !30311 <br />F - PIIAL <br />!!INOR <br />ova NO CISCRARGE ~~ ~~~ <br />NOTE: Reed lnstructlaro before ompMtlnp this loan. <br />PARAMETER - - 13.Grd OnNI QUANTITY OR-LOADING- -- N UrdOgNI--GUANLTY.OR_CONCEN7VATlON _ _ -_ _ ~~ FREm1ENCr SAMPLE <br /> !46531 151-5! 38-161 p6531 15I-5I1 DF <br />l31-371 <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS . EX <br /> <br />111.691 <br />MALVSIS <br />(81-88J TYPE <br /> <br />169-701 <br />ND LiR ASE SAMPLE '[+00000 ~ 9V) >b40Dt+0 3~Oaaa ~ asaoao <br />V I ~ it A L MEASUREMENT <br />tl4U66 1 0 O ~~:=:f. RMIT.:.,.. <br />I..«..,~ : ' Ip.ai+P171~1i0 <br />~ <br />~ <br />- BSPDA:T E5=1 0#Id1D#9i .+i~104g1t1:#... .. +6AIRIg/1:.;. LY00 .:; 'E'~tfL.T: ISpA. <br />::PFLUBNT G@0$$ VA,LU <br />. E,QU ~iEN1ENT. <br />.: <br />'. ..: :: <br />.. <br />. ... <br />..:~~S.T~'~lCA.x <br />^0=4 <br />~.., :. ~:: :~~~.. ~.~:. ..~ <br /> <br />.. .. .... <br /> <br />.~.: r . .. .. ..:. .. :. <br />~~.:~ a <br />T4i0' <br />:i..•a <br /> <br />,, .., ..... <br />'.:. ' <br />' <br />- SAMPLE <br /> MEASUREMEI~IT '. <br /> <br />~ ~ <br /> <br />: <br /> <br />~ ~ - <br />-T <br /> PERMIT .. ...~...... _ ... a., ':,,: <br />., ... <br />l '. ': <br />, r <br />~ <br />x <br />. <br /> <br />:REQUIREMEN'F~ <br />. s <br />r` <br />,?; - (. <br />~ <br /> h _ _r _S , <br /> SAMPLE <br /> MEASUREMENT - ~ ~ n'~~-- <br />. PERMIT ~ ~ ~, <br /> REQUIREMENT - ~' ~ - ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~ ~ ~ ~ ~ ' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> .; .PERMIT. ..: .. .. .. ... <br />.. ~~, .. <br /> ,9EQUIREMENT ~ .~: ... .. . <br />.. ...... ;~... ........ .~ <br /> <br />,. <br /> <br /> <br /> <br />. <br /> <br /> <br />., <br />= <br />~ <br />i' . <br /> .. .:. ..:. ..:...:: :: <br />: ::: <br />:: <br /> SAMPLE ~~ ' <br /> MEASUREMENT ~ ~ ~ - _ <br /> PERMIT <br />. <br />.: ~ ,' -.' ~,:~ <br />,.. <br /> REQUIREMENT ~ ~ - ~. ~ .. ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~- ~ <br />~~~~ <br />~ ~ : ~ .. <br /> REQUIREMENT: :~: ~ <br />~ ~ <br />~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED MD - TELEPHONE DATE <br /> AM FA MILIM WITH THE INFORMATON SUBMITTED HEREIN; MD GASED ON <br /> <br />T t <br />~ p ~ ~ ~ MV INQUIRY OF THOSE INDIVIDUALS IMMET)IATELV RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />Q <br />~ TRUE. ACCUMTE MD COMPLETE. I AAI AWME THAT THERE ME f / <br /> SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING - l <br />' <br />1` <br />r <br />~ , <br />THE POSSIBILITY OF FINE AND IMPI1180NMENT <br />SEE to U <br />S <br />1 AND S] <br />C ~~ `/ <br />~~- <br />~OI ~ ~ L~ <br />1 p fl <br />H . <br />. <br />. <br />. ! 100 <br />B <br />I giONATURE OF PRINCIPAL EXECUTNE " <br /> <br />v U. <br />.C. 7 1010. IKrI. <br />S. uIM IMr Wfuh. ^wY NrAe7. rxwa Ip ro !!0,000 <br />TYPED OR PRINTED .nsanr.irwe nWirmrrr o/srlwrr16 monuraW 6Yrral OFFICER OR AUTNORI2ED AGENT CODE NUMBER YEAR MO DAV <br />+R <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference sll sftschments here) <br />;2TTLBABLE SOLIDS LI!!IT APPLIES ONLY IP <=lUYk/24HR PRECIPITATICM EVENT IS CLAIMED. PERlTITTJE HAS <br />bUitD@N OP.PROOP WHEN RE1~Uk:STING RELIEF PRUH SET2LEABLE SULIDS P6IMARY LIMITATIONS. <br />Epp Fwm 3320-1 IDS-951 Previous editions may be used. (REPLACES EPp FORM T-40 WHICH MAY NOT BE USED.) O 049 4 / 9 B C 2 2 3- I Z S b ~ PAGE , OF <br />