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--r <br />PERMIFiEEHAME/ADDRESS O.dV•F.emryNawL«anw pDy~rrmq - - - -' -- <br />NAME--FGLILlritt40}tN COAL C(}lfPktlt-- <br />ADDRESS b~b~IDE tfINE, N E S PORTALS <br />P.O. BOY 1430 <br />PALISADE- CO 91526 <br />FACILITY <br />LOCATION <br />aTTN: JOHd A. NCGA°, PrESIGHNT <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />1762/1 177-731 171-751 /16771 I7B-791 !36311 <br />(SDBA iC) <br />P - FINAL <br />MINOR <br />1=98'~ <br />nCO NO DISCHARGE ~~( V'^~^~ <br />NOTE: Raed Irntructiaro before co pletinp this Corm. <br />PARAMETER 13A.d Onlrl -QUANTITY OR-LOADING- -- - ~ I1-frd-Onhl:- OUAN7ITY-OR-CONCENTRATION - - - - ~N FREauENCr S'AMPL'E <br /> !1653 F51-511 !38.15 !1653 151-611 EX DF <br />137-371 <br />ANALrsls TYPE <br /> "AVERAGE MAXIMUM UNITS MINIMUM AVERAGE -MAXIMUM UNITS Ie2-e]! (5/-6gl 159-701 <br />L AND GREASE SAMPLE Eke4~#~A ( 94) 0~#0#0 Yd Oa}¢Oa 4ROOp4 <br />Y I ~U AL MEASUREMENT ~ ~ - <br />tt4U65 1 0 0 '." PERMIT ; OIyiIDa#Lr REPORT BS=1 .4i>a~7## , . ." ~!OO+Y~:4 d1+6~lIC>it': #4# '` E&KL3 .:~SUAI <br />EPFLUEN2 G$OE5 VALU REQUIREMENT :'; ' ~~7f <br />~R$'~ <br />' NO=0 ` fl . <br /> . <br />.. <br />. .<., 4#O <br /> SAMPLE ~ ., ~ ., - <br />' MEASUREMENT ~ ~ ~ -- ~ %= <br /> ~ .+ <br />r <br /> <br />f <br />3 <br />i _ _ <br /> <br /> <br /> <br />. <br />•. <br />>zr <br />., ~:. <br />,.,.. _ .. <br /> <br />I;:.~-. <br /> p :. -., . .. <br />,> <br /> " •SAMPLE <br />' MEASUREMENT <br />- PERMIT .: ,:: :::. . . :. <br /> REQUIREMENT <br /> <br />~ ~~ ~~~ ~ '*~~'` <br />': <br /> SAMPLE ~ ~ ~ ~ " <br /> MEASUREMENT <br />- <br /> ' PERMIT ~ ~ . . ~:.: „ <br />" ,.. .. <br /> ~REOUIREMENT ~- :..:.j,,~. < <br />.. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,: ., <br />:. <br />~ ~':' <br /> ~~HEOUIRENIENT <br />-. <br />~ ..:. <br /> <br />... . <br />..:: . <br />.. .. <br /> <br />.:. <br />:;:.. <br />":+"e^:. ~.: ~:~; <br />,... . ~ <br /> <br /> <br /> <br />x <br /> <br /> <br /> <br /> <br /> <br />. `,., <br /> ,.. ~:... v.,:.... ,.... -. :.. .. <br /> SAMPLE ~ .~ _ '~ <br />" MEASUREMENT '- <br />. - <br /> . .PERMIT::... :.:.: <br />~ <br />~ <br />~ <br />~ .. <br />... .. <br />~ <br /> REQUIREMENT' <br />,.:. ~~ <br />~ <br />,.. ~ <br />~ ~ ~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT' ~ ~ ~ ~ ~ - <br /> REQUIREIuIENT~ ~. ~ ~~ <br />~ <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I HAVE PERSONAUr ExA/AweD AND <br />i eennFr u11DER PENALTY of uw THAT TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SVBMITTED HEREIN; AND BASED ON <br />r }1 <br />S E J <br />D V C (' MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IB <br /> <br />~~ <br />I TRUE, ACCURATE AND COMRETE. I AM AWARE THAT THERE ARE <br />SIONIFlCANT PENN <br />TIE9 FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />t <br />~ ' <br /> , <br />. <br />t <br />1 <br />T <br />E [ <br />~d / <br />~ O ~ <br />J { <br />Q <br />U <br />C ~ THE POSSIBILI <br />Y OF FlNE AND IMPRISONMENT. BE <br />1B U.S.C. 1 <br />00 <br />.AND 37 IONATlM1E OF PRINdPAL EXECUTNE / <br />" I <br /> u.S.t. E r 71 e. IAIn.lFlr. uwr rMr mnm. m.r MICAiN Pows ~ ro S roaav AREA <br />J <br />TYPED 011 PRINTED .b nnMaim.n hwHaemrtt el MnrrnemprNa.n06Yr'>! OFFIdER OR AUiHORRED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS ANU EAYLANAIIVN Or ANT VIVLA IIVNJ IlrerlreDCl eII IRIC/ImeDES nere/ <br />SETTLEABLE SOLIDS LItlI't APPLIES ONLY IF ~l0YR,24HR PRECIPITATION EVEN1 IS CLAIt1EC. PEAtlITTEE HAS <br />tiUiiDEN OF PRUOF NHEN AdQUESTTNG RELLEF f$Of1 SETTLEABLE SOLIDS PRIMARY LItlITATI015. <br />~.,]~ <br />?j. <br />EPA Fwm 3320.1 108-951 Previous edlnons mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 OO S 3 4 / 9 B C 2 13-1 ~ S G PAGE ~OF <br />