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FFRMITTEE NAME/ADDRESSO.~'A/risWryN.r/Lovu! dD/Bta.ei) -- <br />NAME..- t@i1AC$MGAIt C'IItL CSEPiYt _ .T ~!_ <br />...emu'-___ <br />ADDRESS HUADSIDE ;~;'lE, F ~, 5 PORTALS <br />P.J. iiU1I 1430 <br />PALISADE CO 91526 <br />FACILITY <br />LOCATION <br />A TTN7 dORiJ A. r,'NAF_ D.:: e7h: ar <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 4 TO ~ <br />/10/11 l11-I31 /II-75l 1I6T7I !IB-79/ /30-311 <br /> <br />(Sl1BA iC) <br />F - PIIiA1 <br />nINOR <br />re605-3 h88 -~ <br />45 <br />ot=~ Nn gi[SCHAkC6Pi 1~~ "~~ <br />NOTE: Res mtruetlons • w Istinp thh fwm. <br />PARAMETER l3 Grd On(YI QUANTfTY-OR-LOADING---- -- pGr{{On/v/, -QUANTITY_OR.CONCENTFIATION _ _ __ <br />~ NO_ fAEOUENCY SAMPLE- <br /> M5-53 /5b511 l38-a51 196-53/ 1516/1 OF <br />l31-37! EX <br />ANALrss TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />IL ANU L;HEASr SAMPLE >,IpOOP~ (ga) o~srsoo aloao4*.+ aoaata <br />- <br />V I i3 U A L MEASUREMENT <br />84U66 1 0 0 ....PERMIT:'.' <br />1 <br />yREQU1REMENT :>?i#Ill~rf. . <br /> <br />~~~ <br />Raa.Pts1~7 <br />Ys=1 <br />O.g4'P+O>;? <br /> <br />;, <br />~ ~~ <br />e~a>a?~s <br />a»:dg+p#;: <br />plop <br />BSnLY <br />'~SUA.L <br /> " '.:'P: ~.~ ... ... .. .: .. ~. . <br /> SAMPLE <br /> MEASUREMENT _ ~ - <br /> AERNIIT <br />~: ~ `. ...,. <br />:. <br />.. <br />:..:':: . <br /> <br />, <br /> . <br />:REQUIREMENT ?-: ::....::: .::.(.':....r <br /> <br /> <br />. <br /> <br /> <br />. <br /> <br /> <br />....... :. <br />f! <br />3i) :. <br />_e::'.. <br /> <br /> <br />. <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT <br /> <br />~: <br /> <br />.. <br />~ ... <br /> <br />.... <br />~ <br /> <br />~ <br />~ <br />~ ..... ., .. <br />. <br />U <br />' ~ :REQUIREMENTS ~ <br />. ~ . <br />~ <br />.. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , <br />~~ <br /> REQUIREMENT ~ ~ ~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> ~:. ~. PERMIT .. . .... .. <br />~ <br />' ;REQUIREMENT ~ ~. .. ... ::. . <br />. ~ ... - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . <br /> :REQUIREMENT~ ~ ~ ~~ - ~~ ~ <br />~~ ~ ~ ~~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :~.: .: :~ ~~~~ .. .. .~ <br />~~ <br />~ . <br /> 'REQUIREMENT': :. ~.:. ~ ~: ~ ~ ~ . .:. <br />:. ~ .. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTr OF UW TNAT I HAVE PERSONALLY EJlAMINED AND TELEPHONE DATE <br /> AM FAMIUM WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON <br />l <br />E <br />~ 1 ~ `, e r <br />r MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />O <br />I <br />. TRUE, ACCURATE AND COM0.ETE. I AM AWARE THAT THERE ARE <br />SIGNIFICANT PENALTIES FOR SUBMITTNO FALSE INFORMATION <br />INCLUDING <br /> <br />+ <br />A , <br />1 100 <br />THE POSSIBILITr OF RNE AND IMPRISONMENT <br />SEE 15 U <br />S <br />C <br />~/1 1 <br />~~ <br />y <br />~ ~ n <br />l <br />%) <br />~ ~ h , <br />. <br />. <br />. <br />1 AND ]] BIONATUIIE OF PRINCIPAL E%ECUTNE } <br />" " <br /> <br />ti' TYPED OR PRINTED U.S.C. f 131 e. lFYn.IFYF YWI/ dMM mlvns m.F kI[aW fvr. w ro S IO,OOD <br />Wwmuinun MplawlwlrWbMwr snwlN. NdbF•val <br />OFFICER OR AUTNOR2ED AGENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAV <br />GVMMCNIS ANV [nrapnnllVn yr nnr Ylvanllvrva lrtoermce an errscnmenu nere/ ' <br />:,~:TTLBAbLE.SOLIDS LIMIT APPLIES ONLY IF <=lOYii/24HA PRECIPITATION LVF.6T IS CLAItED. PEHMITTEE f1A5 <br />±+UHUE:FI OF PRDOP YHPN R6{~UESTING HELItP FROH SETTLEABLE SOLIDS PRIt1ARY LICITATIOlIS. <br />EPA Fwm 3320.7 108-96) Previous edidone mey bs used. /REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />• 00574/990223-1255 2 <br />u <br />