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PERMITTEE NAME/ADDRESSRM,L FrWyNawiae,ilm l/DIQ.r,q <br />ADDRESS~AD$ITJE EIYNE, B E S POA'PAl$ <br />P.U. BOX 1430 <br />PALISADE CO ilLi26 <br />FACam <br />LOCATION <br />A'TiN: JONh A. MCNAB, PtiESIDEhT <br />- PARAMETER 13 AFd Only/ QUANT <br /> N5-531 151-611 !3~-IA1 l/653J 75i-a1J EX TYPE <br />/37-371 MALY95 <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS iaa-an /51-5g1 la&701 <br />LC~U STA'PkE 4BNR AC SAMPLE ao:zsaa JCr00ila ~o-a#000 aL0000 ( 23) <br />~ <br />CEHIUDAPNNIA MEASUREMENT ~ ~OQ ~ ~~ <br />TAMjH 1 U 0 PERMIT Op:S?L!Rtp GIOp9#A17 Ou0 S.DQ'.dOq.i. a04~4iP. <br />.. <br />.. a>a>E~a>a. BR- '~IiI,Y :QAB <br /> <br />EF'FLUEhT L,NOSS YALU REQUIREMENT : ~ ~ <br />;:....;,., ~~ <br />:";: <br />ba00 <br /><~M..::~ LU ... - <br />. <br />LCSU ~f A;fLE Y6Hfi AC SAMPLE OL=aOaa CI EUp6a9 OC4+ROa OOaaat ' 23~ / <br /> <br />l'tfnlhAL6$ <br />MEASUREMENT <br />O~ / <br />In N6C 1 U O PERMIT ###~ :?Of11L.. ~ g.°:.~~EY!R?t~Al9ty!;:~.~. 400 (~':N~Q{) <br />~~ <br />~: ; <br />~. <br />sy±n~a,a~':~ '~- y,:::#+C~A!O~+QIIA~•'' jR- s <br />: `z liLY ;R~A6 <br />tfFL'Je>~T GROSS VALUc REQUIREMENT : <br />% 4a4a : <br />. <br />:~ : ~~ . <br />. <br />' k:: ~ ~ ~. <br />: <br />r'° » <br /> ,, . ~ s <br /> SAMPLE ~ - <br /> MEASUREMENT <br /> PERMIT ~ - ~ ~ ~ ~ : <br /> REQUIREMENT ~ ~~ <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> .~ PERMIT ~ . . , .. .. ~- - <br /> 'REQl1.IRENIENT <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT - .. ., ~. .. ~ . <br /> REQUIREMENT ~ ~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~~ ~ <br /> REQUIREMENT: ~ ~ I <br />~ <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER I cERTIFr UNDER PENUTr of uw THAT I NAVE PERSONALLr ExAMINED MD <br />AM FAMIUM WITH THE INFORMATION SUBMITTED HEREIN: MD BASED ON I <br />~ TELEPHONE DATE <br />T <br />E ~ ~ l7 `~ C ~ MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />I BELIEVE THE SUBMITTED INFORMATION IS <br />OBTNNING THE INFORMATION <br />J <br />~l , <br />TRUE, ACCUMTE MD COM0.ETE. I AM AWME THAT THERE ME <br />INCLWINO <br />SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br /> <br />~ ~ <br />. ~ . <br />THE POSSIBILITY OF NNE MD IMPRISONMENT. SEE 18 U.S.C. 11001 MD ]7 <br />BIONA E OF PRINCIPAL EXECUTNE <br />X74 11 y1 <br />~ ~" "'O ~ 7 <br />O <br />l v <br />. U.S.C. f 1]1a. lAnW6r, I,Wr N.,, mNy, m,Y Ax.'/u0, r,waW ro iIO,000 AR A' <br />TYPED OR PRINTED wwn.,rt/n.,n inplvlrnanrWA,rwwn anwnN, rwayw,.l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV <br />~. <br />,I <br />COMMENTS AND EXPLANAI lON OF ANT vIVLA I Ions lNerorence sn ertecnmenra oars! - <br />:ibL PART I.D.4 FOit DETAILS OF TEST PROCEDUitE. dPY COYEST DILUTION (.EF'fLUENT) YHICH IS LETHAL TO SOX OP <br />'IIQyT OiLGANISHS ([,~CSU) L ATTACH ACUTE TOXICITT TEST REPORT FCR!" 70 DHR. COPIES Cf ALL LNPO HUST HE :,ENT <br />may <br /> <br /> <br />PERMIT NU MBER DISCHMGE NUMBER f- F I 1 A L <br /> MONITORING PERIOD '~ I RO R <br />YEAR MO DAY YEAR MO DAY <br />FROM To :~:~ NO DISC HAHCL ) <br />1 ~^%~ <br />!16211 177-731 121-I51 176-771 118-Z9I 1363E/ __ <br />NOTE: Read InaLUCtiona before complatin0 thia form. <br />TY Qg~QADING QUANTITY OR CONCENTRATION <br />!1 GEQ Onlyl NA FREQUENCY BAM <br />PI F <br /> _ . T ~ I <br />00300/9662s3-1256 r"~" 1 <br />