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t <br />ADDRESS IdE FIIIfE, A ~ 5 PO'R ALS t <br />p.o. sox 1u30 <br />PALISADE CO 41526 <br />FACILITY <br />LOCATION <br />hT2N: JOKY A. ^1CHAH, FkESIDENT <br />DIBCNMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAV <br />FROM TO <br />(1677) 177-73) 174151 11617) i18-191 1303// <br />{5U8~R 'iC) A P ~ ~53t-9A'T"`~ <br />P - FINAL a <br />.~. <br />nINoR ~ r;a, <br />### NO DISCHAAGE ~~ aa# ~ :,_~ <br />NOTE: R.ed Irntructloro b.t«~ pbtlnp this t«m. <br />PARAMETER f3 Qrd Oo[y! QUANTITY OR LOADING is Rrd Orthl QUAN LIY.AR CONCENTRATION Np. FPEGVENCY ~SAMPE <br /> /Ibb31 15481 !3B-I5I !4653 !546/l OF <br />l31-371 EX <br />MAlYSIs TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 1s7-sJl 161-SB) l6&70/ <br />LC ~U STATHF. 4tl11k AC SAMPLE ##aS#O ###a## ###+}## #9C0#Ip ( 23j <br />C:,iiIODAPHNIA MEASUREMENT <br />TA%38 1 U 0 PEaMIr ~Ioo?-.ya ~raoa..ala ##a iQO.t+©CII: ..>9ty>l11YIpy y#~'f~'~,:.:. 'ER- .!'(lLX : 'R~8 <br />dFFLUENT GRU35 YALU BEnuwEMEriT > yy#y Nll:::~lL~.l <br />, <br />': <br />,.., ;. 1.: ;~::, <br /> <br />.. .. <br /> <br />. <br />LCSU $TAiit6 96HR AC SAMPLE +:#yyay ayyyKFy ##ai0a ####O.O <br />( 23) <br />~ ~ <br />FIdBPflALES MEASUREMENT ; : . ~ <br />., <br />1 A d bC 1 0 0 ses' FEf;MIT:: ;? . ::'` <br />..itONd. Ai1r.:';~; a:?QFSfM.: y#a ~ ...:.a Q~'f :.:. <br /> <br />` .. .IpdP #3.~~ : :. :~`.?P~'I~>~.~':`! ~.$"r . <br />rxL~ i ~ f) <br />~ <br />cFf'LUBNT (,ROSS TALU ~ EC~IAEMENT•; ~: ;.: ~aa~ y' <br />,~ '. ~ .. + . C <br /> SAMPLE <br /> MEASUREMENT <br /> :~ :PERMIT . . <br />~ .. ~ <br />~ ~ ~ ~ <br />~ ~ - ~ ~ ~ ~ .. .. <br /> ~:REQUIREMENT~ <br />... ..... <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />I <br /> '.REOUIREMENT~ <br /> <br />~~ <br />.. <br /> SAMPLE <br />' MEASUREMENT <br /> <br /> <br />•~ ..: ... ~. <br /> S <br />MPLE - - - <br /> MEASUREMENT .~ ~ ~ ~~ , <br /> ~~~ PERMIT....:. :~ .. ,:. .. : ~ <br />. <br />.. ~ <br />. <br />.. .. ~,.; - ~: ~ ..: ~ . <br />. <br /> 'REQUIREMENT ~ ,. ~ ~ ~ . ~ <br /> SAMPLE <br /> MEASUREMENT <br /> .~RERNIIi':~ ~ ~ - <br />~ <br /> :AEQUIREMENT~~. . 7. .: ~ ~~ ~ ~~ ~ ~ ~ - <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED MD <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN <br />MD BASED ON TELEPHONE DATE <br />~1 <br />C V P r <br />S <br />~ ; <br />MY INQUIRY OF THOSE INDIVIDUALB IMMEDIATELY RESPONSIBLE FOR <br />" <br />~ <br />F <br />" <br />" <br />I <br />O <br />A <br />B <br />ED <br />~ <br />T <br />' ~XUE, <br />A CUMTE <br />. <br />I AM <br />COM0.ETE <br />H <br />E E <br />ME <br />AND <br />AWME <br />THAT <br />r <br />'D <br /> SIGNIRCMT PENKTIEB FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br /> , <br />THE POSSIBILITY OF RNE AND IMPRIBONMENT <br />BEE 18 U <br />B <br />C <br />! 1001 MD 33 O~ <br /> <br />G f n . <br />. <br />. <br />. <br />U <br />B <br />C <br />f 1 ]1 e <br />A BIONATURE OF PIIINGPAL EXECl1TIVE <br />D <br />l <br />(~ ~ <br />7 <br />~ . <br />. <br />. <br />. l <br />MWtl,r Ww M~ .bNha nvr Ncpd. Owa Ip ro S 10,000 <br />TYPED OR PRINTED .rtswmuinyninpiowwlr Wl,LwwlsmonVlr.rg6ywal OFFICER OR AUTNORI2ED AGENT CODE NUMBER YEAR MO DAV <br />;,4 :. <br />COMMEN IS ANV e/trLnrvnllvrv V~MrvT VIVLAIIUrv>IrtererBOC1 !//IRGC/1/I1IO E5 /II/BJ <br />Sr'E PART I.8.4 FOR pETAILS OF TEST pkOCEOUkE. AEPOIiT LO+IEST DILUTION (~ EFPLUEIT) YHICH IS LETHAL TO SOY• <br />OF TEST OHGA~IStlS (LC50) AND ATTACH ACUTE TUYICITT TEST REPOAT POAN TC CrA. COEIES OF ALL INFOkI!ATION <br />MIST NY VPYT Tn yDl- <br />EPA Form 3320-7 108-951 Previous editions mey bs used. IREPLACE6 EPA FORM Td0 WNICN MAY NOT BE USED.I 00 3 H 0 / 9 8 C 2 2 3 -12 5 6 PAGE lOF '-' <br />t <br />