HYDRO24636

• Permit No: C1981041
• IBM Index Class Name: Hydrology
• Doc Date: 7/10/2001
• Doc Name: 2nd Qtr 2001 DMRs
• Permit Index Doc Type: DMR’s
• Media Type: D
• Archive: No

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P.U. liOY 1430
PALISADE CO 81526
FACILITY
LOCATION
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DISCHARGE NUMBER
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YEAR MO DAY YEAR MO DAY
FROM TO
1761/7 /22-331 /7I-I5l 1I6-771 /28-791 136311
(SU9A YC)
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NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTI
AM FA FY UNDER PENALTY OF L
MILIAR WITH THE INFO AW THAT I HAVE PERSONALLY EXAMINED AND
RMATION SUBMITTED HEREIN; µD BASED ON TELEPHONE DATE
[~
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T V MY INQUIRY OF TNOSE INDIVIDUAl3 IMMEDIATELY RESPONSIBLE FOR
OBTNNING THE INFORMATION
I BELIEVE THE SUBMITTED INFORMATION IS
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TRUE
ACCUMTE µD COMPLETE
I AM AWARE THAT THERE ARE ~ /~
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SIGNIFILANT PENAlTlES FOR SUBMITTING FALSE INFORMATION
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THE POSSIBILITY OF NNE µD IMPRISONMENT. BEE to U.S.C. 1 1001 µD J7
IONATURE OF PRINCIPAL EXECUTR/E 990
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OFFICER OR AUTNORI2ED AGENT AREA
CODE
NUMBER
YEAR
MO
DAY
COMMENTS AND E%PLANATION OF ANY VIOLATIONS IReferenee s// sffechmenfs here!
:;zTTLEAdLE SOLIDS LIMITS APPLIES ONLT IF C=lOYR,Z4HFi PRECiPI?AT ION EYFNT IS CLAIMED. PERI~ITTP.E NAS
bYADEN OF PROOF YHEN HEUUESTZNG kELILF FROM 5ETTLEAHLE SOLIDS PFIMAHY LI(1ITATI015. -
Epp Form 3320.1 (08.951 Previous editions mey be used. /REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 0 0413 / 9 8 C Z Z 3-1 Z 5 b PAGE I OF
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