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_1. <br />ADDRESS d0AD5IDE !LINE, N 6 S PORT~LS~ <br />P.U. 80X 1430 <br />PALISADE CO 81526 <br />FACILITY <br />LOCATION <br />AT1'NS JOHN A. tlCNAH, PkESIDEN'P <br />C 7 1 L_QQS A 1 (SUS9 iC) """.°."YZ!'43__._. <br />PERMIT NUMBER DISCHARGE NUMBER,-J F- r I F A L <br />MONITORING PERIOD tl I N 0 A <br />YEAR MO DAV YEAR MO DAV <br />FROM TO OI>•j>.4 NO UISCRARGE ~#^' <br />!14111 /11-131 /1I-151 !1617/ 118-191 !3631/ NOTE: Reed inetrucliaru before completlnq thu form. <br />PARAMETER !3 Grd Dn/yl QUANTITY ORLOADINC 11 Grd On/yl QUANTITY OR CONCENTRATION Np, rnEDUENCV SAMPLE <br /> !05-531 154-571 /38-451 !46-53 1546/1 <br />EX of <br />TYPE <br />l31-371 _ ANN.YSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !s1-ssl !64881 169-701 <br />UIL AND GkEASE SAMPLE aalatf<Atfi (9y) 4##s}>so 9Aq>kork agao>oo <br />Y I S li A L MEASUREMENT <br />84V66 1 O 0 PERMIT.;::.> 4#tlrpidi#. <br />' REpUHT.. ES=1 ;rA0+f4.4.: 4#'9At#0 #.A..OA##.. 1110+0 ::'.: IC~.Y ISCiA <br />EP FLUENT GROSS V11LU REQUIREMENT` :-:_. . . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT, <br />':.' <br />: .:....::~: ~, <br />' ::.:::e. .>;::"`..`."'~~~ <br /> <br />. <br />~ .-. ~~~ .j5. . ; y;:'~~.:(~l:=-::''.::'r,-: .~..:;:~: ~ . <br />1 <br /> . <br />. <br />REQUIREMEN7.~ : : <br />. .. ... . <br />~..'. ~. .~. :. .:~ <br /> <br />. <br />....: .. -~ .b: ~: <br />:..` . <br />:..rc:. <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT ~ .. _ : ~ . .. <br />. <br /> REQUIREMENT - ~ .. ~ %5 <br />..: _ ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> ~. PERMIT <br />~~ <br />:. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ~: PERMIT ~.; :: .:.~~: :. . :.,. _. ..:. ... <br />~ <br /> .... <br />.REQUIREMENT ... <br />. ~. .. ... <br /> <br /> <br />. ._ <br /> <br /> <br /> <br />...I. ., <br />... :..... <br /> <br />.; <br />:: <br />: <br /> <br /> <br />... . <br />~ <br /> <br /> <br /> <br />... <br />. <br /> SAMPLE <br /> MEASUREMENT ~ <br />~ <br />~ ~ - ~ ' <br /> PERMIT <br />~ ~ .. <br />~ ~ ~ ~. ~ .:~ :: .. ~ <br />_ <br />. <br />~,...: ... <br />.::. ~.~ <br />.... . <br /> REQUIREMENT ~ .:. <br />: . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ <br />~ ~ <br />~ ~ ~~ ~ ~. ~ - <br /> REQUIREMENT <br />.. ~~~ ~::~ ~. ~ ~.~ ~. .... ~~ <br />:~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERTIFV UNDER PE,rN.tr DF LAW TRAT I NAVE PERSONALLr ExAMINED AND <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON - TELEPHONE DATE <br />c <br />T ~ <br />+ <br />.- MY INOUIRV OF TNOSE INDIVIDUN.B IMMEDIATELY RESPONSIBLE FOR <br />OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />, J <br />U r r <br />~f. ~ ACCURATE AND COM0.EfE <br />I AM AWME THAT THERE ME <br />TRUE ~D <br /> . <br />, <br />SE INFORMATION <br />INCLUDING <br />SIGNIFICANT PEMKTIE9 FOR SUBMITTING FN I <br />1 <br /> , <br />, ~~~ ~, <br />f. . <br />/6I <br />Y J `I ~ I O <br /> THE POSSIBILITY OF RNE AND IMPRISONMFN T. SEE 16 U.S.C. f 1001 AND 37 IONATUIIE OF P111NCIPAL EXECUTRFE <br /> U.B.C. f 1710. lMWSr+wtlw dww ,ArNAr, m+y lnrA.d+ r,»+.P ro S IO,OOD AREA <br />....+ <br />TYPED OR PRINTED Wwm+rtimvn Nrp+bemwn olMnr,+n snlmNa wiJS yra! OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />111 <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS !Fe/~r~nce el/ erfsehmsnts here/ <br />SETTLEABLt SOLIDS LItlI'i5 APPLIES ONLY IF <=lOTR,Z4dR PkECIPiT11TI0N P.YFNT IS CLAI!IED. PEAtlITTEE NAS <br />bOaiDEN OF PROOF NNEN pE(~UESTING hELIEF FROtl SETTLEABLE SOLIDS PBItlAAT LIMITATIOAS. <br />EPA Form 3320-1 108-961 Previous editions mey ba used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.1 C 0414 / 9 8 C 2 2 3-12 56 PAGE ,oF <br />• ~ <br />