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PERMFTTEE NAME/ADDRESb pwdi4 FeNLryNer~Gocerlm 1/ol~nru) <br />NAME SGtlLCA CDAL COMPANY <br />ADDRESS DHAdER D <br />RAYDEN CO 41539 <br />FACILITY <br />LocArIONHAYDcN CU 81630 <br />ATTN: G. bUD HRDYN, GENENAL MANAGER <br />Form Approved. ~ <br />A^_UTE MET TESTINGDM~fII°•3D~4c~"oGDa • <br />(BURR YY] Approve) LpIEDe105-31-Sf~ <br />F - FI tliL 1 .-7744 ~ <br />SItlOR , <br />sesf~r.,~ DISCRARGE ) ) ~Gt <br />NOTE'e Read Initruetion before omDletina thb form. <br />PARAMETER l3 6rd On/yl QUANTITY O ~ DING ! ~'[/rd only! QUANTITY OR CONCENTR,~,ON ND FREQUENCY SAMPLE <br />137-37/ !46531 !5a . <br /> <br />~ 138-I61 14653 >~75L6I <br />EX of <br />TYPE <br />' AVERAGE MAXIM ,~ UP{ITS= ~ K., INIMUM AVERAGE MAXIMUM UNITS rsr-asl MAiYSIS <br />I64aB1 !6&701 <br />LCSU ~IAPRE 4HHk AC SAMPLE , ..~. r.. , r -:,, -'. 0~T4#~~ . -.r#.Jk ( 23] <br />C:.N1UDwPhtlli MEASUREMENT `v~ <br /> <br />TAA3b 1 0 D r:PERMIT .:: :: ~$#'.F#~ '.%Lt i~1F.Rr ~; ~,-O <:.< ,?. :.::. <br />EFFLUdM1' GROSS VALU .REQUIREMENT <br />,....... <br />,::.,:. <br /> <br /> <br />~~~~ <br /> <br /> <br />~~~~ ~~ -~ <br /> SAMPLE <br /> MEASUREMENT <br /> .: <br />;r <br />,.. <br /> <br />:pEQU1RENIENT~ <br />~ . <br />. . <br />.-. <br />~ ....<.;>.. . <br />..::.I.~g:> <br /> <br /> <br />:: i <br />:: <br /> <br /> <br /> <br />:: <br />i' ::'ii <br /> <br /> <br />~ <br /> SAMPLE "' <br /> MEASUREMENT <br /> ~PERMIT~ ~~ ~:.. ~. ~ <br />:: ... <br /> <br />~ .. :~ <br /> <br />~ <br /> REQUIREMENT .. .. ... il. i'i::.;.,. .:.. ~ <br />~ ~ . <br /> <br />., <br />~::~. <br />~~~~~~ <br /> <br />~ ~ ~ ~ <br /> <br />~ ~ ~ ~~~ <br />-...: <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT ~ ....,~ _.::. <br />~ ..,...: ~•: ~:.; ..~ .. <br />~ ~ ~ ... <br />%3~ <br />~ <br />5: <br />.. ~ .: <br />. . <br /> ~fiEQUIREMENT~ ~ .. <br />: <br />:: <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ~: .~~PERNIIT ~ :. ~ .. <br />~ <br />~ .. .. .. ... <br />~ .:..... ....... <br />~ . <br /> :REQUIREMENT.. ~ ~ ~ <br />:::~: ;?;>s~..::::::::' : ~ : .: ~ . .. <br /> SAMPLE <br /> MEASUREMENT <br /> . :PERMIT :. ~ ~ ~~ ~~ ~ ~~~ <br /> REQUIREMENT ~ ~ ~ ~ <br />.... ~ ~~ <br />.. <br />.. <br />. ~ .:.. .. <br /> <br />... .... <br /> SAMPLE <br /> MEASUREMENT <br /> .:'..PERMIT.:: .. <br />..:.. r;:, ;~:; .. ~ .... <br />. ~:~ . <br />~ .. <br /> REQUIREMENT: ~.:: ::: ~~ ~~~.~..::;;; ;... .. <br />. ~ ~ .. <br />~ <br />, ~~ <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF lAW THAT I NAVE PERSO NALLY EXAMIN ED MD ^ TELEPHONE DATE <br /> AM FAMILIM WITH THE INFORMATION SUBMITTED H EREIN: AND BA SED ON \ <br /> <br />MY INOUIIIY OF TNOSE INDIVIDUALS IMMEDIATEL <br />Y gESPON5IB <br />LE FOR 1 <br /> OBTAINING THE INFORMATON, I BELIEVE THE SUBMIT TED INFORMA TION IS <br /> TRUE, ACCUMTE MD COMRETE. I AM AWM E THAT TNE /IE ME E <br /> SIONIFICMT PENAlTIE4 FOR SUBMITTING FALSE INFO RMATION <br />INC LUDING <br /> THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE to , <br />U.S.C. 1 1001 MD ]S ~ <br />bIGN <br />T <br />' <br /> U.S.C. 1 1 ]te. //Yrrkler udr Ner eorNHr mrY YKA.de fxwe y ro J 10,000 A <br />URE OF M1INCIPAL EXECUTNE <br />TYPED OR PRINTED wnnreNnen Mphrnwrc olMween anNnohe rM6Yeva/ OFFlCER OR AUTNORIIED AGENT CODE NUMBER YEAR MO DAV <br />..... ..~.. ~.. .... ... ~,..~. ..r .. ~. ~ .~.. ., ~ ~..~..~ Inaosnc. w suemnonw nrrr/ <br />SEE PART I. A.4 FOR DETAILS OF TRST PflDCeDORE. REPOkT COYEST DILUTIOd (X EFYLUSNT) YHICH ZS LETHAL TO <br />S0~ OF TEST ONGANISMS (LC50) AND ATTACH -CUTC TOYICITY TEST REPORT FORM TD DMR. COPIES O[ iLL <br />EPA Form <br />may <br />INCYIAt.T3 CCA <br />00051/980914-0923 <br />1 <br />