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PERMITTEE NAME/ADDRESS (l.dd•FrWryNaWiwvnm UDlpsrnq
<br />NAME Cf]J:(lu-Y~J CL7AL CG"PANY L.?.
<br />ADDRESS CO L04YO MINE
<br />5731 STATE HI6HYAY 13
<br />MEEKER CO b1641
<br />FACILITY
<br />LOCATION
<br />ATTN: ., FhcSIDENT
<br />FRI
<br />Form Approved.
<br />Y1FEfiCCSE SERI TOOMarYD,~laoloooea.`
<br />Approval explree OS-31-98
<br />(5U6P. FN) 12385
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<br />NOTE: Raid inetruetieru beiwa'c6fnplatinq thle form.
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTFY UNDER PENALTY OF lAW THAT I HAVE PERSONN.LY E%AMINED MD
<br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN
<br />MD BASED ON TELEPHONE DATE
<br /> ;
<br />MY INQUIRY OF THOSE INDIVIDUN.S IMMEDIATELY RESPONSIBLE FOR ~
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<br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~
<br />/~ ~
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<br />~ TRUE, ACCUMTE MD COM0.ETE. I AM AWME THAT TXERE ME
<br />9GNIRCMT PENALTIES FOR SUBMITTING FALSE INF011MATION
<br />INCLUDING
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<br />THE POSSIBI
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<br />OF NNE MD IMPNSONMENT. SEE 1B U.S.C. 1 1001 MD a3
<br />BIONATURE OF PRINGPAL E%ECUTNE ~l0 Gi24 - IG C.n 1 4 Z tJ
<br /> U.S.C. f late. IMYei. uKr ewr mr,mr, m.r irchr0, ~..W ro iIO,OW ANEA
<br />TYPED OR PRINTED rgrmrimn irrpionwrc,IblwrnsmonM„M6yrn1 OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS /Reference s// sfrechmsnrs here/
<br />SETTLEABLic SOLIDS LIMIT APPLlE~ ONLY IF <= lU-YH, 14-HR PP,ECIF !YlN7 I$ CLAZlIEC. IF CLAIH APPROVED 9Y
<br />N;~CD, T55 E ZRON LIMITS HILL NOT Ctb ppPLIED TC REPCHTED f!EAEUREFEI7S--SEE I.B.1/, PG 4 AND I. S.LD, PG 6.
<br />EPA Foim 33200.1'108-951-Pievious`editian4'may be used.. ' " ~ /REPLACES EPA FORM T30 WHICH MAY NOT BE USED.1 PAGE ~ OF
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