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EEE NAME/ADDRESS (n.rviF fGnNrr'[xuru llOr~rr.rq ~__. {__._ .E_.40YDtHfIUh& CURL CUIlPINY -:-_$ i. ~DRESSROAD3IDt t1INF, p E S PORTALS P.o. aox Iu3o PALISADE a, d1~2D FACILITY LOCATION ATTN: JOdN 1. YCNhP, PRtSiIiENT ___. - .__ :..FdFTii API CDCD RG LQQ6 A.~ ~SiIER IIC~ nPPrvveltv~l~~~.... ...-.. _y PERMIT NUMBER DISCHMOE NUMBERNUMBER F ~ FZlAL 1 MONITORING PERIOD „x NOR YEAR MO DAY YEAR MO DAY ~~-/ FROM V U TO U 4#r". NO DI SGHARGE fJV. '+r'~# nmrl r»-JRl Waal r~s.~n na-gym rvnsu NOTE: Rud InetrualOM befor eomobtinp this form. - - --•----•PARAM6ifR ~ _ l3 Ard Onl l 4U~NTfTY OR OADIN . _~ - G !I Grd On 1 QUANTITY OR CONCENTRATION FREOUENCr SgMP4E 3 / _ _ - ~." -- ... _ - -~F" I Y-371 MursS TVPE AVERAGE MAXIMUM UNITS ~ MINIMUM AVERAGE ~ MA%IMUM UNITS; 61~4JI /s/-sgl 163701 L AND EASE SAMPLE ###+A4# ~ ,~ 9~) rilr091F# .04ti10# ~ IRS###A Y I S U A L MEASUREMENT ~ 4066 1 U U PERMIT. r73i=ytlpFlp~~. ~, ~:~~ .;$E Q~iT~ ~ 65=1 ~ ~ <.IS'#A~.R~. ;~: ~ , ;.;a~~~': tb~~i~lf?O~Oi{':... : '~ •#q ~~ :. ~.',.~ ~llfLT 5GA X EFFLUENT GROSS YALi: 'REQUIREMENT _ - ,. afar:°:. as q : . ,.:.....::. ° ' : . ~..: . . . .. ~ ~ ~~ . "' .. . ~.. . ~ ' ~~~ : :. ~ ~~ SAMPLE ~ - - ~ MEASUREMENT - r - ' ~ ~ r ; ~ ~,~ PERMIT .. ..: .,;: .. .s~.,~_:a ~:..;. ~,.:..:::: ,: i':M~~: a - ~.'-~:.~:::~a.::.:... _ .. ~ Y.' ' ,f t~. Y:.:~< . i;R'' ~e' .REQUIREMENT ~ ,>< ~ ' * ~ _ _~_~ ,3s Jx t -%.. ~% ,~ ~" ~s :~ r s ~ , "~ r SAMPLE i ~ ~' MEASUREMENT ~ ~ ~ PERMIT ~ ~ ~ ~ - ~~~ 1 REQUIREMENT ~ ~ ~ ;. .7, SAMPLE MEASUREMENT PERMIT REQUIREMENT ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ :.. :.. ~ . SAMPLE MEASUREMENT .. .:PERMIT. ~. .. .: ~... : ' " : ... .,,: ~...... :~ , ~: _ , :REQUIREMENT - . . . s~)• ;:. . . - . ... .. ... .. .. '. ~ .. ... o.. ..:. ..'.a. SAMPLE ~ ~ ~ ' MEASUREMENT ~ ~ ~~ ~ - PERMIT :REQUIREMENT ~ ~. ~. SAMPLE MEASUREMENT , ~..~PE .. ... ~ :.~ ~~ ~ ~: ~ . .. :: : ... ~ .. ... .. ~ ~ .. .REQUIREMENT .. . . ~:'~ ~ ... ...... . NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI AM FA FY UNDER PENUTY OF L MIUM WITH THE INFO AW THAT I HAVE PERSONALLY EXAMINED MO RMATION BUEMITTEO HEREIN; MD EASED ON TELEPHONE DATE ~, ~i , J c r SE MY INOUIIfY OF THOSE INOINDUALS IMMEDIATELY RESPONSIELE. FOR OETNNINO THE INFORMATION. I EEUEVE THE SUBMITTED INFORMATON IS - / . l TRUE. ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME SIONIRCMT PFHALTES FOR BUBMIITING FALSE INFORMATON INCLUDING G G9 - , THE POSSIBILITY OF FINE MO IMP/IISONMENT $EE 1E U S C 1 1001 MD 3 ~ / q~ /v' / n /L I T 1 O v\ . . . . ] B C 1 IONATURE OF PRINCIPAL EXECl1TNE / . , I, u. . . tE1e. IPUWer, unM 1Mr man. rn.r MArd. erw, ~ ro Sr0,000 AREA ~~~ TYPED OR PRINTED uld o. nrrinvn tlPrtsuMrrcvre.w«n6ma+rhawsr..~l OFFlCER OR AUTHORRED AOEN7 CODE NUMBER ~ YEAR MO Dqy I;VMMCN 15 NrvU CAT'LNINNIIVn VC NnT VIULN11Vn0 lnelelMCe ell eRICDTMIS nerY) ~ETTLEAHL$ SOLIDS LIDITS APPLIES ONLY IF <=l0YR,24HR PRECIPITATION EYENT IS CLAIRED. PERPIITTEE HAS ~fUHDEN OF PROOF NN EN REQUESTING HELIEP PRO!1 SETTLEA6LE SOLIDS PRIMARY LIriITATI0M5. EPA Form 3320-7 (08.96) Previous editions mey be used. 1REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 0 OU 5 6 / 9 ~9 C 2 2 3- 12 5 6 PAGE 2OF e~ 1