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I - <br />PERMfT'fEE NAME/ADDRESS (1 44 FrWryN~/laanan UD~nnq - _--'- <br />- NAME-`l9Y8L~RttO~a ZOEi-. CDAPXKT~' <br />ADDRessRUADSID=: MI9k:, N ~; ~r'ORTALS <br />P. o. E"Jx 1430 <br />PALISA~d CO 81526 <br />FACILITY <br />LOCATION <br />~I"IN: JJdG A. "i'r~c, F'~.dSIi729'1' <br />~ PERMIT NUMBER I ~ DISCHMGE NUMBER 1 <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />--FROM - j - - TO - I 0-9 30 <br />1161/1 111-131 !14151 !1617/ 118-191 136311 <br />(snBR 31c) <br />F - FINAI <br />";I~OF; <br />>kY~ an DISC~Akc~ ~ ~ =='~ <br />NOTE: Rasd Imtru«iom bsfor~co pletln0 this f«m. <br />PARAMETEA l3 G.d Onlrl QUANTITY ORLOADING . l1 GTd.Onlrl QUANTITY OR CONCENTRATION NO- FREOUENCV SAMPLE <br /> !46531 151-611 138-151 !4653 1545// E GF <br />131-371 X <br />µALY515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !1:-ea! !84681 189-701 <br />i.C:,U S'fATftL' 4cl!l+ A(.l SAMPLE ~Y#;;~;- B=FLT#fi:. ,y;-~.#.; ;:;Cfi-,Y {1 ( 23} <br />CtcIUUAPkt; I9 MEASUREMENT <br />:. I..iU 1 0v PERMIT Ik Ks`,k 41#?? ~ ~. '#C+arii##' #4~^• kao .00{31 =iota#A o+~o.##»'.~ ~R~ .~ ~2 ki.T . ;&dS <br />cFF'Lllc.y'P G40S5 VALIJ! REQUIREMENT #Y/;-# . . <br />~L:UU 3T ATrtk: 96.ik nC', SAMPLE := ###3 4r#4#O: #L###~ 03{1A## ( Z3} - <br />t'1,',i:PfrALk.S~ MEASUREMENT <br />1'n~ul.: 1 0 0 PERMIT vti;.'t~##R' ~'.. <br />~ ~~ : '.:: ~Y4'4Xltie~~l'.. <br />~~ ~ O+%.F' 0 {}' j; <br /> <br />d© <br />,~ fl :~~ TIM#1E19$ ...'~#1Ei;;s7i#~i: '~~ E <br /> <br />R <br /> <br />TliLY , <br /> <br />.RtIJ <br />! c <br />::k'k'LUeI:T (;ROSS Y..LU. REQUIREMENT ~ " '~~' 0180# . <br />t[ Y AB' S <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ~ - ' <br /> SAMPLE <br />',t MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . ~ .~ <br /> ~~REQI IIREM.ENT ~ . <br />NAME/TITLE PRINCIPAL EXECUTNE OFflCER I cERnFr uNOER PENALTY of uw THAT I HAVE PERSONALLY EXAMINED MD <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; µD BASED ON TELEPHONE DATE <br />L <br />Q JU 1'- <br />l MY INQUIRY OF TNOSE INDIVIOUAL9 IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS - <br />T TRUE. ACCURATE µD COMPLETE. I AM AWME THAT TNERE ME <br />SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~ <br />/l <br />qq /^~ <br />)I / <br />I <br />/~ <br /> <br />~ ~ t , <br />THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 MD B7 <br />/ <br />SIGNATURE F PRINCIPAL EXECUTIVE <br />/0 ~ <br />/ <br />'' <br />/9~ /~Q ~ <br />G l <br />~ V /' <br />V <br />_ <br />TYPED OR PRINTED U.S.C. E 191e. fhlrldu up+r e.r mvn+ nrY ~luF+ Firw+ ~ ro t IO,P00 <br />+nsnmuHn+n ini+lr+lnl.nF e/bMwn emonnx rll6 F+v+.J OFFICER OR AUTHORREO AGENT CODE NUMBER YEAR MO DAY <br />+~.~ <br />COMMENTS AND EXPLANATION OF ANY VIULAI IVNS !IlefelenCe el/s(FecBmen FS sire! ~, <br />SE: 2AItT I.B.4 POk DETAIL5 OF TcST PkOCk:DUk~. REFOE•'.T LOV~'.;T, CILOTIOti (` E'F'FLUENT) 4HIC8 IS LF:TNAT. TO 50X ~; <br />OF 'iciiT Uk~ANISdS (LCSU) AYD A[TACk ACUTE TOXICITY resr i1F'PCk'". FORC TC Dra• COPIES CF' ALL INFOFlYA?IOa <br />F t I C. /, L <br />EPA Form 3320.7 10 -951 Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 0 ~ R ~i 119 9 C 2 2 3-12 S E PAGE ~ OF , <br />