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PERMITTEE NAME/ADDRESSOMi4r F~ed~nNaWTxmlm doll wIU - <br />NAME POVDE&HORN COAL COY PANT <br />ADORESSROADSID" NIivF, ~ G S PUkTALS <br />P.V. ,OX 1'!3!; <br />PALISADE CU t; 1`;20 <br />FAalm <br />LOCATION <br />.:rT.r: oo:1e a. '~cNt.~, l~I.:_.ILErT <br />IAL enLUUeeucpLSO ox sYS'CEi1JNPDES)=["'~ __ - _ _ rM proved. <br />_ ;. DISCN=R6 ~ '~.. a n-+e ACUi~ iET.._TEST- pfO °~p~,p~S~~~a <br />CO 7 46 A h v (BURR K) ~°~~3L~ .- <br />PERMIT NUMBER o1scHAncE NuMSFn F- F I E A L <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM YY ~, L'~ TO -) ~ <br />lZ6Z11 l12-T31 !?f-Y5I I7G771 118-I9I !36311 <br />%Il:CP <br />'''s; 90 DISCHARGE (__~ "'-~` <br />NOTE: Reed Inetruetloro before eomDletinp this form. <br />PARAMETER 13 Grd Onlvl QUANTITY OR LOADING !~ Grd OnlYl QUANTITY OR CONCENTRATION f.10• FREQUENCY SAMPLE <br /> !46531 !5461 !38-45 !4653 l548II EX 0 <br /> <br />I32-171 µ/ <br />y5 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS. !st-e9l 154-581 169-701 <br />LC~LI STAiRG 41iHn ACI SAMPLE :::.3?:Y;: :~sYr,:- 4/ dC#OG# 7L#r:YA ( 23 <br />) <br />CLliIODAPI1d1A MEASUREMENT ~~N / V (,t,Q, <br />A.t3b L 0 (1 ~~ PERMIT Y~~•#An'ft :S IRYt4:#.Lr AAA !QD ~QQD2 <br />: ti A~tAG# ~ :~ ~ tltit A~'?~t!. <br />: 'ER- ~;:~ TdLY ~ ;fL#E <br />..FFLUE.NT GROSS YALUf REQUIREMENT ~I y.,yy . <br />~~:. .r ;.~~E . <br />Li:7U STATkd 9611R -C SAMPLE ?;=av;~: 4•,`•~k rf:A ;i ?!t>¢AAA ~ AtAA#A <br />` <br />3' <br />PI%LPHALCS MEASUREMENT ~~DV/!! 2 fY ~ ~ yi~_ <br /> <br />1'A:YbC 1 0 0 ~ <br />•.,. PERMIT <br />~:.... . A <br />+•#~: t.~"v` <br />'%:.AG'iTm -. <br />CAC <br />~ ~ <br />~1$>aiF!#>~C`'~ <br />:. j`'~IA"'{.~'-0IA~:: ~~ <br />,8~ <br />..-.~ .:+ <br />THL~.S <br />s~~;8 '~. <br />~PYLUCNT GSO35 YALU 'REQUIREMENT tltpg6 <br /> <br />MR.-:~A'I1T~ ~ <br /> <br />';' ;, <br />.,. <br />..,. <br />~~ <br /> <br />8.11 <br /> SAMPLE <br />~~ MEASUREMENT <br /> :PERMIT ~ ~ <br />~ - <br />... ~ REQUIREMENT - ~ ~'^'~ <br />e: : .~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> . ~ PERMIT <br />~ <br />~ ~ ~ <br />~ <br />~ ~ <br />~~ ~ <br /> REQUIREMENT ~ ~ ~ <br />~~ -- ~~~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <br /> REQUIREMENT ~ ~ ~~ ~ <br />~ ~ ~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .'. <br /> REQUIREMENT ~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~ . <br />NAME?RLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSONALLY EXAMINED AMD <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br /> MY INQUIRY OF TNOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR ' <br />~ is A <br />•G~L <br />J OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 19 <br />I AM AWARE THAT THERE ME <br />TRUE <br />ACCURATE NiD COMRETE ~ <br />- <br />/ <br />~ , <br />. <br />SIGNINCANi PENALTIES ROR SUBMITTING FALSE INFORMATON, INCLUDING <br />~~ ~~ /~/ <br />~ <br />/ <br />V CA+'r THE POSSIBILITY OF NNE AND IMPRISONMENT, SEE 1B U.S.C. ! 1001 AND 99 SIGNATURE OF PRINCIPAL EXECIlTNE ~ <br /> U.S.C. ! t 91 e. (Mt.lEir. uIln Mw .oem. nwY hcM.~. liwa y ro S 10,0°0 <br />TYPED OR PRINTED ..dwmuhturr inprlaomwlf bsrrrwvlemurNr rget'+.rA/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />~7 <br />C <br /> <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Re/erencs sll effechments here! <br />~ti: PAHT I.B.4 E'Ok DETAILS GF 'CEST PiiOCEDJkS. ftP1' LOW E."iT DILUTION (:EFPLIIENT) IlHICH IS LE?HAL TO SOw Of <br />iE~1' OnGAdIS17S (LC 50) E ATTACH ACUTE TOYiCITY TEST hEPOH'P FOkt, TO DtfR. COPIES CF ALL INFO t!UST BE: SEOIT <br />'i'n ~U FL T•^T c rr n r -m r r.~, cT a n n nn rrn~ n T n m <br />EPA Form 3320-T 106.951 Pratrioue editions mey be used. - (REPLACES A FORM n40 HICH MA OT aE US •1 D 0294/96 C 2 2 3- L z 56 P E '' <br />i _ <br />