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<br />PERMITTEE NAME/ADDRESS (Include FaciGry NamJGncaY D,$erem) m° NA'
<br />NAME V '~
<br />COLO:iYO Cu'AL CC~p9!r'Y, {~='.~ a ":'.. ~.
<br />ADDRESSCO L04Y0 S7[HE , N '~° ~ '=~:~~~:C
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<br />5711 .`,TAT? HIGNYAY 1'!W ~' ~ ?'
<br />nEEKL'A //~'C,O`rd1E•sl :~a:
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<br />LOCATION
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<br />ATTN: J. D. HARMCfi, GE:1=,tYAL ,,".3>:AG._+
<br />POLLUTANT DISCHARGE EUMINATION,SVSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT--.(DMA1 OMB No. 2040-0004
<br />(z~rel ~. efi9:r91 ~ +, i ~. O ;? Approval expires 0531-98
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<br />NAME/fITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT 1 HAVE PERSO NALLY EXAMINED AND ' '°' " TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY
<br />~
<br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ~ /
<br />
<br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. ry~~~
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<br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT CC 'o r
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<br />{~/~ / ~ , ~ ~~ PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1B U.S.C. § 1001 AND 33 U.S.C.~.+ ~~...
<br />FjAs SIGNATURE OF PRINCIPAL EXECUTIVE q~ s a 4~ i uoD
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<br />TYPED OR PRINTED 4 1319 (Penettles untler these statures may inclutle lines up to St0.000 antl or
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<br />NUMBER
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<br />SETTLk:ABL'' SOLIDS LI"IT APk'LIES CNLY If' C=10YR~ 24H.A PA.ECIP EVENT I3 CLAiHi:D. IF CLAD APPRCV,°.D liY N4CD,
<br />TS5 G IRON LIMITS HILL NOT bE .4PF'LIaD TU )?SPORTED !'FASUkEMF:NT$ -"SEE I. A. 2, PG. 5 POR BURDEN O~ PBOOF
<br />- - --°- -
<br />320-1; (OB-9$) Previous edlhons may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE US'Eg1D~~)",~. ~p.AJ~/ r~ ,PAGE y
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