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PERMITTEE NAME/ADDRESS prii4 FrWyN~[oef)r'~^~~ <br />NAME POYD$RHORN CO-L CONPAIFI <br />ADDRESS ROADSIDE rtINE, R E S POR?ALB <br />P.oe I ox IIaJo <br />PALISADE CO d1526 <br />FACILITY <br />LOCATION <br />R 1"fh: .70HM A. `~. ('t:1 ~_ D9 h'ST LCNT <br />I PERMIT NUMBER I <br />DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM 1 U1 TO U 03 I1 <br />1929/1 /99J 71 I969FI tlf.9 )I UA-991 /32911 <br />-_.~ r~__._.-_-.~fm-ApDroved. ~ - <br />POND 1 t0 CO LORAD oooa <br />pp o Ger~e~Ycq~~Ire~ OS-31-98 <br />(BURR iCj ~~1t.iuT <br />F - FI1tAL <br />i"INCR <br />r,:.;.- NO DISCHARGE ~~ #~# <br />NOTE: Rasd Instruetloru belore c Istlnq thu form. <br />PARAMETER 13 Grd OnlYl QUANTITY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION NO. FREGUENCr SAMPLE <br /> /I6-531 !54611 13851 !46-53 1546// EX GF TYPE <br />l31-371 MALY515 <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS lsz~s]/ !64651 !6&701 <br />U SAMPLE :v#•`.rr .#vu## O/}#~I#;~ ( 12) <br /> MEASUREMENT <br />U40U 1 U U ~ PERMIT-~.~~. ::>i#>t#~#$ #~#y!s)<#4 #A. ~.Tj ~ IP'C7ot`A# 9sU ~ ~~ ~ ~EBKLY ~~N.SITU <br />L.FPLUFNT GROSS YALU REQUIREMENT #4#C TN <br />:iL)LLDS, TUTAL SAMPLE #:A###q ##¢¢#>r #~,pr$:; ( 19) <br />~U:iPENllBU MEASUREMENT <br />U`.,JU 1 U U -~~. PERMIT ~ ~#1014~aL1. .~' ~~ .~sr47C>Or~ av. ~tKt~'~>pl>R ~~ ~. ~ ?{3 ..~ ~ ~ 'NCI :RxB <br />FFiUENT GROSS YALU REQUIREMENT ~ #~F4 ~ AT <br />~uLIDS, StTTLEAHL£ SAMPLE #a#>:aa ~z=~;La## ##>r##a ( z5) <br /> MEASUREMENT <br />JUS4~ 1 U O PERMIT #,x##:E 111 #$#4#s3 #aa G#9/7## HEFONS AEi~GF? t NCE/ ARAB <br />"FFLUENT GROSS YALU REQl1iREMENT ##r# N H <br />IdON, TOTAL SAMPLE ##:r:vr ##r### #####Y ( lqj <br />(AS FE) MEASUREMENT <br />~1U45 1 0 U PERMIT #v;.~%~:# x####~ #:r~ r>k4### 3.5 7.0 NCH/ :NAR <br />r FLUENT GROSS YALU REQUIREMENT ~ #> r-: ~ ~ Y F7K I <br />JIi ANll GREASE SAMPLE .'#C~3# ;,:#3##-S ##X`•fiC# ( 19) <br /> MEASUREMENT <br />3582 1 0 0 PERMIT.. ~.?###~#.L~ <br />~ ~ ###### #tC h`#'b#s?p REFG~N4 ~~ I~D ~ ~ O~iTIN .AAB <br />::?FLUEN"f I;RGSS YALU" REQUIREMENT ~ #~# ~ f. ~~ ,~` <br />L'Ja, IN COwDU IT 0'.i SAMPLE ( Oj) #AY,#.'. Ol:TL9: tOt4G <br />:;i ;:U TMEARMF.NT PLh `:T MEASUREMENT <br />UUSU 1 0 U PERMIT REPORT &EPORT r##### #ICL#fi# #Sc="R## #;# E$F:LY HSTAti <br />'•; F'FLU ENT liROSS VA L'.!L~ REQUIREMENT 3UU~ AYG DASH ~"{Y tlGU #1:-Yt: <br />,JL1 US, TOTAL SAMPLE a al=ty# h##;~## #o*. #.~. ( 19) <br />I:iJOLV:,'D MEASUREMENT <br />/U195 1 U U PERMIT a#aa##' <br />~~ ###oFxa >a ata sa#]A1C$ BEfGA1 F.fiI~ORT TitLT ~ •RAH <br />.PrLUtR'f GROSS VALUE REQ~RREMENT ~ ~ #4r NT& 14YG ~ P.TF. 14AX MG/L <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENUTY OF <br />AM FAMIUM WITH THE INFO LAW TNAT I HAVE PERSONALLY E%AMINED MD <br />RMATION SUBMITTED HEREIN; MO BASFD ON TELEPHONE DATE <br />J E <br />~~ MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR <br />TTED INFORMATION <br />T <br />S <br /> OBTNNINO THE INFORMATION, I eEUEVE <br />HE SUBMI <br />I <br />TRUE. ACCURATE MD COMPLETE. I AM AWME THAT THERE ME <br />SIGNIFCMT PENALTIES FOR 6UBMITTINO FALSE INFORMATION <br />INCLUDING <br />9 <br />~L <br />// <br /> , .~ ` <br />- <br />~~ <br />LT/ F~ as e/ <br /> THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 1B U.S.C. 1 1001 MD ]3 BIONATURE OF PRINCIPAL EXECUTNE <br /> U.S.C. 1 1 ]1 s. !lYIWFY. uMr Nrw .bean. nlry /9cMl~ M.. W ro t IO.OOD <br />TYPED OR PRINTED .rN wmuin.n hrpiawlre of MnrwnsmmNa rM 6Yrra/ OFFICER OR AUTHOflIZED AOEMT LODE NUMBER YEAR MO DAV <br />•--_.. <br />~~ <br />C <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS 1Rs/ersncs el/ sttschmsn/s here) <br />SETTLEABLE SOLIDS LIHIT AP?LIES 06LY IF C=lOYR/24HH PRECIPITATICV °VFIiT IS CLAICEC. PFRI!ITTEE HAS <br />uUaGEN OF Pd00F YHEM REQUESTING RELIEF FROM SETTLEABLE SOLIDS PFItlAP.Y LItlITATIOltS. <br />EPA Form 3320-1 10&-951 Previous editions may bs ueed. /REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.1 00 56 3 /'J P. C 2 2 3 -12 5 6 PAGE t Of <br />