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"'." PERMITTEE NAME/ADDRESS(/weY4 FecdlryNUWEaxuraFl/`DdYfRrJ~-~-r~~r <br />,~ NAME pOpOEkRORR CURL COMPAIIY <br />ADDRESS RiJAUSIDr MiNF, N E j PORTALS <br />P.O. $q7( 1R 3U <br />YALISAUE CO 8151 <br />FACUm <br />LOCATION <br />tiTT4; Judi. A. h:CNAC, PndSIDEflT <br />--i/AA ta5 ~ .~ ~ __ ~u~ Fnrm Ap_Proved.000"~, t ` <br />POA'~ 2 TO CtrtoHR.D VV ~at~05- -I <br />(SUBR iC) <br />PERMIT NUMBER DISCHMGE NUMBEN P _ F I N A 1. <S /~, I - <br />MONITORING PERIOD MI80R ~ ,j~ <br />YEAR MO DAY YEAR MO DAY ~ .~ <br />FROM 1 0 TO G D3 31 '~~~+ NO DISCHARGE ::"Y <br />!76111 l22-131 /7415/ 176-271 128-I91 !34311 NOTE: Reed Iratruetlau beforl co pletinp thy fam. <br />,• <br />PARAMETER !3 Card Onryl QUANTITY OR LOADING !I Grd OnlPl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE <br /> (16531 !54611 l38-451 I46-531 (5461 QF <br />(3I-3T) EX MALY515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rd2.e]1 154631 169-701 <br />pr{ SAMPLE 4bC~`.-^;: '~:AG~~t# :k Q"-tt3=f <br />( 1 ~) <br /> MEASUREMENT <br />UU4U0 1 0 0 DERMIT >r~:X#3k#. ##3i~#b #.d 6.5 #>x~### . 9r0 LEEL'! k$ITO <br />~F'FLilt;NT t;ROS5 YALU :REQUIREMENT #G#k <br />~t~LiD5, TOTAL SAMPLE ~;:3:t# R####it ##COID? ( lg) <br />U~ P E N ll E U MEASUREMENT <br />JUS30 1 0 O } .PERMIT 7F=rr4~$'7137. . : d7F#RI~#/p . yi ~.` 4!4#IDL tlI ~5 ' ^f {) j{(~F,, . iRAa <br />Ef'FLUEHT GROSS YALU REQUIREMENT ~~# D <br />:,OLIDS, SETTLEABLE SAMPLE ~x;;M:xa~x t>~#o~t~ apx+taa ( 25) <br /> MEASUREMENT <br />"0545 1 0 0 PERMIT :~#;;ar# a>x##.ao u>:~ tTi40## REFDRY REPflaT I NCE/ :BAB <br />c}'F'LUENT GROSS VALU .REQUIREMENT #Y.~,4` OD YG M <br />iRU(i, TOTAL SAMPLE =s.#a=u~ L~rs'~nIG': #YA,,:tr# ( 19) <br />(AS 'r.>7~) MEASUREMENT <br />1U45 1 ,(h J PERMIT #>r:##`r =YLL#s%~ :yy;~ ?#O~#~ 3aS 7.0 E NC}:/ ;RAB <br />cF'F'LUENT 68055 VALU REQUIREMENT 3r,Ya 30 ~, <br />OIL ANU G~EASIi SAMPLE :A#'f^#3 ry##/:': Ofi#$~:} ( 19) <br /> MEASUREMENT <br />'3se2 1 U. U .PERMIT rX1Yt1?~; =#~:m#:x~ x~: a#a#~91 REFpR; . I{3 UNTI4 'RAa <br />'FFLUENT CiRD55 YALUc REQUIREMENT #'.~:4 0 f 'N :5 <br />FLOif, IN CONDUIT OR SAMPLE ( p3) ~#~##9 '.:+fos#r #>:t;l#a <br />LdLSU TRL'ATnENT PLAN MEASUREMENT <br />UUSU 1 U U PERMIT R~pOHT REPORT =##ifi~ ~##~## #ts,ia## 0#~v ~ , <br />£„xLY <br />:N54AN <br />;:FFLUENT GROSS VALU REQUIREMENT 3GOA AYG DAILY !1 ]( t1GD 0«t# <br />~ULIDS, TOTAL SAMPLE r#saY# rA#;La#c #aaaa~ ( gg) <br />' 1550LYED MEASUREMENT <br />7U1`IS 1 U 0 PERMIT #~x#:~~# ###~4>G#. >7Yu tt>a:#:.W# REFONT AE FORT TRLY ;RAB <br />oF'YLUENT GROSS VALU REQUIREMENT ate„ RYb AYE. RTE 14111( lIC,/L <br />NAME7TITLE PRINCIPAL EXECUTNE OFFICER I eeRTIFr UNDER PENALTY of uw TNAT I NAVE PERSONULV ExAMINED MD TELEPHONE DATE <br /> AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON <br /> MY INQUIRY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />~~ IEVE T~SU~MI <br />TE ED„ <br />OR <br />NI <br />F <br />A <br /> M <br />UE. <br />ACCURATE <br />COMRETE. <br />AT THERE ME <br />AND <br /> SIONIfICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING ~ <br /> , <br />THE POSSIBILITY OF RNE MD IMPPoSONMENi <br />SEE 18 U <br />1 1001 MD 7] <br />S <br />C <br /> . <br />. <br />. <br />. 610NATURE OF PRINCIPAL EXECUTIVE <br /> u.S,c. f +]1s, lP.n.Nr. uW,r el,. mnm....r Nrtad~ runs w ro tlo,asD AREA <br />TYPED OR PRINTED andnmuinun lmArismwnt of Nrwan eew,Na ands Fwa.l OFFICER OR AUTHORIZED AGENT CAGE NUMBER YEAR MO DAY <br /> <br />COMMENTS ANU tXYLANAIIVN Vt' ANT VIVLAI WNO IRala/6IICI el/ efreCDme/I FS n1/a/ <br />SC'1TLEAtlLE SOLIDS LIBIT APPLIES ONLY IF C=l0YR,149R PRECIPITATION EYFNT IS CLAIf'ED. PF,RRITTEF. dAS <br />iiURDEN OF PROJF aREN RE;~UESTZHG RELIEF FROi: SETTLEABLE SOLIDS P9IMARY LIMITATIONS. <br />EPA Fam 3320.1 106.951 Previous editions mey be used. /REPLACES EPA FORM T40 WNICN MAY NOT BE USED.) C 0 5 0 3 / 9 8 C 2 2 3 -12 5 b PAGE 1 OF <br />