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PERMITTEE NAME/ADDRESS pnrY4F«mryNwwL«.ua. pD~bwry ~ ~ ~ - ~ - --`'~yjSGyAgp ~yfEINAgANE~Sf- <br />NAME POp DERHO Rd COAL COMPANY D RG 111 <br />r2-T51 <br />Ti-TS! <br />ADDRESS$OADSIDE `f NE <br />I , N <br />5 PORTALS LL <br />P . V. b0 X 14 3 0 PERMIT NUMBER DISCHMOE NUMBER <br />PALISADE CO 91526 <br />FACILITY MONITORING PERIOD <br /> YEAR MO DAY YEAR MO DAY <br />LocgrloN FROM 0 O1 O1 To 00 03 31 <br />if r I' N : .~ ~ H (J A • ri C li }. t{ . (' :{ L ~ T_ D E N T !1421/ (7Z-731 111-151 176271 129-191 !3431) <br />__ __ Fnrm A~prsved. <br />~OeD ~ SO COAL .CSQF'~INo.2040-ot~ <br />(SUER NC~ kp°P~OVeI e~rRi{~e4053198, <br />F ~ FI IIAL 11345 ' <br />'IINOp <br />;+c=13 NO DISCHARGE )Y~~i ~~"% <br />NOTE: Reed InetructltNU before pletlnq thu form. <br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !I Grd Only1 QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> 116531 /54-6'Tl l3B-151 14653 15L1511 DF <br />l3Z-371 <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX <br /> <br />l67-1]1 <br />MuYas <br />(51-581 TYPE <br /> <br />!59.701 <br />IL AND GkEASE SAMPLE #44~G,^• ( 94) M4w;414~ #a~>xaa ~t?tYY <br />1$ U A L MEASUREMENT <br />406 ~ o o PEpM1T ~u~~#~ R.EPoaz es=1 aa~4ge >x~xafrn *a~><~~ arc .~Ef:LY fI.SUAL <br />EFFLUENT GRUSS Y-LU :REQti1REMENT ~]) 2 !IA -. 10= A30~ <br /> SAMPLE <br /> MEASUREMENT <br /> :: PERMIT.:>' : :.... .. <br /> <br />. :. :.. <br />. .. <br />, . ,:. ..~ :~_: <br /> 'REQUIREMENT. . ... .: ..... ... .... ... . <br /> SgMPLE <br /> MEASUREMENT <br />yL' PERMIT ~ ~ ~ ~ ~ ' <br />7~: " REQUIREMENT <br />' J., SAMPLE <br />~ <br />'~ MEASUREMENT <br />, <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <br />~ <br />~ ~~ <br />~ <br /> REQUIREMENT <br />~ ~ <br />~ ~~~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~ ~ ~ ~ ~ ~~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ - <br /> REQUIREMENT <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I cl[RnFr uNOER PENALTY of Iww THAT I NAVE PERSONALLr ExAMweD MD <br />AM FAMILIM WITN THE INFORMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE <br />1 ~, FL_ , r~Yt_ <br />J <br />~ <br />- MY INOUIRV OF THOSE INDIVIDUALS IMMEDIATELY RESPON9BLE FOR <br />/~ <br />7 <br />Vim OBTNNING THE INFORMATON, I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />SIONIFICMT PENALTIES FOR SUBMITTING FN <br />SE INFOFMATON <br />INCLUDING <br />/ <br />L // <br />~~ . <br />. <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE tB U.S.C. 1 1001 MD ]] <br />f t]te <br />u <br />S <br />C <br />M <br />d <br />Y <br />IM <br />S <br />BIONATURE OF P111NGPAL EXEClTIVE A <br />Z~ <br />JJ~~Y~~I ~ ~/_ <br />T' O~ <br /> . <br />. <br />. <br />. l <br />r <br />„ u <br />« dwsr mm„ m.r <br />NA.a, F,w, tp ro <br />IO,OOD AREA <br />TYPED OR PRINTED «q«mvbwnf'ttA~ivnwn oFMw«nemmua «tC fi T.NS/ OFFICER OR AUTHORIZED AGENT CODE NUMBEq YEAR MO DAY <br />V vmmcrv I o nrvv cnr~nnn ~ wn ~r nn ~ vrvt.n t wno Invrrrnce wi st mcnmmrs nwsr <br />SETTLEAtlLN SOLICS LI!'IT 9PPLIE$ CNLY IF C=lUYR,24HR PRECIPITATIGN EVEKT IS CLAI!'EC. pERtlITTEP 41.3 <br />bUHGEN OF PROOF WNEN REQUESTING kELIi;F FROy SETTLEABLE SOLIDS PEIHARY LI!1ITATIOlS. <br />EPA Form 3320.1 108-95) Previous editions may be used. IREPLACEB EPA FORM TAO WHICH MAY NOT BE UBED.I 0 0 64 4 / 9 9 C 2 2 3-12 5 6 PAGE ~ OF <br />