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PERMITiEE•~{{TAME/ADORESSpebJ.PAeWTN~MiCaexla~EM~fi0yU~4w-U-»-~-----•--~a~in#.r-- <br />NAME f O~D L'rBHORY ~~~I.. ~~cap{_-_ __ .. _ .. __..r ._ <br />ADDRESS HOA DSIDE MINE. N G S PORTALS <br />p.0. BOY 1030 <br />PALISADE CO 81526 <br />FACILITY <br />LOCATION <br />it'f': se JOHN A. NCNA13_ P3 F. iTnFNT <br /> <br />DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM V TO <br />!vo-]r! n]a3l /]L%I !]6771 17H-391 136311 <br />(SORR fiC} <br />F FI-AL <br />MINOR <br />1-98 -_ <br />eYa NG LISCHARGB ~ #~'~ <br />NOTE: Rssd Instructioru bsla! ebmplstinp this form. <br /> !3 Grd Onlvl QUANTITY OR LOADING !~ Grd On/vl QUANTITY OR CONCENTRATION NO. FREOUENDY SAMPLE <br />PARAMETER II653 154-6/ l38-451 !4653 I5L51 EX O TYPE <br />!37.37/ YSIS <br />M/ <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs7-sal l5s-5B1 159-701 <br />~~~U STATRE 4tfHH AC SAMPLE ####4# ###### +8#.## #S#F;:$ ( 23} <br />::cH10DAPtlNIA MEASUREMENT <br />:'.aM36 1 U U PERMIT ~ ~~##ar0~!O+IR ~ <br />~ '~S#4~~r? ### cto,tlaal~ ~ ~~aa:~a~ ~~ ..~#~tFAC~~. BR- ::: R.l~.T ~ :aAs <br />:. FF'LUENT GROSS VALUE REQUIREMENT ~ ~ <br />: .:: ~ ~ ~ ;~~~- ~~. ... CAO pi 'Rj~.'`.1~.jiiB.E: ..: ..~ ~:~~ ~. .. ~ ~..: C N ~ <br />, .. <br />.,::SU STATRE 96HR AC SAMPLE #S=3### O#al0## #t##A# 00#0## ( Zjy <br />rLGEPHALLS MEASUREMENT <br />~ <br /> <br />0 <br />'1 dNbC 1 O <br />PERMIT ~ <br />##.~1 Ol~p~~~::~ <br />.~~. <br />.: ~:: ~??#..., <br />Ci# <br />~ * <br />~~G r.~p~;~ <br />..;#.tt10:#~:~, <br />~.. ~~"~I~~~:~~>~~:::.~ <br />'~I~ <br />~~ .,. <br />::~: <br />~~~.~ ~~ .{~. <br />~~.. <br />iR.P~ <br />c:-FLJEN'L' GROSS YkLU REQUIREMENT - . <br />.: ?##b r~N=. :rx~LS x~ :~ "` e Y ~' - ~~..~..' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT?:. ~: :: , .,: <br /> REQUIREMENT:: <br />, e;,~: ~ ~ ~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - : - .. , <br /> REQUIREMENT ~ ~~ ~ ~~ <br /> SAMPLE <br /> MEASUREMENT ~ - <br /> PERMIT :~ ., , :.. :~;: ~ .. <br />~ .. . ..~ .~.~. .~ - <br /> REOUIREMENT ~: ~ - <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT .: ~ ~~ <br />~ ~ <br />~ ~ ~ <br />REQUIREMENT ~ <br />~:.: ~ . ~ ~ <br />~ .. <br />LAW THAT I NAVE PERSONALLY E%AMINED MD ~ TELEPHONE <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENN.TY OF DATE <br />ANI FAMILIM WITH THE INFORMATION SUBMITTED HERDN; MD BASED ON <br />MY INQUIRY OF THOSE INDINDUAL9 IMMEDIATELY RESPONSIBLE FOR <br />/ <br />7y~ OBTNNINO THE INF011MATION, I BEDEVE THE SUBMITTED INFORMATION la <br />I AM AWME THAT THERE ME r <br />V "'~~ <br />ACCUMTE MD COMRETE <br />TRUE <br />/y(~, <br />. <br />. <br />SIGNIFICMT PENN.TIES FOR SUBMITTING FN.SE INFORMATION, INCLUDING <br />Z4s <br />/a <br />d <br />¢ <br />-7nJ <br />- <br />, <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 18 U.S.C. 1 1001 MD ]a ~ SIGNATURE OF PRINCIPAL EXECUTIVE 6 6 <br />f7 <br /> u.s.c. E tats. lPw.Ytlr, r,vr el,r mltm, nnr lncw,s, r,w, ro ro Jr0,000 AREA <br /> <br />TYPED OR PRINTED <br />,M xmuirN,n hMrr,Frvrwn o/anr„n s.rNeer,..ss H,val <br />OFFICER OR AUTHORIZED AGENT <br />CODE NUMBER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IFs/srsncs s// ettschmsnls hers! <br />Sot PART I.6.4 FUR UFTAILS OF To5T PROCEDURE. REPCRT LOJEST DI CUT ION (% EFF1UE11T) i1HICh IS LETHAL TO 50". <br />uF TEST UHGANISMS (LC 50) AND A`I'TACH ACUTE TJ1(ICITT TE51' REPORT PORN TC CRR. COPIES CF ALL INFURt+ATION <br />H f i" T p F ' R G T T l C D! - <br />EPA Form 3320.1 108.95) Previous editions mey ba used. (REPLACES EPA FORM T40 WHICH MAY NOT BE U8ED.) 0 0 37 5 / 9 B C 22 3-125 6 PAGE 1 OF <br />