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ADDRESSROIRIDSIDERMIN~6~M HYALS, ~ ~ •,. <br />P.O. BOY 1430 <br />PALISADE CO B1S26 <br />FACILIT' <br />LOCATION <br />r.S"Tke .70HN A. tiCNAB_ C.rPST ^F'4T <br />lvd1GE.LR4". mor=~.._ _ <br />(SUER iC) <br />olscxAncE xurABER - F I lI A L <br />- --~ :,_ <br />11-98ty.-~ <br />-- -- r <br />MONITORING PERIOD MINOR <br />YEAR MO DAY - YEAR MO DAY <br />FROM U TO #Ys4 NO CISCHAhGE {~~ ~E'~' <br />r~mfl vvsxl v~~sl n6n7! !aa-aa! l30-371 NOTE: Reed Imlruc0ont bdon compbtln8 thu form. <br /> !3 Grd Onlvl QUANTRY OR LOADING I/ Grd Only! QUANTITY OR CONCENTRATION ~ NO, mEauEHCY SAMPLE <br />PARAMETER !16531 !5451 l38J51 !4653 154511 EX uY TYPE <br />132-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS re:~ss! 9s <br />Ax <br />154551 158-701 <br />H A E SAMPLE #iCY~~ ( 94) as>uaoa 4t=xoaa aaoaaa <br />V C 3 U A L MEASUREMENT <br />' 4066 1 0 O - PERMIT:;.:~~ .~~1R7L~pLII1X ~ ~.~R~.1[±.C!@2 65=1. •tRl{#~~~ : :. t?#4">~.~'>Q. ~~~.~~>O~IC#~F: ? >~#$ ~'.~ .L$~tLx I~v$ <br />L~ FLUENI' GROSS VALU . REQUIREMENT. :.' ~ . ~-.:... ~: ~`xR~3~`.16',1.1I': MO=O ~ ~ ~-. :~.~~~ ~ ~ .. ~~' ~ ;: . <br /> SAMPLE <br /> MEASUREMENT <br /> , ...:; <br />.....: <br />...:.... <br /> 'PEQUIREMENT ~. ~ ~ .:. ~. ~ : : ~:, :~. ~= <br />.. <br />... ..z :~. ~:.<.. ~: <br />~ <br />~. <br />.. <br />.~.; ..:. .: ~y.::,.. ~. <br /> SAMPLE <br /> <br />.. MEASUREMENT ' <br /> "PERMIT ~.~ ~ ; ~ ~`~; ~ .. . <br /> ~REQUIRENIEN7~ :~~ ~; ;:. <br /> SAMPLE <br />' MEASUREMENT <br /> PERMIT: ~~. ~ ~ ~ ~ ~ ~~ ~ ~ ~ ~ - <br /> .REQUIREMENT~~ ~.~ '~.::.r~;~: ~ ~ ~ ~ - <br /> SAMPLE <br /> MEASUREMENT - <br />~i ~ PERMIT' ~ <br />~ - <br /> :REQUIREMENT ~: ~ - <br /> SAMPLE <br /> MEASUREMENT ~ - <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <br /> REQUIREMENT.' .:. ~ <br />~ ~~:: - .. ~ . .. ~: . <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERn FV uxoeR PENALTY of <br />ITH THE INFO uw THAT I HAVE PERSOxuLr EXAMINED AND <br />AND BASED ON <br />RMATION SUBMITTED HEREIN ~ TELEPHONE DATE <br />~ <br />/ / <br />}. <br />~ <br />J ; <br />AM FAMILINI W <br />MY INOUIIfY OF THOSE INDINDUKB IMMEDIATELr RESPONSIBLE FOR <br />I BELIEVE THE SUBMITTED INFORMATION IS <br />OBTNNINO THE INFORMATION <br />. <br />~ <br />r <br />J F <br />. , <br />TRUE. ACCUMTE AND COM0.ETE. I AM AWARE THAT THERE ARE <br />INCLUDING <br />BMITTING FN <br />SE INFORMATION <br /> . <br />SIGNIHCANT PENALTIES fOR SU <br />. Z -~Q OJ Q Q <br /> THE POSSIBILITr OF flNE IVID IMPRISONMENT. BEE 1B U.S.C. E 1001 AND J7 SIGNATURE OF PRINCIPAL EXECUTIVE <br /> U.S.C. 1 1 ]10. lArrM.a IMP eMr .unm. nlrv MICAd. IMa lP ro r 10,000 <br />TYPED OR PRINTED ~ .ndnm.r:rvn L+WoMMnr or afwr.nemanaA.rW SVraI OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRelrrence sll sftschmenfs hers/ <br />SETTLEAHLY SOLLUS LIMITS APPLIhS ONLY IF <=10TRe24Hk P~.E('IPITnTION F.4 ENT IS CLAIMED. P;:RMITTE:. h6S <br />KUl'tUEN OF PROOF YNEN REQUESTING NELIEF FROM SETTLEAE)Lc SOLIDS PFIC,AAY LI!"ITATICFS. <br />f ,'. <br />I~ <br /> <br />EPA Form 3320-1 (08.961 Previous editions mey bs used. IREPLACEB EPA FORM TJO WHICH MAY NOT BE U6ED.) 0 04 04 / 9 A C 2 2 3-12 5 6 PAGE L OF <br />