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IfRMITTEE NAME/ADDRESS (/MrA. AcW4N~r/LxmIa, UD~r,vl ~ NATIONAL PODUrANT DI <br />NAME <br />SENfsCA C7AL COlIFANT .. DISCHARGE A <br />a-/s~ <br />ADDRESS DA4i;ER D <br />• BAi DEN CO 81639 $~. .. PERMIT~NUME <br /> <br />FACam ;._: <br />MI <br /> R MO <br />LOCATION NdTDEN C~0 91630 FROM <br />ATTN: ~. 6UD HRUYN, 6EN ENAL MANAGEB / u=13I ! <br /> PARAMETER l3,C.rd OnlYl QUANTITY OR'L <br /> 146-53) /5bsll~ <br /> 131-37J <br /> AVERAGE MAXIMUM <br /> LCSO 3TlTNE Otl(fR AC SAMPLE Pt:CiRO G;e~nry <br /> CEkIOUA!'HMIA MEASUREMENT <br /> Til138 1 8 D PERMIT 440!¢3 ~aAr"Ei<s7E CFrYs <br /> 6PPLUENT GROSS YALU :REnuIRENIENT :. 0>>tA <br /> <br />lpE EIJMINAAON ~B'ISTEM (/NODESI <br />fO <br />DMR <br />T Form Approved. ~. <br />4 <br />~ <br />RINO REPOR <br />( <br />I O <br />1:7-rel ACUT£ DET TESTING M~L°'~~Y <br />Approv a 05-31-~8 <br />° <br />(sane MN) ~~~14~ <br />'plscHiUlcE NUrAem P - PT NkL ~ <br />ORING •R D hINOA <br />YEAR MO DAY <br />TO aas ND DISCHARGE ) ano <br />~~ <br />_ <br />q ~ ~l16.171 118-?91 !343/1 NOl'E: Rwd krtructlarr befan eompNtlnq thY form. <br />QUANTITY OR CONCENTRATION <br />1 C./d.On(yl~: Np, FREDUENCr SAMPLE <br />, <br />'l38a5~ ~ M6-53 I5I-611 <br />EX OF <br />TYPE <br />. <br />MINIMUM AVERAGE MAXIMUM UNITS rsa-sm ANALYSIS <br />f6f6g1 I6S701 <br />saaaaa aalu;ra4 (, 23) <br /> <br />"3.':' <br />`~~` <br />? ~~~.:..: <br />~ .AIIEra>pli~:llk:;. ER- <br />s ,~.l1x.t:.: >l1C~':. <br />: <br />::: , .. . <br /> .PERMIT <br /> <br />REDUiREMENT <br /> <br /> <br />. { <br /> <br />~~ ~`4 C; b'L .~ <br /> <br />CaV ~.~L ~' <br />a <br /> <br />.~ <br />. <br />... .;• <br /> <br />~. ~~: .. .. .... . <br />,.. <br />;.:~:. ::::1:; <br /> <br /> <br />..:... ,... <br /> <br />sya.:. ~~.. ~.. ~~..'... <br /> <br /> <br />.,: ~..~:: ~~1~:~: <br /> <br />~ t <br /> <br /> <br />p <br /> <br /> <br /> <br /> <br />:.'.::: .. <br /> <br /> <br /> <br /> <br />.:. <br /> <br /> <br /> <br /> <br />:. ::.. . <br /> SAMPLE <br />MEASUREMENT <br />V G <br />J rAn a <br />5 -~) <br /> PERMIT . ~ <br />;:,.: <br />.}' s~rt'~"zf''`'iy:::i:1s>;J::;.;.: i~:r<ict:( Ss~~;;::'::: i<:!Si <br /> <br />:. <br />:. <br /> <br />: <br />~ <br /> REn HEM T . <br />. . <br />.. ..: .. . .. ~ .. <br /> <br />~~,'~'~ <br />RE.QUIREMENF.: ir+fki~:. `?"''R`: :_~:` ':' <br />SAMPLE <br />MEASUREMENT <br />.. .: .. <br />.. . <br />.::¢. PERMIT!,'::: ::. ~ .. .. ..: <br />~,REQUI.REMLN7: .~ ~~~ .... ~ :.~ .:.. ~. <br />SAMPLE <br />MEASUREMENT <br />:_. ..... <br />;::. <br />><: ~, <br />'. <br />z::.~:s Y.:.;yy;.;,... <br />REQUIREMENT' :~.:~.. ~ .::. .........:. ,. ..... ... . : . <br />. -::.. <br />NAMElfITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY IMDER PENALTY OF LAW THAT I HAVE PERSONALLY FJ(AMINED AND TELEPHONE DATE <br />AM FAMILIAR VAIN THE INFORMATION sUEMITTED HE@EIN; AND EASED ON <br />MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR 1 a <br />pRTUNIUC THE INFORMATION. I EEUEVE THE SUBMITTED INFORMATOM IB 1 1 <br />me rvay,~u ~ r or nnc MH ~~.r~.mv~+~... ~. I 610NATU1IE OyPpINCMAI EXEC1fiNE <br />U.s.C. f t ate. lRNWen MM,• e'wr NRIM1E mFY !`IEA.~ ~/ IO ro llO,g00 9" <br />TYPED OR PRINTED wnnwhn.n:+m+ra++r+r ,I6rrwwlemmerE eldsr,r>l OFFlCERO AUTHORQED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS /Reference sl/ettechments here/ ~.' <br />5Ed PA&T I. A.4 F'OR DPTA[LS OP TEST P$OCP:DURE. REPORT LOi(E5T DILU?ION (~ EPPLURNT) l1aICR ,23 LCTRiL <br />SOX VP IE5T OBGiNISBS (LCSO) AND ATTACH ACUTE TOXICITY TEST RL'PORT PUAM ?U Dl1R, COPIlII 41 iLL <br />trrnnNrt~rlLtlE ~ pr errq• ~n ~ i~. <br />EPA Form 3320.7 108-951 Previous editlonEµmey bs Used J~PLAC£S,EF}1,FORM TAO. WNICH MAY, NOT BE USED 1 ~~¢;, PAGE 1 OF <br />