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PERMITTEE NAME/ADDRE55(IMd~F«drnNw/Loru4w l/ptd¢ETIj--~- .. --_---~~ I' - - ~ '- ~~ roved fir- ' - -- - NAME POYDEHNORII COAL COlIPART "-°'r , > '~ : ~_ ? pp~~ ~~ •~p~ '~~~ ga TJ VB e l x ADDRESSROADSIDE !INE, N : S PORTALS CODO$ 4 PD (SOBA iC) ~~ ~ L P. U. BOY 14 3 U PERMIT NUMBER DISCHARGE NUMBER F- F I! A L PALISADE CG 81526 MIR~R FAaun MONITO RING PERIO D LOCATION YEAR MO DAY YEAR MO DAV ,~ FROM / TO :~# NO DISC iIAAG $~ ~~~ +'/+=# :.'f T p ; J O h N A . ", C N A B , P k E `; I D .° N T !167 J! l77-131 !74761 176771 l18-791 !3631/ NOTE: Reed Instructlaa belon completing this form. PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !/ Grd Onlyl OUANTITY OR CONCENTRATION NO, FRFDUENCr SAMPLE !16531 150-611 138-1.51 14653 15L6I1 OF l3I-371 EX ANKrSlS TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS l61-s]! 164681 189-701 'rl SAMPLE rF#4#a# #a#l.A3 :7'R.;#a# ~ 12j MEASUREMENT UuOU 1 0 '0 PERMIT #axeq>mI:~L .. -?II+~OIIx+ 4#k ,$ o#O±gII10 4,..0:.. ~EtiLY tiSIT'0 `iFFLUENT GflOSS VALU REQUIREMENT ~' ~ ~,. ..~' ... #aa# ~..n.j.JLj~.(1~ : - ~ ~liA1~ ~ U ,. .~ ULIi/S, TOTAL SAMPLE #Kr#a#a O#04'*# oa#sea .f 19) ~UiPENDEO MEASUREMENT U~90 1 0 O PERMIT. ~tA#IM~F# II~~*; wC i `~:#t)'q~01>L4... $g :.::...'.:::. ,:: ;: ;' ~ r , $CE ~~*H . 'FFLUENT G110$$ fALUE :REQUIREMENT. ':? ~~a 30 ~:it4 A~~x . . .,OLID:i, SE~LEABLE SAMPLE a~xsaaa ~a#a .'# ##>dA#4 ~ 2S) - MEASUREMENT ' JUS45 1 i,0 O PERMIT .: ##40aC ##IC7DOr# . ### Bg10Ji>outr ~ RE E'~X{:'j .R$:~0$S':. f AGE/ i~L~O :r'fLUL'NT 48055 YALU :REQUIREMENT ~ o#a# 30DA XYr+' T'' ~ ~~~ L kON, TO ~ SAMPLE #aA#v# #a4Q## #OIJ+C-',r J} ( 1~~ (AS FE) MEASUREMENT 1045 1 O O PERMIT a##IIG# . : #aftstPtO'# #:: tF'A~#1f>pl qq ~ FI LO ENT GRO$S YALU ~IiEQUIREMEN7~ - aa#a ~:. 3OD8 -A.YG DAII~ l1Y MG h ~' .:. y IIL AND GatiA$E SAMPLE ####;Y# #3C### 4##taaa ~ 19) MEASUREMENT J .1782 1 O 0 ;.. PERMIT ~ CTYV.l4~ '~~~5+#tOr>C#I aaa ~>a.~l>~.1±7,#4 ~ &E f.<1~RT ~.~ I~~ ' :;:';;~ :..- . '. 'O VRI N~ ~>~8 ~ 'FFLUENT GROSS VALUE ..REOUIREMENT ? aa#a ,.;',:.. 3onA.:.:ar.c . . . : , .::t~~~t ~ Y dG L c N . 'LU F N CpAD IT OR SAMPLE ( Oj) ##IIIbo~O +CL#II!4 of###tY CNHU TREATl1LMT PLA NT MEASUREMENT 10050 1 0 0 PERMIT., RSPORT RC1'O&'? #4#0*Fa aoas~a# A!#>cY~~C+II #>a• ~ '~$ALY :MSTAN 'FFLUENT GQO$S YALUE :.REOUIREMENT' SODA ~A.YC~. DLI~LR' ~tx~~ GD ~ #LI~t3 ~ e AL SAMPLE ~#G# O#*a## b#a#>Fe - ( 19) ISSOLYED MEASUREMENT 70295 1 0 U PERMIT': IIO'~EYfi'~:' .: . aaa~1>GEx ate' !I#.##.a+o.. R.BF4AT REFOA 2 TRLY :RAH 'FPLU£NT GRQ9S VALUE .REOU.IREMENT .... : ; '::::'. .. :. ... .' .: #C# cesa '~Y~.. :':gar~ n ax. ec/L NAME/TITLE PRINCIPAL EXECUTNE OFFICER I OERTIFY UNDER PENKTY OF lAW THAT I NAVE PERSONALLY E%AMINED AND TELEPHONE DATE AM FAMILIAfl WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY INQUIRY OF TNOSE INDINDUKS IMMEDIATELY RESPONSIBLE FOP ~. E. Stover OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. ACCUMTE AND COMRETE. I AM AWARE TNAT THERE ME SIGNIFICANT PENKTIES FOR SUBMITTING FKSE INFORMATION INCLUDING Agent . THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 1B U.S.C. f 1001 AND 9] BIONATURE OF PRINCIPAL EXECIlTNE D TYPED OR PRINTED U.S.C. f t 71e. /FMWPF, Yler Oh,r Wam, nl,y hch/d, Ter, W ro S 10,000 wwmufnre hlylsnnrnr or arr,..Bntotm,wsy..r.l oFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY COMMENTS AND EXPLANATION Of ANY VIOLATIONS (Referents ell effschmsnM hire/ 3tTTL£AdLE SOLIDS LINI'CS APPLIES UNLY IF <=LOYR,24HR PkECIPITATION EVENT IS CLAI'EDe PEHtIITTEE HAS bUkUL'N UF' PROOF NHEN REQUESTIAG kELIEF FRO!S SETTLEABLE SOLIDS PFItlARY LIMITATIONS. e ,) t ~I ~r EPA Form 3320.1 108-95) Previous editions mey be used. /REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 0 0447 / 9 R C 2 2 3 -12 S 6 PAGE 1 OF