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PERMITTEE NAME/ADDRESS (lPdrNfnlilrA'a!/L«maed <br />NAME POYUBB80R^ COIL COAPAtl~~-~ <br />ADDRESSHOAUSIDE NINE, N 6 S PbR~S <br />P.C. SOX 1430 <br />PALI3ADr: <br />CO 81520 <br />FACarrv <br />LOCATON <br />ar~rtl: ~ut{N e. r.cvAa, PFESIL'E1iT <br />DISCHNIGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO _ <br />1101/1 l11-131 !11.151 116-171 l16-191 !3437/ <br />_ r , yed. ' ~ri <br />~'°``~ a~2o2o-oo5a <br />(9USR iC) ve[eg~iEe¢s053a 98 <br />P - FINAL 1L Y <br />rI NOR <br />:~~ ND CISCaARGE ~~.~ a>F~z <br />NOTE: Reed Inetruetlone belore compMtlnp this form. <br />PARAMETER !3 Grd Onlvl QUANTErY OR LOADING 11 Grd Only) QUANTITY OR CONCENTRATION. Np, FREDUENCr SAMPLE <br /> 146-531 151671 138x51 M6-53 !51-51 <br />Ex OF <br />TYPE <br />l31-37I ANALYSIS <br /> AVERAGE MAXIMUM UNITS ~ MINIMUM AVERAGE MAXIMUM UNITS rs1-sal .rµ581 159-701 <br />AIL AND GitEASZ SAMPLE a~can: ~ 94) alaaa>da aa~~~1s~ aeauaal <br />V I:iU AL MEASUREMENT <br /> <br />4 Ub 6 1 D. D <br />~ PERMIT ~ ~ <br />#~IR49t:lE.. .. A <br />::... 8~,~t~1.$ <br />1' . <br />SS=1 <br />~ ~~.9*.$#4. . <br />~ ~. 14.!C O'AA.~1 <br />;; #~IL:4A=#..:~ <br />d>rlp <br />~~~- <br />~,15~1(lCLT <br />- 3SDA <br />EFFLUENT 6R0!$ HALO REQUIREMENT. .: . <br />.. <br />', .~ ~;.:!l:R.Xs: ~O~D `::.r`=, i:. :. >/+Af?' t-. <br /> SAMPLE <br /> <br />. MEASUREMENT ~ ~ ~ ~ ~ ~ ~ - <br />. <br />- <br />~ ~ ~ PERMIT ~. <br />~ .. <br />..... .:..: ~ <br /> <br /> <br />- <br /> <br /> <br /> <br />.: . <br />.... <br />,, . <br />.. ~~.. <br /> <br /> <br />~ <br />- <br />,. REQUIREMENT ..;~...~._::~ .. .. .. <br />.. . . ... .: .... .. <br />.... .. <br />... ; .. <br />.,, <br />::~:. ~. <br />:e .. <br />... . <br />,. <br /> <br /> <br /> <br /> <br />. <br />L <br />~ <br />. .: ~.:: <br />- ~ SAMPLE <br />' MEASUREMENT ~ ~ ' <br /> PERMIT .. <br />~ <br /> REQUIREMENT ~ .... ~ - <br />' ~ SAMPLE - <br />-~ MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ~ - <br /> SAMPLE <br />- MEASUREMENT <br /> PERMIT ~ .... .. ., ,, ... <br />' ~ .REQUIREMENT <br /> SAMPLE - - <br /> MEASUREMENT ~ - ~ _ ~•' 1 <br /> PERMIT <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> ~: ~PEHMIT ~,.;.~ <br />. <br /> .. <br />... <br />REQUIRENIENT:~ <br />~ <br />~ ~ ~ ~ ~ ~• ~ ~ ~ ~ ~ <br />~ <br />~ ~ <br />~ <br />~ ~~ <br />NAMElTITLE PRINCIPAL EXECUi1VE OFFICER oF <br />I CERTIFY UNDER vENUn <br />AM FAMILIAR WITH THE INFO uw TNAT I NAVE PERSONALLr ExAMINED AND <br />RMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br />C <br />~ 1 ~ , ~I <br />G 'ipy ~/(~• MY INQUIRY OF THOSE INDINDUAL9 IMMEDIATELY RESPONSIBLE FOfl <br />OBTNNING THE INFOIU/ATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />- TRUE, ACCUMTE AND COMPLETE. I AM AWARE THAT TNERE ARE <br />LTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />T PE <br />~ <br />~ , <br />SIGNIFICAN <br />NA /J L/~ A/OI <br />" ryT <br />~ O Z G <br />~ THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 AND as 610NATURE OF PRINCIPAL EXECUTIVE 7 V <br />I V y <br /> U.S.D.! tarp. lnn.rdr.urr dws .sema m.y icArA r,..A tpro JrO,000 AREA <br />~ <br />TYPED OR PRINTED m'CO.munwn:nA+bomwnoFe.n...oe~a,wsE+•I OFFICER OR AUTHORIZED AOENi CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS !Reference d/sttschmsnts here/ . <br />;eTYLEABLE SOLIDS LIMIT APPLIES ONLY IF <=lUYH/24HA Pk~~IPITATICN BYPI? i5 CLAIFBG. FERl1I?TEE HAS <br />±UHUEN OF PROOF ^HEN kEs1UE5lItlG kELIEF•PRiJM SETTLEABLE SULIDS PFIMAAY LINITATIOiS. <br />EPA Form 3320-1 (08.95) Previous editions may be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 C 04 8 6/ 9 B G ~ 2 3-12 5 6 PAGE 10F <br />