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PERMRTEE NAME/ADORE55 (GeYl.sdgN../tarla.UD~.r.u) <br />NAME pOMUF:RkO$N COAL COtlPAY~ <br />ADORE55 ROAD51 Gt ."ICE, N £. 5 PORTALS <br />P.O. c0% 1a~0 <br />PALISADE CO J1526 <br />FACam <br />LOCATION <br />n'fi;l; JQhH A. 1:CNAP, Pk:ESIDEN'f <br /> <br />'~tl~~ ~~ ~- E:fj~l <br />(SUBA iCj <br />~ PERMIT NUMBER ~ DISCNMGE NUMBER F- F I E A L <br />MONITORING PERIOD f1 I N 0 A <br />YEAR MO DAY YEAR MO DAY " <br />FROM 'J TO '^t'%'+ NO DISCNARG 6. ~~~ ~~~+ <br />!16111 l11-131 11I-151 !16171 118-191 !36311 NOTE: Reed ImlruMiam before co pletlnp thb form. <br />.I <br />PARAMETER l3 Grd OnlYl QUANTITY OR LOADING ,. -- !I Grd Onlrl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> !46531 154811 l38-I51 la653 1545/1 <br />E of <br />l31-371 <br />.AVERAGE <br />MA%IMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MA%IMUM <br />UNITS % <br />!e1-esl ~MN.ras <br />!5,4581 ~ TYPE <br />169-701 <br />OlL AN GkEASE SAMPLE ~:#a#C~ ( 9LL) as#aa4 tl##fiII# #i#### <br />V I S U A L MEASUREMENT <br />4U66 1 0 0 PERMIT #tFit04# ". :..HICPETRR E5=1 aq+v~?a#. . . la"IRfI¢?&IR #~'130~ f#4 ~~ICEY" .TSUAE <br /> <br /> <br />EFFLUENT GROSS YALL REQUIREMENT <br /> <br />. ~ " " <br />,: . <br /> SAMPLE - ~ : <br />- MEASUREMENT _ <br />~ - ' <br />~~ ~~ PERMIT. ~.. .:;:...: ~":~:~:.;. <br />.. <br />.".:~~~: <br /> <br />r ~ ~. ;~.'s <br />- ': . <br /> REQUIREMENT ~ " .. .:-.... , :. .~. :.: ~%~ <br /> <br />. . <br />G <br /> <br />.... . :x .. . <br />.._ <br />_ <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ - <br /> ~REQUIREMENY ~ ~ ~ ~ ~ - ~~ <br /> n_ <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT " <br /> REQUIREMENT ~ ~ ~ ~ ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> "PERMIT. ~: ~ ~ ~ ~ - ~ <br />' <br />~ <br />~ "~ <br />" " <br /> :REQUIREMENT ~ .~.:. ~ .. . <br />.: <br />~ <br />~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ <br /> REQUIREMENT~ ~ ~ ~ ~ ~. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~" ~~ <br /> REQUIREMENT . ~~ ~ ~ " . <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I cennFY UNDER PENN.Tr of LAw THAT I NAVE PERSONALLr ExAMINED MD TELEPHONE DATE <br /> AM FAMIDM WITH THE INFORMATION SUBMITTED HEREIN; MD BASED ON <br />/1 <br />,,~ C~/ MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BEDEVE THE SUBMITTED INFORMATION 19 <br /> TRUE, ACCURATE MD COMPLETE. I AM AWME THAT THERE ME <br />SIONIFICMT PENALTIES FOR SUBMITTING FN <br />SE INFORMATION <br />INCLIAING <br /> <br />~~ , <br />. <br />THE PO <br />BILITY OF NNE <br />MPRISONMEN <br />EE 18 U <br />S <br />1 <br />D <br />C <br />! <br />D ~~(~ <br />(~~ ~.~f ~~F" <br /> . <br />SSI <br />M <br />I <br />T. S <br />. <br />. <br />100 <br />M <br />37 <br />SIGNATURE OF PIIINCIPAL E%ECUTNE ~y ~ ~ yv {/•F- <br /> u.s.c. 1 1G1e. lMWer+uwr era mue++nrr McM.l+ An++w ro Sr0,P00 ~ <br />TYPED OR PRINTED rgrmuinlnr lnPd+arvn+ntwNrw++n emona+rNer.Nal OFFlCER OR AUTHORIZED AGENT ~ CODE NUMBER YEAR MO DAY <br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS (RSfersncs sll sffechmenfs Mre) <br />SE.TLEAdLE SOLIDS LIlIIT APPLIES ONLY IP <IOYR,24HR PkECIPITATION EVEN'[ IS CLAI`.EC. PER`II1'TEE HAS <br />uUdUN.N OF PROOF MHEN RF.~UESTING RELIEF FRO(7 9ETTLEAbLE SOLIDS PAItlAAY LIMITATZOtlS. <br />EPA Form 3320-1 108-951 Previous editions may be used. IREPLACE6 EPA FORM T40 WHICH MAY NOT BE USED.) D D S.' S/ 9 8 C 2 2 3 -125 b PAGE 20F <br />