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"^"~ pOYDSY'HOBN COil <br />ADDRESSHOADSIDE !IINE~ <br />P.O. BOY 1430 <br />PALISADE <br />FACam <br />LOCATION <br />Af'lN: JOffd A. MCNAH. <br />[0lIPllli~' '~ I. <br />N E S PORTALS I r-r <br />CO 81526 <br />P~+~SIr1 ~?NT <br />PARAMETER l3 Grd Onlyl QUANTI <br /> 1s5-531 <br />l31-371 <br /> AVERAGE <br />~tl SAMPLE #; ###.^- ####'r# #«###.: ( j2) <br /> MEASUREMENT <br />uuuu 1 e D PERMIT TictC#,'~; . g$#g'#Xa #"# ;~ #~###~ 9.0. BEKLY. NsTru <br />r: t'FL'J at:T GROSS YA1.0: REQUIREMENT <br />~ <br />~ #Od:# ~ I' ~E <br />~ <br />. <br />"OLIO:,, 'TOTAL SAMPLE ?#li### #~1#.'ti><i# >0it###C ( I9) <br />ii U:; F'.~.+i1EJ MEASUREMENT <br /> <br />'JS,fU 1 U 0 PERMIT. -~ ~ ~ ~ <br />###Matkal~.~:..: ~ ~ ~ <br />:~:~: ~+R9!slo~?a... <br />### ~ ~ ~ <br />~:.i+?f#IO14# ~ ~~ <br />35 '. .- . <br />l(}~ ... <br />~-: <br />~NCI;l <br />>RAB <br />e'FFLUi.+.1' GROSS YRLIi!~ REQUIREMENT - #### ~ <br />iOLIDS, SETTL°.A;:LC SAMPLE ###### #ii#### ###A#-# ( 25) <br /> MEASUREMENT <br />U54S 1 0 O .PERMIT. =,.aYnyl6fi. .. ~ipil#I~Ip #;~~ p##~,~a REFgAT &E:FQR? NCE/ SAAB <br />EFFLUENT GR0;;5 VALI1 REnuIREMEN7 #>e~a 30 E R <br />IkO Lr, TOTAL SAMPLE ,<;:#.## #=:r•.## 4#Ci=O# ( iq) <br />(AS FEJ MEASUREMENT <br />11UU5 1 U U PERMIT ~~#'.`•`r OI..-# ###O#'} ### ###### ~eS 7sfl MCE/ fAAB <br />F.PFLUENT GROSS VALUE REQUIREMENT #4,## y/. <br />AIL AND vkk:A:iE SAMPLE :;:##i=/:r ~',:,",--".:-:: '-i'.J#$C:: ( I3) <br /> MEASUREMENT <br />!35d2 1 U 0 PERMIT -,:~:~tp:x~- Attc#AC+# ##:: ##IG#+GO REFO.R'! 10. OkSIN -RAU <br />oFFLUENT GNO55 YALIJr. REQUIREMENT #4-~# 0 'lt S <br />LUr1, IN CC:tUULT CIF, SAMPLE ( 03) +~#-:##'? ##r}IG## :=lC#r# <br />IH8L1 TfcEAI'"t:t,T PL: S: MEASUREMENT <br />UUSU 1 U u PERMIT RE90ttT REPORT ###x+## #*«41>dlp #; 4### ### A EEISLY ;tiSTAN <br />FFLUE,-~i G40.i :; YALU REQUIREMENT 3QOA AYG DAILY !SX MGD ##3# <br />OLIDS, TOTAL SAMPLE #####: ###### ####,:# ( 19) <br />ISS OLV:~;U MEASUREMENT <br />/ULyS 1 U 0 PERMIT <br />~ ####*#. =.asYa«+R# #a# #CO«I#o R <br />Ef <br />OR? RBFORs TRLY 'AaA <br />•['t LU EN'I GROSS YALU REQIIIREMENT ~ ~ 4k#:# ~ p <br />p <br />~ QATF AY'G RT6 !!AY AG/L <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDFR PENALTY OF <br />AM FAMILIAR WITH THE INFO LAW THAT I HAVE PERSONALLY E%AMINFD N!D <br />RMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br />c, <br />~~ <br />J MY INQUIRY OF TH09E INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION <br />I BELIEVE THE SUBMITTED INFORMATION IS <br />4 .- <br />, `. <br />.,~ , <br />TRUE. ACCURATE AND COMPLETE. I AM AWARE THAT THERE ME <br />SIGNIFICANT PENALTIES FOR 9UBMITTING FALSE INFORMATION <br />INCLUDING <br />~ , <br />f 100 <br />S ~+ <br />4 <br />Id/ <br />VV <br />OT Z <br />O <br />~ THE POSABILITY OF RNE AND IMPRISONMENT. SEE 1e U. <br />.C. <br />1 AND 7J 610NATURE OF PAINdPAL EXECUTNE i. <br /> U.9.C. 1 131 e. IMelni. uMr N,s mrona +rry irclul. A+w. w ro t IO,ODO AREA <br />TYPED OR PRINTED rld u~muinur+irWlao+vrnnr elMMwnemonMa rN6yral OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe/rrenes e// stteehmenb here) <br />SETTLEABLY SOLIDS LIB LT APPLIE5 ONLY IF C=l0YN,24HR pRECIPITATICN FYEaT IS CLAI!!EG. PF.BMITTEr HA5 <br />~UHDEY OF PRUOP YHEY REQUESTIYG R@LIEP FROM SETYLEAtlLE SOLIDS PRIMARY LIMI?ATIOFS. <br />EpA Form 3320-7 108-951 Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 PAGE OF <br />OOG45/98C223-125b 1 <br />_ proved.- <br />-+rF' Tr~!iF---- o. 2040- <br />i9='rI.PQUBRaYC) COiL C~ ve1~P11U B f •r, <br />Ott <br />PERMIT NUMBER I DISCHIJiGE NUMBER F- F Z h A L `~ r <br />'~ <br /> MINOR ~' <br />MONITORING PERIOD ~ <br />~ <br />~~ <br />YEAR MO DAY YEAR MO DAY -~ <br />~ ~~ <br />FROM 0 04 O1 TD 00 06 30 :`+'~« rIU DISCHARGE _ <br />~~~ =3°~' <br />110111 l22-231 114251 /2G27/, 18-Z9/ /36311 NOTE: Read InetrucUone bela e co pletinp this lam. <br />TY OR LOADING !1 Grd Only! QUANTITY OR CONCENTRATION N0. FREQUENCY SAMPLE '•1+ <br />!54611 138-I51 146-531 ISb511 <br />EX DF <br />PE <br />! <br /> NlQy518 TY ~ <br />MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rat-sal !84681 163701 , <br /> <br />