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PERMITTEE NAME/ADDRESS (1.rv4 FrWryN~Wfasnm I/Dlp...np <br />NAME POYUnHHORA COP.L :.'O;;PA6Y <br />ADDRESS ROA DSI Di :"Ipd, ;i ;: ~ POH1'A LS <br />P.U. DUX 143U <br />PALISADE <br />FACIIITV <br />CO tl1526 <br />LOCATION <br />67'Iti: JOdN R. NCNAD, Prat-ilUENT <br />NATIONAL POLLUT/yl7~ISCtlM06 uMINADtiN SY3/TEAi_INRDES/ <br />OIS~N/I['/YE6C/`E~•.--MM''ONFTOI~INO REP6Rf /OMRI <br />n~ Ts/ <br />7 4 <br />PERMIT NUMBER DISCHMDE NUMBEn <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM Y U 1 TO b _ <br />!76711 177-231 !74751 176771 118-791 !36311 <br />PARAMETER !3 Grd Ontyl QUANTITY OR LOADING !a Grd On/yl QUANTITY OR CON <br /> 1d6-531 15b5/1 I3B-r51 !46-53 <br />l37-371 <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161.6.TI lµ661 !6&701 <br />SL ANU i:REASE SAMPLE 44a~1s~ ( g4) A10140$G Y+aao4~ it9~a>G <br />Y I ~ U A j, MEASUREMENT <br />d4Ub0 ]. D D PERMIT '%;: #Q+C!Jitkl: RE..POiiT ES=1 fi?OIIkt1+3~ OIOC109:?G ' tf>: <br />z+ymll~ oa# EEKLY r~XSUA. <br />t.FiLUENT GRO55 VALU REQU.IREMEN3:;: '; <br />:. <br />' : <br />:::: <br />:': Ii1S3: <br />lIAY 110aO ~• <br />;': : :1 <br />` . <br />;.. #4 <br />,. <br />,. <br />: <br /> ,. : <br />. <br />.; <br />,. <br />r: <br />4 ..... .: .... ... .. .. .. <br />: <br />. ... <br />,: :•::.:.: <br />.: . . 081, . <br /> SAMPLE ,- ~ ~ .' <br /> MEASUREMENT ~ ~. ~~ <br />1 <br /> ,< <br />;... .. <br /> <br />, <br /> .R ~UIREMENT <br /> <br /> <br />;. <br />~aT~:., <br />>; <br />Y" <br /> <br />:. <br /> '- SAMPLE - <br /> MEASUREMENT <br />ij ~: PERMIT ~ ~ ~ .. <br />.•~- <br />- ~i 'REQUIREMENT ~ ~ - ~ ~ <br /> SAMPLE <br /> MEASUREMENT <br />~ <br /> PERMIT ~ ~ ~. ~ ... .. <br />. <br />: <br />.... . . <br /> .REQUIREMENT , <br /> SAMPLE <br /> MEASUREMENT <br />- <br /> .;..~ PERMIT ~ ~ ~' ~ ~ ~ <br /> :~REQl11REMENT ~ - ~~~~~ ~~~~~ <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ PERMIT _ ~ ~~ _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~. ~ ~ . <br /> .REQUIREMENT: ~ ~ ~ ~ ~ ~ S <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF UW THAT I HAVE PERSONALLY E%AMINEO MD - TELEPHONE DATE <br /> AM FAMILIM N1TH THE INFORMATION SUBMITTED HEREIN; MD BASED ON <br />/ n' L~ ~ <br />/ <br />~/ L` <br />~(i` /r Y'T <br />MY INQUIRY OF THOSE INDINDUK9 IMMEDIATELY RESPONSIBLE FOR _ <br />A <br />/ <br />VV 1 OBTNNINO THE INF011MADON. I BELIEVE THE SUBMITTED INFORMATION IS <br />T <br />E T <br />T T <br /> RUE, ACCURATE MD COM0.ETE. 1 AM AWM <br />HA <br />HERE ME <br />SIGNIFCMT PENALTIES FOP SUBMITTING FALSE INFORMATION <br />INCLUDING <br />~ <br />~ <br />. <br />~ , <br />THE POSSIBILITY OF FINE MD IMPRISONMENT. SEE 1B U.S.C. ! 1001 MD 3] <br />BIONATURE OF PRINCIPAL CUTNE ~`, ~ ~ <br />`/ ~ ~ / <br /> <br />'TYPED OR PRINTED U.S.C. f 1 ]te. lP.n.IWI uNr rM« mema IrYy pl[IIn11 Nwa 1p ro a IO,OIXI <br />m0a+muim.n Mprlerv«nf oFMM«nemonNS rW 6«va.l <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference sll snschments here) <br />SETTLEADLB SOLIDS LIHIT APPLiE5 UNL[ IP C10Y8,24HR PRECIPITATION ErF.NT IS CLAIMlG. PER:IITTEE HAS <br />vIiHOEd OF PROUF YHEN AEQUGSTIYG RELIhP FROM SETTLEA6LE SOLIDS PRIHAAY LIlIITATIONS. <br /> -Fotrn APProved. „~f;'. ..Y <br />°-0Op4 <br />PoeD a to ~' <br />CdLOAAD~M~IPr~~ <br />06-37=96 <br />' <br />($D9R MC) . <br />PProvaLa2, 4 <br />l1 <br />P - FZNAL <br />R1NOA '.I ~' <br />tiy>tio MO DISCHARGE ~'~'~ <br />~ <br />Ietinp this form. <br />NOTE: Reed IrutrucUors belor i co <br />CENTRATIO <br />N NQ. FRE OFNCY SAMPLE ~~ <br />r~ <br />6t/ EX ' <br /> MALrsls TYPE :; 1 <br />EPA Form 3320-1 108.961 Previous editions mey be used. (REPLACES EPA FORM T40 WNICN MAY NOT BE USED.1 00510 /99 C 22 3-1256 PAGE :OF <br />