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PERMITTEE NAME/ADORERS p~m FsY1ryNa•/Lzarle. UOI? r.wrl NAME pONllENHORH CJAL Cii9~ARY ADDRESSRUAUSIDE: HIN4, h b .; FUR.AL.i P.U. BOY 143J PALISADE CU b1526 FACILITY LOCATION ATTBi JOHN A. rCVnt,, FP.~':>lU::NT NATIONAL POLLUTMiDISCHMGE[LIMIN~~77110 SYSSEM /NLsQeSA. DISCH1 R61EAAQNIiOF{INGE{EP~ORT'{OM~/ - 0 0 ~ u YY77 PERMIT NUMBER DISCHMGE NUMBER MONITORING PERIOD YEAR MO DAV YEAR MO DAV FROM 4 TO !16111 !II-131 /14151 116-171 /78-191 130-311 PO~~ 1 20 (SUER iC) F - FIlAL RINOR "~~form"Approved. _,~, ca to A a Dp~"~flPr~°k°-ooo< pproveL ellp~r4g~05.31-58 44q NO DI5CHAAGE ~ ~ 4~'r' NOTE: Read Inetruetlom bola o I•tinp this form. PARAMETER l3 (SrO OnIYI QUANTITY OR LOADING !1 Grd On/YI QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE 1~8-531 1548/1 138-151 14653 I5b61 EX OF 131-371 AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 161.691 MALVSIS !64681 TYPE 169-701 FH SAMPLE #48444 444844 gC4g44 ( I2) MEASUREMENT - " U4U0 1 0 D 'PRMIT."i;. ~,~.:..:..... 4.44O4ij ":##O#4"i >t g44 • 6 5.' : :, .:. 4gtL'AL6~.:. [}~Q. ff~AL.T [M$I'f aFFLUENT GROSS YALUk REOUIREMECiT, ".; ' ~:..~~. - "~: g444 ~iYi-~:.~2 ~:. SOLIDS, TOTAL SAMPLE >-4g444 a14444q 40400q ~ 19) SUSPENDEu MEASUREMENT 'OS30 I V U PERMIT lildylMl 41(F 4~O##Ib 804 4.10143'fEtAl ~:y: : . 7~i x~E/." {~~. S FPLUENT GROSS YALUi ~REQUIREMENT .~:~ 4;4 #. ~ 3 DA A9G DA .2 COL ~ ;)E?TLEABLE SAMPLE 44044# 444444 4g4g44 - ( 2S) MEASUREMENT ` ~ " US4S 1 0 U PERMIT 844444 >iq#44>l~;.~ q4~ ROOK"qq A"EFONT ~~. A'$.~O~AT:.: ~ ~ ~ fNCE/ ~ a.RdtB FPLUENT GNOSS VALUt~ REQUIREMENT ~ ~ :. z~::?` gIIY4 ~ ~ ~ 3ODA ~AV6 :-DaI"~L2 r!Y ~. "110N~ . Ii<ONA 'IOTAL SAMPLE {:4444-.` 444444 44g44t ( Ig) (A5 FE) MEASUREMENT _ r 1045 1 .. V:" 0 ~ PERMIT ~ 4444:#4 ~ ~~.. 410.!IA>1C## #fiA ~~C'.~#tA9 3 • SI 'f ~.V :~ ~'":.. ~.~ ."ll~Ef ; RAb ~'FFLUENT 6AOSS YALUk .REQUIREMENT ~ ~,.~` ~~~ gg4q 9ODa A.Y A. ':r 1<: /L tl Mn't L ANG GAEASE SAMPLE 444444 404444 448404 ( lg) MEASUREMENT 35H1 1 0 U PERMIT 44>xaa4 44444.0 44a 4kJ4>w>44" REFffAS"": '1(t :.g~. :DNTZN :kAB .FFLU BNT GP.~O55 YALU REQUIREMENT ... .,.. 444q ...:...:: ' ' .3O D.A .:,A~. , :-:'T RS"t' A.Y~ MG ~. -. .G$NT ' OME IN NDUIT Uh SAMPLE ~ ( 03) 404400 ' 4C#qA0 9.C4g44 1rIhU THEAT[:ENT irLA NI MEASUREMENT 7liUSU 1 U 0 PERMIT R pt7RT .. EiEPOR'i 44saoa . :. 400~4?Q" : "'~44q+Og I t:4# EEi(LY f'NSTAN YFLUENT Gh05$ YALU . .REQUIREMENT 30Dr1'A:rG DAILY hx" nGD 4444 ~UL • T T L SAMPLE 444484 444#44 4>04g40 ( Igo ~iSSOLrED MEASUREMENT 70295 1 U J PERMIT: OOp44... :..F4#44'0 444 4.>k#!q4 REF#R't: ":.::A.$FGRT TRLY :RAH FPLUENT Gh055 YALU REQUIREMENT: .,: ggrjq QR7i~: LkG gRTA MA% ` nc/L :.:, . :: . ~.,, NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERTI AM FA Fr uxDER PExuTr of MILIM MATH THE INFO uw TxAT I NAVE PERSOxALLV. ExAMINED MD RMATION SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE n/(~y ,/ ~'~.~irAy>II /_JI//~ ~~ ~/V OBTNNINGRTNE NFORMATION II (BELIEVE ITRE ESUBMITTED INFORMATION IS / , TRUE, ACCURATE MD COM0.ETE. I AM AWME THAT THERE ME - SIGNIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING ~ , THE POSSIBILITY OF RNE MD IMPWSONMENT. SEE to U.S.C. 1 1001 MD ]] BIONATURE OF PRINCIPAL EXE E U.S.C. f 1]18. Ih;WW uYMI eNY mNro. rrrY In[kd1 rvMAW ro J10,000 TYPED OR PRINTED wo.mu•nrm:ePdo+•I••rwbrrw..,emwreu rM6Y•v.l OFFlCER OR AUTHORIZED AOENT LODE NUMBER YEAR MO DAV COMMENTS AND EXPLANATION OF ANV VIOLATIONS lRe/erence Bl/ sffschmenb here) :iLTTLEAHLE SOLICS L1HIT Ai?PLIES ONLY IF C=lUYR/24NA PRECIPITATICA FYEMT IS CLAICFD. PERMITTEE HAS bUdDEY OF DROOP WHEN REQUESTING RELIEF FAOl1 SETTLEAGLE SOLIDS PpIl1AAY LIMITATIOIIS. EPA Form 3320.1 106-951 Prevtoue edluons mey be used. (REPLACES EPA FORM T30 WHICH MAY NOT BE USED.1 ~ O O S4 g / 9 A C Z Z 3-1 ~ S 6 PAGE lOF ;.5, y, r .n I C