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f ' <br />PERMITTEE NAME/ADDRESSO~dr FrWryNw/Lranm dDls..rq <br />NAME POriDEHHOHB C^AL Cv;1PANt ` <br />ADDRESS HOAUSIDE !!IS';i, L Z; ~ PuicTALS <br />P.O. bOR 1430 <br />PALISADE CJ d1Slb <br />FACIIITy <br />LOCATION <br />ATTh: JOHN A. !;CMAH, FriF.~1LcAT <br />NATIONAL POLLUTMT DISCHMDE ELIMINATON SYSTEM l/VPDE$/ <br />DISCHARGE MONITORING REPORT IOMRI <br />!7-I Sl 1I7-19I <br />00 7 46 <br />PERMIT NUMBER DISCHMOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM Y U TO b <br />116111 l11-131 !II-151 /16171 128-191 !36311 <br />•~ .. .'form Approved. <br />POND 1 TC COLOR~DDY~o~°-oooa <br />(SUER WC) PProveLe:{p'ru~05-31-98 <br />F - FI ItAL 11 <br />MINOR <br />~~# KO DISCHARGE a._;. <br />NOTE: Reed inetruetlone belor i ompletin0 thu form. <br />PARAMETER 13 a.d Onlyl QUANTITY OR LOADING 11 Grd Onlyl QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE <br /> !16531 !5451 l38-151 !46531 !545/1 DF <br />l3Z-371 EX <br />MALr515 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS Is=-s]I l60-sBl 169-701 <br />L AND GAEAS° SAMPLE 4;~Ct?S# ( y4~ #Ofi### #d#### ~ #tC0### <br />Y I SJ A L MEASUREMENT <br />U4U66 1 U U PERMIT ###4'414 .- RE~.Ei~T F5=1 ¢:##*~~ OAIli'+101`4. #16+C:AT?fi. ### E$RLY i~$DAi <br /> <br />f:FFLUEWI' GROSS YALU <br />REQUIREMENT <br />~b$~':.1'~~Y:: <br />w0=~ ~, <br />-:: : <br />:.. :: r, .: :.... .. <br /> <br />,: :: <br />#~r#0 <br />? <br /> SAMPLE <br /> MEASUREMENT - ~ - ~ ~ "' <br /> PERMIT <br /> <br />~~ ::~l;q:~~•S:;t3: :~~.>rr::': :';;~~:?'.:~'::'::r: ~::5:::'s' <br />r <br />I <br /> <br />. <br /> REQUIREMENT f_''...: _ <br />.,'. :. " <br />- <br />~< <br />: ~ <br /> ... , <br />w _ <br />,:.: . <br /> SAMPLE ~ - <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~ ~ ~ ~ - <br />~ <br />~~~~ <br />~- <br /> REQUIREMENT. ~ - ~ ~ ~ ~ <br />~ <br />.'_ <br /> SAMPLE - ~ ~'r <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~ ~ : ` <br />;~ ~ ~ _ <br /> REQUIREMENT ~ ~ . ~ ~ ~ ~' _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~ `"~~ <br />' <br />~ <br />~ <br />Y <br />~ <br /> ~REQVIREMENT ~ - - <br />: <br />M>_ <br />:' :%~ w': - <br /> SAMPLE - <br /> MEASUREMENT ~ - <br />~ <br /> PERMIT ~ ~ ~~ ~ - ~ - <br /> REQUIREMENT ~ ~ ~ ~ ~ .. <br /> SAMPLE <br /> MEASUREMENT <br /> ~P.ERMIT - <br />~ <br />~ ~ <br />~ ~ .. ~ . <br /> REQUIREMENT -~ <br />~~ <br />~ ~ ~ ~ ~~ <br />~ ~ ~ ~ - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 cERTIFr usDER PENN.TY of uw 'HAT I NAVE PERSONALLY ExAMINED AND <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN: MD BASED ON TELEPHONE DATE <br />~ <br />~ ~ <br />~ DIN <br />U <br />R <br />E <br />E <br />O <br />~I <br />~. ~ <br />~ OBTNN M <br />G <br />TNE INF011MATION <br />BELIEVE THE <br />SUBMITTED <br />NFORMATION <br />IS - <br />V`~ TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br /> ~SIONIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLWING <br />2 <br />~ <br />~JJ ~~ , <br />THE POSSIBILITY OF FINE MD IMPRISONMENT <br />SEE 13 U <br />S <br />C <br />1 1001'MD 3] {~ <br />~ / <br />( . <br />. <br />. <br />. <br />1 <br />S <br />r <br />l BIONATURE OF PRINCIPAL EXE E ~ <br /> <br />TYPED OR PRINTED U. <br />.C. E <br />]10. lF <br />Nle <br />d.. IldY N.r Nerh, re/Y McA.N /vr.W ro f/0,000 <br />rM rmuhil.n brrlatnwnr of an..sl ssoNtdr,wslrral <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER ~ <br />VEAR <br />MO <br />DqY <br />G V MMCN I S ANU CAr'LP11YX I I V M V r nlrT V IVLM I IV IYD IRIJO/e/ICe e// IReCOTlOf4 DY/f/ <br />:,2TTLEAGLE 90LID5 LIMIT APPLLE3 UMLY IF C=lOYR/24NA PRECIPITATION EYEk7 IS CLAMED. PERtlITTEE NA5 <br />tfUdUEN OF PROOF NNEN REQUESTING AdLIkF FAOtI SETTLEABLE SOLIDS PFIlIAAY EIMZTATIOYS. <br />EPA Form 3320.1 108.951 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 005 50/ 98 C 2 2 3-12 S 6 PAGE `OF <br /> <br />