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IERMITTEE NAME/ADDRESS (/wild. iwyllryNr/Lecanm IjDIC r.nq <br />NAME PO+IUE. :f hCi n:l l'l:,L C~~Jfi i'A ffY <br />ADDRESS ROAD~ID~ I'1' f:, S .; _; FI)k1'ALs <br />P.O. I;OX 1u.3~ <br />PALL:;Ati!' CO 91526 <br />FACILITY <br />LOCATION , <br />w TTNS .7n FI .L A_ /;'NGA LJ 4C rn rum <br />p:.; cc I <br />NATIONAL PoLLp"~!+T~6I]CHARGE ELIMINATON SYSTEMI Q~rKl~ ~-, I,( <br />DISCHF~uE"MON{TORING REPORT /DA1~k • ~~ - - ' ~! <br />!-5/~ n7- r Pot,p z TG <br />rnnn~ I non (jU9R kC) <br />PERMIT NUMBER DISCHARGE NUMBER F- F I X A L <br />MONITORING PERIOD r I N C R <br />R MO D V <br />~' - - Form APProved. '' <br />COLORAD~P}o~ePexplree05-31-9'8 =~'r <br />123x5 <br />YEAR MO DAY YEA A <br />FROM 9 04 TD 10 ~i%f: N~'7 Cr~CHARGE, ! 1!I `~~'k <br />/1dI11 Q2-131 121-251 12G771 12b-191 130.311 NOTE: ReJd InitrucboFr be or 5dhl21etlnp this farm. <br />PARAMETER 13 Grd Only! QUANTITY OR LOADING I<Grd Ontyl QUANTITY OR CONCENTRATION ND. PAEOUENCY SAMPLE <br /> I<5-53 154671 136-<51 !4653 151-61 EX DF T <br />l32-371 <br />ANALYSIS YPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ma-sal Iµ561 159-701 <br />IL ANG i;kEASE SAMPLE Y'#p#„~ ( 94) #e#o0# Op#Yi#': #aa### <br />VISUAL MEASUREMENT <br /> <br />D4Ubo 1 U 0 ..;.. <br /><,•::::,PERMIT ... <br />;. ... <br />R6.eG <br />RT <br />E5=1 <br />#-~0!.0`1?+0.# <br />fi4@+D'dit <br />is#.iQ.#LI~3; <br />>f#C <br />.I <br />E~YLY <br />LSUA <br /> REQUIREMENT: ..:, r..... . <br />. ..::..:: ... <br />,. <br />SG <br />~...,., :.,.r :.:....::.:.:•.:: <br />.. . <br />. <br /> <br />:..:. <br /> SAMPLE <br /> MEASf <br />D~iEMENT , <br /> , r <br /> . .::... <br />::,. . <br /> <br />. .. <br /> <br />.... <br /> <br />REQUIREMENT <br />~: •" ;. <br />... <br />.:, .. <br />... ::.:.. <br /> <br />- <br />~ <br />~ <br /> <br />... .... <br />r:.. :. . . <br />: <br />. <br />~ . <br /> . , . <br />: <br />: <br />: . <br />. <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> i <br /> PERMIT ~ ~~~ :~: ~ ~ .~y.:., <br /> REQUIREMENT <br />p <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. ~' f7 <br /> REQUIREMENT ~ ~~ ~ ~~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> .. ~~: PERMIT':: <br /> <br />.:. .. .. ~.:.; ,; .~ ..... <br />:.... <br />.. <br /> <br />.. <br /> :REQUIREMENT . <br />.. <br />~~~ ~ ~~~ ~ <br />.. .. <br />~ ~~ ~ ~~ ~ ~ ~ ` <br />,. .. .. <br /> <br />. <br /> <br /> <br />/ <br />: <br />' <br />~'~~ ' <br />~ <br /> . <br />.. <br />. <br />. <br />Y: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> ~fiEQUIRENIENT ~ ~ ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT . . .. .. .. <br /> :REQUIREMENT: .. <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CEflTI <br />AM FA FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND <br />MILIAfl WITH THE INFORMATON SVBMITTED HEIIEIN; AND BASED ON <br />~- TELEPHONE DATE <br />w ~ / / I ~ ` / /! ~ <br />V !~ /., ,'i A MY~ INOUIRV OF TNOSE INDINDUALS IMMEDIATELY RESPON9BLE FOR <br />~ L,pe~yNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS ~ -- <br /> T UE. ACCURATE AND COM0.ETE. I AM AWARE THAT THERE AAE <br /> NIRCANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLIIDINO ~ ~ / <br />_. <br />' , <br />E <br />PR <br />T <br />EE <br />1 '/ ~ <br />,~ <br />7 <br /> THE POSSIBILITY OF RN <br />AND IM <br />ISONMEN <br />. S <br />IS U.S.C. <br />1001 AND ]] g10NATURE OF PRINpPAV UTNE 1 y <br /> U.S.C. 1 1 ]10. lMWer. wWr Nrw mem. mry irtpd~ ivw. w ro i 10,000 <br />PED OR PRINT wdnmuinvn inPrlwmwnt olMlwwnemmdu rMeywra/ OFFICER OR Al7THORl AGENT CODE NUMBER YEAR MO DAV <br />COMMENTS ANU [:APLANAIIVH VF ArvT VIVLAIIVHS llfe/ireOCe a//IRGCIITBPfJ OYFeI <br />~ETT'LE;AtiLE SOLIDS LIF.IT APPLIES ONLY iF <=l0YH,24NR PRECIPITATION EY:11T IS CLAI!!ED. PERIIITTEE kA~ <br />HUkDEN UP PdOUF MHEN fiEQUESTING H¢LIEF PROM SETTLEAP.LE SOLIDS PRItlAR! LIhITATICMS. <br />EPA Form 3320.7 108-951 Previous editions mey be used. IREPIACES EPA FORM T-40 WHICH MAY NOT BE USED.1 PAGE OF <br />00590/99C2:3-1256 2 <br />1[ <br />:}~ ~' <br />1~ <br />t <br />}¢d <br />