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PERMITTEE NAME/ADDRESS pwririFrY~ryNrfJlnculai~i/UTA'wru) .. NAME pONUERHORY coJ-L ~ c0lSpaai _ _ ADDRESS D J1INE, N % 5 PORTALS P.U. 60X 1436 PALL5ADE CO 81526 FACILITY LOCATION hTiN: JUiih A. "CtiAE:, PnE:iIDcNT NA7fONA6AafftlTMT01SONMOE EDMINATIOK6VSTEM INPpES/ - - FOtm ~AppfOVED. .:, DISgHARGE MONITORING REPORT.lOMRI~ ~ - A~O~p~o Q~ t°~ !z-+sl_ r7-ISl HOaB9IS! G34 .TO G~ veLeij~ea0531 sB- 0000271U6 ($UbP. NC) ...+~ PERMIT NUMBER DISCHMGE NUMBEA F - FIFA L MONITORING PERIOD h I N C fi YEAR MO DAY YEAR MO DAY FROM U U TO ~ _ =t#rt NO DI SCNARGE ~__~ {v.~yt !762/1 /22-731 !14251 lI6-77/ l76-791 !343/1 NOTE: Reed Inetructloru belore complatinp this form. PARAMETER l3 Grd On/rl QUANTRY OR LOADING 11 Grd Onlrl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE l16-531 !546/1 l38-151 !4653 !54611 EX OF I32-37I Marrs TYPE AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 167-s31 !54651 169-701 L'N SAMPLE 6{t#~7:;Y# #{: PTO#4 CCi:n#{: ( 12) MEASUREMENT 7. / / I `~ `~ ~ ~`' OU4U0 .1 0 0 PERMIT #:-KL4#`r CDCC## . A#.' 6e5 #tp glO CtG 4.0 ELf:LY [YSIT cf'FLUENT GROS$ YALU REQUIREMENT #4## fll.Aj111Dff JIAY .pU S ~ciLIDS, TOTAL SAMPLE {t###C#. 44#C## ####qIC ~ ~~ ( 19) ! / G~ ,i U:i k'ENDED MEASUREMENT ~ 5 ~' ~G US30 1 0 0 .:.:..PERMIT :.: ~ . #09LdL4ta ~: rX#glquR:q!.. it#C .: b.i01.>•.kgr+R ~ . ;5 ~. ~~~ ~ .:' ~ ~~pC.F! : o:1td~8 h'Ff'LUBNT' GRO55 VALC ..REQUIREMENT ##CC 3DDA AYr, DiIIY AY !JG !ItlkT :: LitJA, T L~ SAMPLE ###C.':% ###### #####Yr ` 19 ( ) I " ~ (A °i PF) MEASUREMENT ~5 /-~ti ~ 3~ ~ ~ . F ~ , J1U45 1 D 0 PERMIT: ##4`(t## .h##### tb#{t aaa#a# 3.5 7,0 t NCF;/ ;AAH ofFLUCNT GRDS$ YALU REQUIREM.EN7 #C4C 30DA AYG flA IY C! tlG L NOB 4 ;1:. ANU e,kEASE SAMPLE :~+YC.{'{~ #~t+<':C~F #C#;+YF>7 / / ~ 19 ( ~ MEASUREMENT ~{~ r / Q ~ N ~/~ ~/;r~ f5~2 ), G U PERMIT.' Y-+;sC{iR ##CIOV# GIC4: OCC#x+# RpFORT IO ON~iN ;$AlE r.r'FLUBNT GfsOSS YALU REQUIREMENT CC## 30DA AYG IN53 1NAX RG/L G6HT Uw, IN CONDUI~C OR SAMPLE 7 ( U3) ###t+ay O;*#C3 #qOG#tk IHl{G TRBA1l5R4T PLAN MEASUREMENT II.2. .1. 17 ~- ~~~ 1 ,i1OS0 1 0 U PERMIT iti.F'DRT. REPORT ~~~~~~ ~#q#'9# >:+~q#+~# = fi{:{~ EF,ALY ~NSTAN EFFLUENT GROSS YALU REnuiREMENT 3OUA .AYG DAILY !IX !7GD #### i0L D , TOTAL SAMPLE :-^--7'%:.r #iP##C CO#tt#9 ( 19) // I $:iULV EU MEASUREMENT p 70~ 0 ~ 7 9- ~- , ~~n ,r ! ~s r, /Ul9S 1 U U PERMIT :Y-'.'a.;t~. %s<+>iROY+ ~#~~ r•+P~a#r Rt?FORT RtFCRT ! TRLY :RAE ..f'FLUEN'1' GROSS YALU2 REQUIREMENT. 4a{:~ ryR4F. AYG RTb. yAX. !!G/L i1L AND uFL. .i. SAMPLE '.:fi#{:#:t ( ily) ###YF ~F'.} :'S#•#+y# #Cq### IyUAL MEASUREMENT _(~ ~(~- //~~ ~t ~4Ob6 1 G D PERMIT #ul##~tlp RE PART Y ES=1 +}###+~x+ #C04x7t #lkgq~t? #+:~~: £EKLY I5UAL EFYLUFNY GRU55 YALU REQUIREMENT JkN$T. .1tAX NC=O #### NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERT FV UNDER PENALTY OF LAW THAT I HAVE PERSONAILV FxAMINEO MD TELEPHONE DATE AM FA MILIM WITH THE INFO RMATION SUBMITTED HEREIN; MD BASED ON LL ~ ' V ' r MV INQUIRY OF THOSE INDINDUK9 IMMEDIATELY RESPONSIBLE FOR OBTNNIMO THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION IS - < / C i , TRUE. ACCUMTE Mp COMRETE. I AM AWME THAT THERE ME TIES FOR SUBMITTING FN SE INFORMATION INCLWINO SIGNIFICMT PENN G y ~ J ~ -~ . . , THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE to U.S.C. E 1001 MD 3S SIGNATURE OF PRINCIPAL EXECUTNE (~ 2 ~V/ U I ~~ U.S.C. 7 t Sto. !/vrtenM. uWr ewr mama nvr blr/ew Fires+~ ro t 10,000 AREA ' TYPED OR PRINTED rq rmuinun i.rrirwtturt otbwwremmNSW6reua/ OfFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAy COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRe7erencs e// s{TSChments here/ IJIIS UU'IYALL IS hUT ELLGl;rl:; FOR L'%EMPTIONS PkUM TOTAL SUSPENDEG SOLI C5 (TSS), 70TAL IRON AND/On Sil"ILtAtlLE SJLIUS L7 iI'1'A:'iUN~ - StE I.A.2. EPA Form 3320-1 108-951 Previous editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 G 0 319 / 9 9 C 2 2 3 -12 5 6 PAGE 1 OF