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PERMITTEE NAME/ADDP' 4rcLM fwdrryNw/Lxarrw dDl3.nnp NATIONAL POLLUTANT Dlr ~ 9GE ELIMINATION SYSTEM INPDESI FOfm ApprC <br />NAME COI,O 7. (, {)MuA)ly I„P, DISCM7R6 ..•ORINO REPORT IDM91 <br />.1L NF'ST PIT SED PONI)A~N h ^~i?~s <br />ADDRESS COLD MIND, r ~ (SN[tR NN) P 4505 <br />.fi~131 STAB? fIC,H4l4Y 13 PERMIT NUMBER DISCHMGENUMBER F - FT,1AI, <br />T1-i:Y.:,li CO t}1641 MONITORING PERIOD MINOR <br />Fac¢m <br />YEAR MO DAY YEAR MO DAY <br />__ <br />LOCATION <br />FROM 90 0{I U1 TD 9A 06 3 •'•-'~ NO D~:,CHAR~ ~ 1 ~ '=v-k <br />l <br />hi <br />f <br />l <br />TE <br />R <br />d <br />l <br />~ N <br />• <br />s <br />orm. <br />neErua <br />one a or cvm <br />ol <br />op t <br />O <br />: <br />ae <br />n r <br />r ~ : a . U . 7 5 I I, T {1 ;1 P i1 E `i I U fi N T !703 El l11-731 !ZI-161 173.771 178-191 136311 <br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !* Grd Onlyl QUANTITY OR CONCENTRATION ND FREQUENCY SAMPLE <br /> !4653 (6431 !33-45 1663 /6431/ OF <br />(3I J71 EX <br />N+ALVSIs TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />r e7-em 134-s31 rsa~a <br />JIL AIIU .~'t i?451.: SAMPLE .#tY##: ~. 94) ~..-',;',o~eX ~##:}-'.c,: :;r :;#:.`•d:* I <br />/ <br />V1 <br />Y I S U h L MEASUREMENT ~ O 7 SUa,~ <br />_ <br />i} 4 Uti G 1 U ll ~. .PERMIT...:.;. ::'.::....::. .. <br />.x'^#.a•R.+a:; . <br />0: <br />.: <br />''.: <br />: ': <br />F5=1 :` <br />r.~Fr:t:;i~' .:.: <br />'.::.'~x~>;+'f'+r :,.' .. <br />; :.: ~:;: <br />t<r;r~:,:':: <br />; ~:;; <br /> <br />f <br /> <br />F <br />E <br /> <br />IS A <br />v .. ,. <br />..PI'LIILM1I 'REQUIREMEN7~ :':'~~. ~: ~. ~~.: ~.: :~..... .. <br />.:: <br />. <br /> <br />.....: <br /> <br />.... ... <br />.... <br />..:. .. . <br /> <br /> <br /> <br />........ <br /> <br /> <br /> <br />:~:::t <br /> <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> .. PERMIT ~.:. ...... <br />':.: .. <br />: .. ... <br /> <br />:,.. . <br />.. <br />: <br />~ . <br /> REQUIR.E.MENT . <br />~... ~.. .. .... .:.: <br />,.. <br />..: <br />:... .. :. <br /> SAMPLE <br /> MEASUREMENT <br /> <br />~. ~.' PERMIT ~:~~: :.. <br />.... ~~ . ' ... .... . <br />.. .. .... <br />..~.. <br />~ <br />~~~. <br />. <br /> REQUIREMENT. ~ ~~ :. ..:... .....~.... ; .. .: ... ....... <br />~..:.. '::. <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ ~ PERMIT .:: ~ ..::...:. ....:.....:.... ...: <br /> REQUIREMENT ~~~.': ~ ~ ~~~ ~ • ~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> ..~ .PERMIT ~: ~... .:': ... .. ....~. .. ....... .. <br /> REQUIREMENT. ~~ . ~. ~'~" - ~ ~ ~ ~~ ~: ~ ~~~ ~ ~' <br /> SAMPLE <br /> MEASUREMENT <br /> ....PERMIT:..: ... ~.~. <br /> REQUIREMENT. ~ ' .. .....::..~. ..~ .. .: . <br /> SAMPLE <br /> MEASUREMENT <br /> ..:. <br />; <br /> REQUIREMENT: ::..': ~: ~ : :~;... .. ..:. <br />NAM ERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY f%AMINEO AND <br />AM FAMILIAR WITH THE INFORMATION SVBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDINDUAL9 IMMEDIATELY RESPONSIBLE FOq <br /> OBTNNINO THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUF, ACCURATE AND COMRETE. I AM AWARE TNAT THEgE ARE <br /> SIONIFIQANT PENALTIES FOq SUBMITTING FALSE INFORMATION <br />INCLUDING <br />,1 , <br />THE POSABIUTY OF FlNE AND IMPNSONMENT <br />SEE 1B U <br />S <br />C <br />1 1001 A <br />D 77 <br />1 <br />J <br />~ ~L <br />~ <br />6 <br />p Y1A/W~eh , <br />. <br />. <br />. <br />N <br />P <br />M BI ATURE OF PRINCIPAL EXECUTNE D ' ~ IP D (/ <br /> <br />TYPED OR PRINTED U.S.C. f 1 ]1 <br />. /hrrA <br />. vWw dNw .nrvNa nNY Mrchd. fires. w ro t 10,000 <br />.nddmuim..r lrrpraomNnr orarwwn emo.m,.rlse r..rAl <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />;.vmmcrv r a nrv.+ cnr inn., r rvr..,~ .,r., .r.,~n r,.,n~ r...r.. e..,:e ..r .unuunenu .r.rsr <br />~ETTI,EAJLE SOLLDS L7MI'i' APPLIES ONLY IF <= 10-YR, 24-IIR PRECIP F.YENT IS CLAIIIP,D. I~' CLAIM gFFROVP,D RY <br />a~1CU, 'I'SO E IRON LI~'7IT5 HILL NOT BE APPLIED T~ REPORTED 'tEASUREMP,NTS--SEE T. D. 1. 4, PG 4 AND 7. Fl. 1D, PG 6. <br />EPA Form 3320-1 108-95) Previous editions mey be used. {REPLACES EPA FORM T~0 WHICH MAY HOT BE USED.1 nnnrl rl I n ~ n~ ~ ~ _ + ~ ~ - PAGE ,~OF <br />