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PERMITTEE NAME/ 'P«66 FS10ryNe./Leceuo„IlDldnm) <br />NAME COL: ..UAL cn;1pANY L. P. <br />ADDRESS () [) !, D ~ Y J ~q ~ // t.~ <br />5731 STATE HTG!iH1Y 13 <br />lEF:F:c.li CO U1541 <br />FACILITY <br />LOCATION <br />'T <br />NATIONAL POILUTM y+OE ELIMINATION SY9TEM INPDESI <br />DISCHAR TORINO REPORT OMRI <br />1-7 I7-t9 <br />~. <br />PERMIT NUMBER DISCHMGE NUMBED <br />MONITORING PERIOD <br />YEAR MO pAY YEAR MO DAY <br />FROM 9El Oa Dl TD 4R 06 30 <br />1141/1 l11-131 /24-16/ !16171 l19-191 (3437/ <br />Form ~1 <br />ST4F,ETFF` GULCH TOAP'aldt191~pSle~`o3t~s <br />(SIInR na') 12345 <br />P - FIFIAI, <br />"'I NOR <br />NOTE: Read Getructlone be}or~ LroT~latlnq this Corm. <br />PARAMETER l3 Grd Onlyl QUANTITY OR LOADING I I Urd OnlYl QUANTITY OR CONCENTRATION ND. FREQUENCY SAMPLE <br /> 16531 5a-6/ 39-461 !4663 !6461 <br />EX DF <br />131-J71 MALY915 TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS r s1-1]l l6a691 169-701 <br /> <br />O L L A ri 0 G li (' i 5 r SAMPLE ....« <br /># ~ # •. ,--. .~ ( ~4~ -.....~......... <br />.: ............~ ;. ;..., i;;..; .~.....A.....- <br />... ,..: ~ -:.. <br />O <br />~ <br />x I <br />~J I S <br />VISUAL MEASUREMENT O ~ + <br />U4Utib .L U U .:: ;..PERMIT:.~~~~~ :~~.~#u+~:~,y:~#~>:~.: <br />~ <br />~ J;::::' ::::.:::.::...:..: E5=1 ~~F'cittk,>~"~:~:~:. ~:~:::##~'t~Xrrt..:~ .~..;.::>.*'>X.~i~.":.:: :=~`'"` ISUA <br />F:F'F'LU~';7'C GI lS3 Y t 1. <br />REQUIREMENT <br />:: ~~~ <br />~ <br /> <br />:. <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ PERMIT.~~ .. ~ ~. .. .. .. <br />:: . .... .~ .. . <br /> .REQUIREMENT ~ .. ~ ~ ~ ~ ~~~~ ~~~~'~~ ~ ~~ :~ <br />:. <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT : ~ :: ~ ~ ~~ ~~ ~ ~ ~~ <br /> ~REQUIREMENT~ ~~~.: ~ ~ '~' ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> ~.. ~ PERMIT.: ... ~ :. ~ .......-..~~~ ..... .. <br /> REQUIREMENT ~ ~.. ~: ~ ~~~ ~~~~ <br />: .... ... <br /> SAMPLE <br /> MEASUREMENT <br /> .: ~ PERMIT" ~.~ <br />.. .. <br />. ~. ~~ .... <br /> REQUIREMENT ~ ~ ...... ...::.. ~ ~::.:.. ......:~ ::.:~ ~ : ~ .. <br />:. .:. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~~ ~ ~ ~' ~ ~~ <br /> <br />REQUIREMENT <br />... .:. :. .:: :..: <br />~~.:.::.:.: .. <br />~ .. <br />.. <br /> SAMPLE <br /> MEASUREMENT <br /> <br />~:.PERMIT.:~:~. <br />.: ~ ...:: ~.: ~::...:.. ;...:.. <br />..:. ...:~.:.. <br />.. .. <br />~ <br /> <br />.. <br />.. <br /> ~REQUIREMENY ...:.:.:::.::~~::.:.::::::::'<::: .;':::.~.~:::,..::::..:.:. :.. <br />~~. ..:~.~ ~~~ . <br />. <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER AM FT <br />~ <br />TMN HE <br />MOW r <br />I <br />T <br />S TELEPHONE DATE <br /> INFO <br />u <br />iILI <br />I 9UBMITTED <br />HEgEIN <br />MD B <br />ASED ON <br />MATON <br /> MY INQUIRY OF TN09E INOIYIDUAl9 IMMEDIATELY RE9PONABLE FOfl <br /> OBTAlNlNO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION 19 <br /> TRUE, ACCURATE MD COMPLETE. 1 /.NI AWME TNAT THERE ME <br />INCLUDING <br />SIGNIFICANT PENALTE9 iOR 9UBMITTNO fAISE INFORMATION Wr//' <br /> <br />/~ <br />-~J + Narmo <br />, <br />THE P0591BILITY OF FlNE MO NAPRISONMFNT. 9EE 1B U.S.C. 1 +001 MD ]] <br /> <br />AnJRE OF PRINCIPAL E7(EL~UFNE /}~ <br />'1 /~ <br />~ _/ <br />~ <br />8 <br />~/ <br /> U.S.C. 1 1]te. !lNlwldrl vNM dMw mnmr m.r 4shd~ ILNr W ro ! 10,000 AREA <br />TYPED OR pRINTEb .n4wnrrbun lrlFVlwmNnrWbrw«n smonN..rgerwAl FFlCER OR AUTHOR1IED AGENT CODE NUMEIER YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe/erence el! ettechmsnts here! <br />~ <br />:iE'1'TLc:AHhl: S!~LCnS LIMIT APPJ.IES ONLY IF <= 10-Yii, 7.'~-RR PRFiCIP F.VENT IS CLAIMED. <br />IF Ci.AI`1 APPROVED DY <br />al?Cn, ?'S;, ''~ IR;I?I I.TFSITS HILL NOT RE APPLIED TO RF,pORTF.O 'fEASURF.MRNTS--SEE, I.R.lA, !'f; 4 ACID t.fS.1D, PG fi. <br />P Form -1 108. 51 ~ievioue a Itions mey be used. IREPLACEB EPA FORM T40 WHICH MAV NOT BE USED.1 <br />PAGE <br />OF <br />nr\Dr\ ^ r ^ ~ ~~ ~ ~ ~ <br />_ <br />