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PERMITTEE NAMEIADDRE55 QrcLdr FruiryNaw/LorwnonQ - - - - - -- - - <br />ADDRESS TE.HNUR CREfK L]AD]JT III IIIIIIIIIIIII III <br />1840 HIGHdAi 133 999 <br />PAONIA CO B1Y29 <br />FACILITY <br />LOCATION <br />A TTMe 64.11 V PwTn7{ ,•,•p 1J.: L,1 PT~14C w~'I <br />Form Approved. <br />S.DI F'~h:. el ^.~ ~oflte,rllD~zoao-Qoop k. <br />Approval e: it a O55 3~1-98 <br />F - FI::AL <br />°I".OR <br />:; r~: :O JI SCH ARCS IxXYI Gt,^^- <br />NOTE: Reed Inetruetlone before eompletinQ this form. <br />PARAMETER !3 Grd On1Y1 QUANTITY OR l0 !I Grd OnNI QUANTITY OR CONCENTRATION ND. FREQUENCY <br />OF SAMPLE <br /> 106531 (5461 ~ - ~- 138-451 !46-53 1545/ EX V95 TYPE <br />l3I-371 AVERAGE MAXIMUM 5 MINIMUM AVERAGE MAXIMUM UNITS !e~-E31 . MAL <br />(64681 I69-]Ol <br />H SAMPLE rrPvR~ p;ICrr`.+ 4Gd ~# ( 12) <br /> MEASUREMENT <br />DUUOU 1 U U PERMIT :. R:VOiOlO: $ '+R r,.;;= 6 <br />b~t•* 'x$$$. ~ ~..0:.. EEiSLY N.5TIU <br />p <br />LFFLU..NT JHOSS VAL'Jt REQUIREMENT <br />.. ~. <br />_ <br />coa: .. <br /> <br />,. <br />rlkl/~. <br /> <br />~ <br /> <br /> <br />~AICIHUI4 <br /> <br /> <br />ll <br />SOLTD3, T]TAL SAMPLE 'raazc~ „.~c=a x;ldla4~%:Y ( 7'I) <br />SUSPENDED MEASUREMENT <br />0053) 1 U J PERMIT. hrFlXO'YG =kRS'G#;: tY `9rgn'Y>x$?7 jy 7[~ NCfi/' iRAB <br />EFFLUENT ]ROSS VAL'Jr :REOUIREMENT ra>k ;: 30U YG . UJITLY f4Y HG/L ONTH <br />SOLIDS, StT7L~AhLE SAMPLE .S?'.3;= .dC ter'.`- k'14:=Ji: ;: ;F# ~R ( zS) <br /> MEASUREMENT <br />OOSYS 1 D ] PERMIT L=.:.`•S':.;r -:`Sr=.*.:xCr .. Sla$Ip~$i~: $4alY '-S CJ .. /j #i i. I:/ ;RAA <br />EFPLJY.NT ~H]Si YALUE REnuiREMENT <br />~ pAILY MY ML/L : >'sOUTH <br />I Ii, TOTAL SAMPLE :<uG;~!~~ .. :,};.:` aaacar ( 19) <br />(AJ FcI MEASUREMENT <br />lOYS 1 U U PERMIT 5=%}h'fS ., .,..• F r %-., aaaG+YaY 36tY 6.U t-CE/ +P..AB <br />EfFLUEHT GH]S; YAL'JE .REOUIRENiENT .,y~ 3apk.::; i/G. AAILY tlX 'SG/L ~. 8(11f2H <br />IL AND GREASE SAMPLE )}trv:1;~ aaaa;:;: ax:xr;:;: aaa as ( 19) <br /> MEASUREMENT <br />3541 1 O (1 PERMIT.: C'?R/<t<~ :xclsa~a ;a•- ar:ati";Ta auo#:.'~ : I:A. .. bll?Ip :.RAF <br />EFPLUEN'[ GflOS5 YALUE :HEOUIREMENT r, :,1{:t. pAjLY rix MG/L ~ U4 <br />OM, ~]NGUI[ Ofl SAMPLE ( 03) Y:4+%~ L~4R 44 ~°•• <br />[HILU TNEAT!fENT PLANT MEASUREMEN7 <br />UUSO 1 0 ] PERMIT PTj]NAL: REPUH"T SA61.;Y+%%s aaaa: ~. +~t~~~#fi ^ <br />r !d'LPLY N-a2AN <br />FPLUEKT GR055 YRLUE :REOUIREMENT 3Ut3A .AY;,: pALL.Y'MX CGD 4C'°~ <br />D , A SAMPLE ~ O aaarc~s aaaca•r G4$ ~a ( 19) <br />jSSJLYEG MEASUREMENT <br />70195 1 D 0 PERMIT ~1 34ROR4 ;~'~ R#PV+k# .::' aa~aa! +~ REFDR T ' ?ALT •RAR <br />L'FfLUdNT GHO55 YAL'JF REnuIREMEF}7 <br /> <br />~ <br />.. . <br />. .,.. aaar pATLY...l YX.: RG/L <br />1 cERT <br />NAME(TITLE PRINCIPAL EXECUTNE OFFlCER IFV uND[R PENALTY of uW rNAT l NAVE veas oNAUV ExAMI <br />N <br />MD B <br />ERE NED MD <br />ASED ON ~ TELEPHONE DATE <br /> ; <br />AM FAMILIM WITH THE INFORMATION SUBMITTED H <br />I <br />MY INOUIIIV OF THOSE INDINOUALS IMMEDIATELY RESPONABIE fOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> <br />_ <br />~~/ , <br /> <br />TI <br />ER TRUE. ACCUMTE MD COMRETE. I AM AWME THAT THERE ME <br />F <br />NF <br />RMATION <br />INCLUDING <br />T <br />E ~ ~ <br />-" <br />L <br />KELLY FRI , <br />SIGNIRCMT PENALTIES FOR SUBMI <br />ING <br />ALS <br />I <br />O ~ <br /> THE POSSIBILITY OF FNE MD IMPRISONMENT. SEE to U.S.C. 1 1001 MD 33 <br />E ~n ~ C A 1 <br /> u.s.D. f 1316. lMW4F YWr MY NNM1. m.r i1cA,d. An.F y ro J10,000 OF %il dPAL EXECUTIVE <br />BIONATUR <br />E A A <br />N MBER~ <br />YEAR MO <br />DAY <br />TYPED OR PRINTED wrmuhwn hrpionwnr orMnr.Fn emonVlsW eYev><I R OR AUTHORIZED AOENT <br />OFFIC CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IUN, llTererenee u/ ettscnmenrs neiel <br />SETTLEAF3L6 SOLIDS LIMIT APPLIES ONLY IF C= 10-TR, 2LL-NH PRLCLI' cVEpT 15 CLAIHEL•. IF CLAIM APPROVED 9Y <br />;iQCD, T55 5 IR]N LI9ICi BILL NJT 9's APPLIED T] REPOkTE] 9fAiCHt~:ng1S--5 E Z.F.1P„ PG 5 AND I.B.1[`, PG 6. <br />108-95) <br />may be <br />:. ,.y: - ~ . ~ .., . <br />-" iF~d.?m_ ~e ~ _~.~F-.tr,.T1,GS.c.",...riF..w,.rL..Y..lw~iw...i.~vwi..'rt~`4fi"Fi+;r~e <br />ICH MAY NOT BE USED.I O1D5/97U819-I, ~r~e~ <br />1 <br />