Laserfiche WebLink
PERMITTEE NAME/ADDRESS (/nclude Faciltry Name/Gocanon ifDi$erenQ <br />NAME <br />liLUE MOUNTAIN tNERGI'. INC. <br />ADDRESSJESER ADO MINE <br />360'7 COUNT`! RGAD 65 <br />FACILITYN FINGLY CO 816/F Ei <br />LOCATION <br />gr'r;J- ICFF f111RT7FRT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SVSTEM (NPOESI <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM q TO t i l y l <br />Form Approved. <br />OMB No. 2040-0004 <br />M I I'-;! 7 H <br />; :~ I,qd H hl ld t <br />RP-;.•'<3 SE-.U t POND TO t2ED WASH <br />~n~n NG D1~"IiARV'E I~(I A~a~~ <br />NOTE: Read Instructions betor~-L~dmpleting this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER EX of TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS aNALrsIS <br />1U HI`+-i GREASE SAMPLE ~~u"~tt trtl y41 ,'!"~.4 tt~~ -~ ~ r a u~u ar~aE r-nor <br />I JUAI_ MEASUREMENT <br />s4C'•;S ' 0 O PERMIT. IkiF4aNHk .. .. ~~' Y -:+=1 ~1F#dF_### 1k#it9F~F# ###iF#iF ## <br />W <br />-F_KLY <br />38V~,. <br />-FFI t'FWT GRLISS VA U - "REOUIE7CMENT , .~#,M, <.;,-, ." <br /> <br /> SAMPLE <br /> MEASU <br />REMENT <br /> }y <br />~' PQ.~rI~ t $5 ~ G <br />• <br />~ ~>Se a ;..t <br />~ .~ y :.1 e ytlym ._~~~ <br /> AEpUIREMENT ' ~" 9 <br /> SAMPLE <br />" MEASUREMENT <br /> ~.PBRMIY~• ': ax <br />~ <br /> d7EQU1REMENT ~~ ~ . ` <br />v °f <br /> . . ~, ,, <br />.r_..;• , <br /> SAMPLE <br />' "MEASUREMENT <br /> <br />AEbUIt7EMENT <br />~ <br />- - <br />l~x <br />•~: "% <br /> SAMPLE <br /> MEASUREMENT " <br /> t'ERM}f <br />~ ~ <br />~ _ <br />~ ~ _. <br />~~ ~ <br />`~ ... <br />~" rte <br /> REOWREM~NT ~ ~ ~ 3 T '~ ~~ ~` ~ = <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> .'PERMIT '~" ; ",.a ".:, , "+,; ny ,~ .:¢y:~ w~•.w .. ,_ ..w:, <br /> REQUIREMENT -~-3 „~. ~''_ <br /> SAMPLE <br /> MEASUREMENT <br /> t ( <br /> REQUTAEMENT .. ~-- ~~ _ ", <br />~ - - . <br />V <br />NAME/TITLE PRINCIPAL E%ECUYIVE OFFICER I Cediy untlar penalty or law that lnia document antl ell adachmenls were <br />i <br />d <br />i <br />i <br />i <br />I <br />d <br />h <br />d <br />i TELEPHONE DATE <br /> n accor <br />prepared un <br />er my tlnea <br />on or superv <br />s <br />on <br />ance w <br />t <br />a system <br />es <br />gned <br />r' 6~ Cl~9 , S~[s~'~~ to assure that qualified personnel properly gaNer end evaluate Iha mlormauon <br />submihetl <br />Basetl on my Inquiry or the person or persons who mana <br />e the system r J <br />~ :~ l %y <br />r9r ~ <br />~~ . <br />g <br />, <br />orthose persons directly msponsible br gaNedng the information <br />the informatlon . <br />~ ~ <br />~'~ , <br />itt <br />d i <br />heat <br />r <br />owl <br />ll <br />t <br />b <br />roth <br />k <br />tl <br />d b <br />t <br />a <br />r <br />t <br />ntl <br />l <br />t ~- ` <br />n.. ~ <br />j , <br />su <br />m <br />e <br />s, <br />e <br />o <br />my <br />n <br />e <br />ge an <br />a <br />e <br />rue, <br />cat <br />a <br />e. a <br />comp <br />e <br />e. SIGNATURE OF PRINCIPAL E%ECUTIVE ~U -+7 <br />%-'~3~ ,fit, !r% / <br /> <br />TYPED OR PRINTED lam awarethat there ere signilicam penalties for submitting false inormaton, <br />m f <br />I <br />l <br />di <br />th <br />bil <br />lf <br />d i <br />i <br />k <br />i <br />l OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> nc <br />u <br />n <br />e si <br />i o <br />ne an <br />m r <br />sonme <br />or <br />now <br />n no <br />aoons. p <br />l: V MM tN 15 ANU tXYLANA I IUN V h ANY V I V LA I I V NS (He/ereDCe all aRdCflmerllS ^ereJ <br />l ,~5 <br />"~ °~ TOTAL IRON LIMITS WILt_ DE WAIVED. ANL SE'TTI_EADL-E ^I?LI?~;, i_ fT•~iT ."-PPLTED Tt ., -:OY'" L"k:-; i=RF' tP LVEN! <br />SEE I A. ~'~ PG Vr FOR REQUIREMENTS. CIL is GREASE REPORTING-SEE I. li. t f", PC ',/Tl ;-11-. T;Y~.~ "~;..•~r _IpiG <br />ForIK33 - 99 Gio iti may be used. THIS IS A 4-PART FORM PAGE OF <br />0008E • ~il)~1)2:5;'~- ".! ~, o <br />