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PERMIT7EE NAME/ADDRESS 9,NA,e. FrerryNra/Lecarru dDlpi.aq <br />gNAME BASIN '$BSOURCES, INC <br />^noDRESSGOLDEN ~AGL$ 1lI~IE /y~~~lF <br />'iK~1,'' lYr-~45#+'8g1I11'jTE .7 A/whf! CfSC.KDE //fx' <br />11'°'Aairrv BDT2'E Cn~u Sp85 w _.l'ila~i@1 <br />~,'%VLOCATION G.~- 50^4 ~(,I YJJ ~~7i <br />ITTN: Pi1aL-9trZ-ctiL'zta, 9ICE PBESIDYT <br />~ i!, <br />t -! <br />,•~i . <br />;~ <br />NATIONAL POLLUTANT DI9CXMGE ELIMINATON SY6TEM (NPOES) <br />DISCHARGE MONITORING REPORT IOMRI <br />11-161 (17-191 <br />O 4 ~ <br />PERMIT NUMBER DISCHAADE NUMeEa <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ~ _ 1 <br />!16171 l11-131 111-151 116-171 119-191 !343/1 <br />Form Approved. <br />DSCAG 1C PUAGATOI~.B n°'Z~R-~~~ <br />($DEA ~F) PProve[q~~Epe~ 31-98 <br />F - FI-AL i VV7- ' <br />NINGfl <br />4t# NC DISCHARGE ~~~ '~' <br />NOTE: Rssd instructions belors comp6t~' thi. fwm. <br />PARAMETER l3 Grd On1Y1 QUANTITY OR LOADING <br />- !/ Grd On/yl QUANTITY OR CONCENTRATION NO, FREO'U Pcr SAMPLE <br /> /1653 <br />151-571 13851 ' /4653 lSL6'il I " <br />/31-371 EX . TYPE <br /> AVERAGE MAXIMUM 'UNITS MINIMUM AVERAGE '.MAXIMUM UNITS !s:-sal 5 <br />'/ 591 /59-701 <br />PR SAMPLE 4#4### #440#4 - #t;4##Lt ( 12~ I~ , <br />~ <br />' <br />' MEASUREMENT ~ ~ <br />I~r <br /> ~ <br />~ <br />04UU 1 0. !0 ' <br />_:.:."p.,RMIL:.:~' <br />~ <br />~:~'~##R4~#":.: <br />..."4~I~~#br".;" <br />.. <br />4## <br />.r~; ~':~:..~" ~'::~:~ <br />r., ~'>R>k"~"~>~p0" <br />:~3~~: " <br />'. ":; <br />z ~" <br />. <br />:..:.:., <br />." <br />::"b{ I~U <br /> <br /> <br />EFPLUENT Gh03$ YALU :RE.QI <br />REMENT. 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SA9 <br />" t3"vi.: ~ <br />,ji <br />LOY, IN COYDUIT OA '' SAMPLE 0 r<~>t4~t Oz~ „' r w , <br />RRU TREAT MSM-T PLAN MEASUREMENT 7° i+ ;~ <br />0050 I 0: 0 <br />" PERMIT ` " ' xTIORAL <br />- R$9 T :: '~ ',~;IIIt6a+a4 +7$1F>sl#q " 444 <br />. i[STA <br />ti <br />EFFLUENI GROSS YALU ;REDUIREMENT ".+*{Q1b~rrSfb' ~}JAII ,. <br />MG , 2 .. <br />'~ .~....::"... ...-; <br />;.. ., ... ,`:. .:. 44+G>4 , <br />. <br />IL AND GRE~S$ SAMPLE. #A#i#4 ( g ` 'ObYA±6'4 4 4' ###4## ~~ C <br />I S U A L MEASUREMENT , <br />4U66 I Q~ '4! <br />` ei5::'PERM.LT;=~1: <br /> <br />REnUIR E T <br />r ; ::~iCSI,~!..Al..:r"~• <br />~ '.:'::1[Br,kEII~E'T.; <br />~ <br />- L'SaI ~.....~?P ::: <br />~ <br />'~ <br />" ~d<.i-.'C.##1-1f611i>" <br />I <br />~ <::t:>a.."t~?CIIII#":i <br />~ <br />' q#C <br />' . i <br />~ ~, .,. <br />iiCzCy~y. <br />~$IUAL <br />FPLOESS 6i <br />4S~ PALO , : , <br />•.. z ,, <br />'. ~`:~'.qjL <br />S>li ~~~ Ga0 . <br />.. <br />+~:. y •, n~^„ ~ 4>ti## ~ ,`1! 118 <br /> ~ . <br /> <br />~ r SA~P4 <br />M , <br />~ <br />~ <br />1 <br />~+ I •r. <br />T <br />.}F i EA EA~NT ~ y <br />, y <br />,n . r , <br />. <br /> <br />' <br />' <br />:e -- R,hFRM1T. i ' W ~ ~" <br />:; "" <br />I'1 ti ~-- ~ ~ '_ <br />~ ` ~ 1. " r <br /> <br />, <br />~ <br />' ~ ~ ~` ~ - s1 ., , <br />- REQl7 REMENT" <br />' _- <br />'#' <br />S <br />' <br />'~ L <br />s <br />~ . <br />- ~ <br /> <br />~ % `_ <br />- <br />, <br />1. y <br />.. _ / <br />t.. r X. <br />1:. <br />' ~ ~ ~ SAMPLE " - ~- - <br />' ~ - MEASUREMENT - - <br /> ~ <br />... e.,; <br />,:ERtiA <br />~ <br />" <br />REO~./IRE,ME..T ~ ~ .~~ <br />.. <br />~ ~ ,~ ~ " Ir a 'L' ' <br />~ ~ " . ~..~ ~~' <br />..: . <br />~ ~ <br />.. <br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER 1 CERTIFY UNDER PENALTY OF UW THAT 1 HAVE PEASONAILY EXAMIN ED AND <br />TELEPHONE DATE <br />AM FAMILIAR WITH THE INFORMATION 9UBMITTED HEREIN; IWD BA 9ED ON <br />/ <br />~ <br />~ <br />~ ( <br />/'Y <br />~~~ ~`~s DBTNNHG THE NFORMATION,INBEL ~~E HESUBMITTEDENFORMA TEON IS ) <br />//~J{% <br />~ <br />~ <br />~ <br />~~j"~~ <br />~ <br />~h <br />..+)L <br />"`~~~77\\FTT\ I TRUE. ACCUMTE NID COMPLETE. I AM AWME THAT THE <br />SIGNIRCANT PENALTIES FOR 9UBMITTING FALSE INFORMATION <br />IN RE ME <br />CLUDING ~ <br />~{ <br />,~~ <br />~ <br />~ <br />~ <br />InQkW ~ <br />/ ~ <br />~y <br />y <br />O d/ <br /> <br />- , <br />THE P0951BILITY OF NNE AND IMPRISONMENT. 9EE ie U.6.C. 1 1001 AND 3] <br />! t 91P <br />U <br />9 <br />C <br />lPwWNr. ureAr err mnrr. m <br />Xlchd~ <br />F <br />ro S/0 <br />000 <br />SIGNATURE OF PRINCIPAL EXECUTNE 7~ <br />(( RF` <br />, <br />eV, O <br />~ O~ ~~ <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />y <br />. <br />ilm W <br />, AREA <br /> Wrmvwrvn inp/rwlwNwMrwrn smmNarg6YPVa1 OFFICER OR AUTHORRED AGENT CODE NUMBER YEAR MO DAY <br />.'r G VMMCri I J P.IYU cnr~nnn I wn air nn r vlvLn I wrva IneTeFence e// eRlCOmen E! ne/el <br />9E~;LEABLE SOLIDS LISIT YAIYED FOR 10-YR, 24-NR PRlCIP EYE N7 50E!!EC! 7C BURClN CP PROOF REQUZREtlEN?S ZN <br />DiABS I.k1.1.D, P. 6. STORlIWATeR eAYAG$l7E11T PLAY DUE 1-30.98 <br />~' <br />' ~~ EPA Fam 3320-1 108-951 ~ Precious editidne mey be used. IREPIjLCEb Epq FORM TAO WHICH MAY NOT BE USED.) PAGE OF <br />. .~~;~`;', -00018l98C120-1426 I <br />