Laserfiche WebLink
.,.>..er' ~~.. , <br />~.n Form Approved. <br />PERMITTEE NAME/ADDRESS ?.rAyFrleryNa+/Iuana IlDlEirnq NATIONK POLLVfANT DISCHMOE DJMINATION ~ ~ ryESI r.1° _ <br />NgME DISCHARGE MONITORING REP O~I R (;~P~O ~y~!j 8 <br />,,.C~RAVD 'VA[.L':i .'.UFL .:`I"^tYy r2-t5/ Se0 POND riSCNG tOA eves re <br />AD~Rr~bi7UNG£R CANYON MIkF: - ~%' (SUER NC) 12345 <br />Y.O. B0~ /0 '. idlir' 8ER UM d E etR p pI IiAL <br />LUMA CU FIl52U-0070 <br />*` " TITNC)R :. <br />3RING PER 0 <br />FACILITY GRAN 1 <br />J YiLLET COfIL '~~t <br />O <br />LOCATION - ~I,, <br />YEAR ~`W OAY <br />1 X 4::+4 <br />..;:5, <br />a, FROM <br />~ I C <br />TO ~ ~ 1 7 ## TneSvCirtR•tlpu Mf«/ COr Ij ~Ntinp this form. <br />ATTN: JUiI;~ ry. r.11."!''~S '?AN <br />~- l1 l !?s-171 !19.191 I3o-3 <br />PARAMETER !' rd Onryl QUANTITY OR LOA a GM, Ontyl QUANTITY ON NO. fRE oFNCV SAMPLE <br />~ <br />653 /5L51/ l5bb/ EX TYPE <br />(3s-~51 /16- <br />µALrss <br />132-371 <br />AVERAGE MAXIMUM NITS MINIMUM AVER MAXIMUM UNITS rFx•dal /6~-5s1 16s-7oi <br />nIL AND I:RItR3P. saMPLE ;:-saltNl. ( a4) 4~fi#a; a+no ;-~: ;:;,#s## <br /> MEASUREMENT ' <br />Y I ;DAL _ <br />~ <br />~ <br />84066 1 0 ~ D ~~` ~PERMI7~' ~ rt#~~4~'9rt <br />..:. . <br />~ _,:: <br /> <br /> <br />:Y. <br />... ._., . .,:'+A.t+~.. <br /> <br />.: ,:: '~~ <br />...;c:aQ!: ~~~~~~; Rt+~ ER'lY . I$VA <br /> EOIE11HEkENT <br /> <br /> <br />~ ~ " ,, ::~.....: ~ . <br />.. .'.,'::'n:. ~' :.. :... ..: <br />~. .. <br />::: :. <br />~~''Y:i:. <br />. <br /> 5NMPLE <br />~' ,' <br /> <br />' ~ <br />~ ' ~`~ <br />• <br /> REMEN7 ' I ~ <br />J ~ ..: <br />•' <br />~ ' <br /> I <br />ri F 1 .. ~. <br />. <br /> <br />r `i:~ <br />9 <br />P A.. <br />:::: <br /> . <br />... ,: .... <br />4y1:'.a::.... <br />:':. <br />' SAMPLE _ - ` <br /> MEASUREMENT ~ •/ <br /> : <br /> PERMIT <br />. :..:~:: w... <br />.,. <br /> <br />_:!; <br />`~xs;.- <br />gY.: <br />.' ~ <br />. :' ~ <br />:~;:?~. <br /> :REQUIREMENT '. .: ,:-t.-. <br />,. ,. <br />......:.u}~:.. ,:_ <br /> <br />,:... <br /> <br /> <br />~ <br />.: ... <br />, .:. . <br /> SAMPLE <br />~ <br />~ <br />~ <br />~ <br />~~ ' <br /> MEASUREMENT ° <br />'r <br />j, <br />, / <br /> ~ ~ . <br />,. .. <br /> PERMIT ~ ~ .' ~ . n.; »: . ~ ... •' ~ .. . . <br /> REQUIREMENT ~ 'b'~~' ~ ~ ~ _ <br /> SAMPLE ~ <br /> MEASUREMENT ' <br />. <br />-'• <br /> f ~ <br /> .. .PERMIT.' ~ .;,: :~: <br /> <br />' <br />~ r;"~.: ~ <br />... .. <br />~ !l. ?.' <br />.~ <br /> ..t!iEQUIREMENT .r <br />1. .;e::.:; ~ ~ .:. •;•, '... ., .. .. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> ...' PERMIT ~ .:..-';: .:.. <br />~ <br />' <br />~ <br />~ <br /> :REQUIREMENT '"::;~ ~.. ..: <br />: <br />..; <br />...: <br />. <br /> SAMPLE <br /> MEASUREMENT <br />- <br />PERMkT <br />~ <br />~ ~ ' ' <br />~ ~ . ~ ~ - <br />.'HEnU1RENIENT ~ . <br />.. <br />'z < <br />..:".. . <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER 1 CERTIFY UNDER PENAL ~ ~W <br />AM FAMILIM WITH THE "i ~ THAT I HAVE PERSONALLr ExAMI <br />f10N'SUlM1T7ED HEREIN; AND B NED AND TEIEPMlONE <br />ASED ON DATE <br />((,, ~ ~~!! `l r` MY INQUIRY OF THOS <br />(_.n ICI r y ••I(1~~1~T OBTAINING THE INFORMA DUALS IMMEDIMELY RESPONSI <br />1 ELIEVE THE SUBMITTED INFORM <br />~ <br />e BLE FOR <br />ATION IS I.~ <br />~~ <br />TRUE, ACDUMTE ANO COM TE 1 AM AWARE THAT TH <br />~ ERE' ARE <br />SIGNIHCµT PENALTIES i0R <br />JT THE POSSIBILITY OF qNE AND I <br />~ SebEi11TN0 FALSE INFORMATION, IN <br />\ 1001 <br />SEE 18 U <br />S <br />C <br />MPIIISONMENT CLUDING - { <br />AND S] ~ ~ <br />I ~ <br />r <br />r r~l a <br />lawn <br />. uwr <br />u <br />s <br />c . <br />. <br />. <br />. <br />000 <br />drw .nnm. m.r +~~. rm., w m +x0 SIGNATURE OF %11NCE'AL EXECUTNE <br />A A <br /> <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />. <br />. <br />Mb (Y .Y+,yn11YI1 /TP//YNYIN/If 0r e.n...n eT,.,rA).w bY~/al <br />OFFICER OR AUTHORIZED AGENT NUMBER <br />CODE YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRo/ar6nce al/sttechmsnts hare! <br />T~5 E TOTAL IR04 LI!t)T; IaILL ~I~: '.ACYF.D, gun SE;TTLP.A9L8 SOLf~S lrt APF1.7`:~ FOR <=lUYR,211H9 PkYCIP EVFN'*; <br />-;ETTLBABLB SOLIDS LLMLP RAY HE 9AIV~.SS F!)E >lUYK,24flR P.VF."T-i}.° T.'t.l, pP j'4, ARD I.A.3, ?. i. QRtALT <br />EP P e Ifl fitio • m a ue i CE A W O EE <br />00276/961217-1206 2 <br />~.W_. _._~...;. . <br />