PERMFILE58837

• Permit No: M2001001
• IBM Index Class Name: Permit File
• Doc Date: 4/4/2001
• Doc Name: DMRS FOR TWIN SPRUCE & TAM KOENIG PITS
• From: MOUNTAIN GRAVEL & CONSTRUCTION
• To: DMG
• Media Type: D
• Archive: No

PERMITTEE NAME/ADDRESS!/nc/ude
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ADDRESST -
FACILITT
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LOCATION_
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (IV l'UE$1
DISCHARGE MONITORING REPORT ! Dh1R)
(1-I61 (l7-19)

PERMIT NUMBER o1sc HARCC .+vuasw
MONITORING PERIOD
YEAR MO DAY YEAR MO DAY
FROM 5~ U7 (;I TO 96 V'3 ?0
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NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTiF+ u1JOER RENALTV of LAw rMAr I HAVE PERSONALLY Ez AMIrvED
^ ' TELEPHONE D A T E
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/ AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN: AND BASED
ON A:'I INQUIET OF THOSE INbiVIDUALS IMMEDIATELY RESPONSIBLE FOR ,
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/L7C.]//`-I OBTAWING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION IS / q
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TP.UE ACCUFATE ANO COMPLETE I AM AWARE THAT THERE PRE ~
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SIGNIFICPNT PENALTES FOR SUBAOTTING FALSE INFORMATION INCLUDING ~
THE POSS1BIUrI OF FwE AND IMRRISONMENT SEE IB
SC 4 1001
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33 USC 6 IJ19 (Prwhia untlrr tlmsc slamms ma
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to SIGNATUREO PRINCIPAL EXE IVE ~)
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SIU(XNJ and or maomum impnsnnmrm pl brrucrn b mpnlhs anJ 5 )xagl OFFICER OR AUTHORIZED AGENT A NUMBER YEAR MO
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COMMENT AND E%PLANATION OF ANY VIOLATIONS (RClcrcnrC all anarhmenls ^erc)
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EPA FD(m 332-1 (R¢V. 9-88) PIBVIUII$ ¢di(10/IS may be I15¢(]. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1
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