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PERMITTEE NAME/ADDRESS nn[hG FnarGry NmndGm•nm r/org.rnr) <br />NAME dtAd GOAL CCtlPANY <br />ADDRESS beAll NO• 3 AI NE <br />•` P.C. bOX 51tf <br />SUMERSB'f L. L) 81N3u <br />FACaITv <br />LOCATION <br />dTTa: ll:LdltiL 1]E9R, MINe NAbeLGhB <br />NATIONAL POLLUTANT DIBCHMGE ELIMINATION SYSTEM lNPDES) Form Approved. <br />DISCH1 R6E MONITORING REPORT /DM91 rU NOF'f' TC N FR GIPMR ~.°rO?H~fP~#I <br />couou::~n u ~sadi; wc) Approvel.a><FRL~D sB <br />PERMIT NUMBER plscH GE NUMBER F - FI N A v <br />MONITORING PE NINGN <br />' MO DAY YEAR MO DAY <br />)M ~ 70_ u U #rM AC DISCdARGE ~_~~ #+$ <br />l10-7U l17-731 veers! ~ '.. 176771 128-791 !3631/ NOTE: Rud IroWCtlorn 6doi~ complatin9 thb form. <br />PARAMETER i3 Ord Onlyl CUANTITY OR LOADING /t nlyl QUANTITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> !46531 !50-61 -45/ !4653/ /54-6/) EX QF TYPE <br />I37-371 ANALYSIS <br /> AVERAGE MAXIMUM UN INIMUM AVERAGE MAXIMUM UNITS 162-631 16a-681 (65701 <br />U1L AtiU mod): n;; .. SAMPLE t;:#«'.:=: ( 9 #::+::; ~;• . . r•. ~#Y+`#r <br />YiSUdr MEASUREMENT <br />bYUbb (. L PERMIT X'a'~c##K`~'t <br />REP¢~CT <br />ES=i M~y~. <br />;FiY~-j <br />...4 #'~i~#YJ A <br />#``V~~~..; <br />#~#Y <br /> <br />' Ly <br />ELl1** <br />~ L <br />y (fig <br />.V! I ~ U'A <br />1FeLU:.wL' dROSS VALU 'REQUIREMENT . <br />19ST NU=J k,. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '•<' ~~ ~ <br /> <br />REQUIREMEN7 . <br /> SAMPLE <br /> MEASUREMENT .~ <br /> PERMIT '~ ~~ <br /> REQUIREMENT ~~; ~:: ~ ~ ~. . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ~. <br /> SAMPLE <br /> 1 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMI <br />AAI FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND B NED AND <br />ASED ON TELEPHONE DATE <br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS 1 <br /> TRUE, ACCURATE AHD COMPLETE. I AM AWARE THAT THERE ARE <br />SIGNIFICANT PENALTIES FOR SUBMITTING FAESE INFORMATION <br />INCLWING ~/ <br />/~ ~ , <br />THE POSSIBILITY OF FINE ANO IMPPJSONMENT. BEE 18 U.S.C. 1 1001 AND ]] <br />IGN <br />E OF P <br />NCIP <br />EXECUTNE <br />T .29.52 S <br /> <br />TYPED OR PRINTED U.S.C. f 1310. lParla! mIS•r N•w meuha rNV /nahd, A,...m ro SlO,QpO <br />•rWO. muMnum inpdrarvrwnr orNrw..n Enwrdv rM6yra.l RI <br />S <br />A <br />UR <br />AL <br />OFFICER OR AUi'NORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IONS (Reference aq sffacnmentr nerel <br />155 6 TCTdL iRCL L1::12~ GILL BB wAiYEJ, ANi: StT'fLEin~L^ ~OLIJS iIL7IT APi-LInJ FCd <=10 <br />TS:i, ZdCn AN L' SLTTLSALL:; SGLLDS LIgITS rAIY>;U FCIi >luYt,24dii PB£CIP 3VSNi-A'PTACi1 DOC <br />may <br /> <br />4dR P&bCIP EYEhT; <br />TATIOA-SEE L.A.3. <br />U12u7{Jf9b 943 <br />