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f°_RYITTEE71AYFlADDRESS//irlaG N <br />tFonlu7 Nun/Laml/an i/d//cKnll <br />NAME _ RDIJ(CA `1T LE ~ Q+ Tb E~ j-G ~ SS]L rig ~]- _ _ <br />ADDRESS RRP-NYAN-($,TP,j ].L B.A r1T I.N Cy(HgCD-Q,j)Ti,I,_ <br />1___ <br />-_-OAIE_EAS2 ~I.1.Yd O.B EB SihE3'..Z____ n C. <br />_1dllES.YILLE-------JiL~3592~T "• <br />FACILITY `! = ~ = ~T ~ ? <br />__ n -__---_ ~ _ _- rI ~- uFRI <br />LOCATION_ _ __ ~ _ _ ~~_ ~' _ _ _ _ <br />.~ '/1 <br />ATTY_ T1AY T11`.l hA('il (7111_17 T._ Rtif~_ - <br />(NPDESI <br />ll-161. I naro/ F~-.FINAL <br />1-A PIT /4 CSCNHG TO GAASSY CREEK <br />PERMIT NUMBER ly ~ ~ .DISCHARGE NUMBER - ' <br />ti. h. I~ f' <br />5 MONITORING PERIOD ~ ~ , <br />AR~ MO -DAY' ~ YEAR MO DAY 3 ~~ w: ~~ -~ <br />•!. TO tlINOR (SDBE;YH).- HOUTT <br />.m, nnz3l nazn.~ ~~',nbzn /7x.z91 /i0.3l1 NOTE: Read lnBlruclfone belore completing thisform. <br />v.' <br />' pCard Only/ .; QUANTITY OR LOADING ~ <br />^' <br />~ ` !!Cold Oldy)~ pUALITY OR CONCENTRATION '' ' <br />~- <br />' <br />' / <br />~ <br />~- <br />NO. FpEOUENCY <br />SAMPLE <br />PARAMETER I a <br />(16731 ~ 131.6!) ~ <br />~ ~ ~~ - - ~ • ; ~ <br />(38~J) <br />IJI-6!/ <br />!*~J31 EX rYPE <br />(31-17/ := <br />~~ ~ - is <br />r. AVERAGE T ? ~« MAXIMUM;i - UNITS'. ., MINIMUM AVERAGE MAXIMUM 'UNITS (67-63 ANALYSIS <br />l61-6,4I /69-70/ <br />Pii. " ~ SAMPLE ;: ####Q#1 ~ "###$##~ ~) I: ~~ -~+ .-y ~;. ###### <br />~ ~ L MEASUREMENT^ r. ~ :~ O ~- ~ u N i [~ ~. r n ~=. u j ~ t ~ _ '" .. i <br />00400 1 .~ hO ~ '"-PERMp- " <br />lT~ <br />IREY # #¢# ~ <br />~ m~#~#, ### 5; b~5 ;~/7 :#~..1~~0+##': <br />~ 9.0 ~, c + 3 NCE/ BAB <br /> ~l ~ ~ : :~1 #~##i Fj =: <br /> c . <br />SOLIDS, SfiTTLEABLE> '~ sAMPLe' '~ ####~#. .=;;#~~p###~ 0~ is 1 r' #$?P~## <br />' ~ ###### ' <br />< , ~ MEASUREMENT=' j I, ! T ~ .+~ I LT <br />.. <br />1 ~ ': <br />- <br />~: n- - r <br />` <br />00545 1 . 0' ~-0 ~ <br />E~ ~###~ ~ ' <br />. #23~###~ ~# ~## <br />?~~ :O.tS.• ~ _ ~, - - NCE/.- RP.B <br /> I:NT~ <br />EO ~ ,~ ~i"~ <br />~' #### ' ~ <br />, <br />OIL AND 4~ <br />ASE y--'tU443A)APiE ####~~#I ''.~~######~. ,~! ;4;r ~,^ •:,~~###~; rl~ ####~~ <br />. <br />;,.. <br />~~.. <br />~ <br />, <br />FREOY EYSH-GEAY~tlET MEASUREMENTy p' r ~ <br />- ~ L/ `. i :~ :J <br />_ <br />- e ~ Iv: .. <br />- ~ ;, <br />~• . <br />t <br />00556 .:~'1 a0 _~0 e? <br />_°- ~ <br />~'- <br />j <br />u <br />IE +~ 4## y ~ <br />, #aI##~#5,~ <br />~ #3####.• ,10:E: '~ ~' <br />~ ONTIN 'RRB <br />, Nr <br />Eg <br />in <br />EIA ~ <br />~4 ~ ''~ ' ~ <br />' + <br />c ` <br /> ~ <br />, <br />c # <br />###? . , <br />I BOY O `" i : !:t i` F SAMPLE O ######: p . ##~#~#; a ti ' ~ U ;,###### <br />' ###### t • } <br />TOTAL HECOY ERAHLE per,-, MEASUREMENTS T :: 19 b ,~ j ~ I. <br />u ~ ~ <br />:.l ; <br />00980 1 ~ 0 :=0 '° ° <br />'~ -S; PERK ~ a~ <br />° <br />_~ <br />?~#4~p ~######,rr: #0# v n#YJ~;### ~ ~#>~#### ; OP•TIOY L i ~~ -- i• } OYTIN HAB <br />~ ; ~EOUIREI~ENT',l7 ~ <br />7 <br />~~ <br />Cpl ' yrw -~^1.y ' t"`.'~` #"##1 fl C u h n r.'"T.?.T.,/x ~ <br />~ - <br />PLOY, IN -COYDOI2 OH' <br />n SAMPLE .': ~-,iii~k###tt: <br />' '' ? :i a <br />~ a - -' v ., ~ ##4### <br />~ ~ ###### ~ <br />6i###### <br />' <br />I <br />TNHU,THEA-'~llEhT 'PLAY MEASUREMENT•~ 1~+ . <br />j <br />- - <br />V ~ .~ ~ ~ iCf tZ : <br />~ '; ~ <br />~ „ ' _ <br />-. <br />5DD$0 I .; Q7 ^~ r, ~ <br />`~'" PfipM{L = <br />ANT _ <br />EOU 4 <br />T"#.##~?~ <br />i .'` E~PO ^. Ya' T ~#~##~# §~ <br />~ ' c`i## <br />####,: ? ##### <br />~ ~## - 'tlCE/ ' <br />C- YSTAN <br /> K <br />~EM <br />t U' ~ <br />.y ~`Kr t= ' ~ +l ~i'i a 'S <br />.~. ne ~ <br />Y, t.: } ### G' . <br />SOLIDS, TOTAL ~ SAMPLE .~ :t ####~~: ,ii 1?D#~~!##~ o ::~ - ~ `#3#?¢#0; _. ,###### -_ <br />DISSOLYED; A/'" _ MEASUREMENT_ .~ p .< '' y _ .-t ~ <br />h ~ ~ ='. I <br />I c ~ <br />70295 1 ='0 ~0 . A~PEI~TT'r # <br />,#`# ## ``~{#~ #~ #%I# o T iR~###~ ~###~#~'~ +.. 'BFPO ?; ~ ° i+ <br />z ELT, 9AH <br /> ~ - <br />E = ~ <br />CIL A71D-GEE <br />AS (] SAMPLE. ;~ =" ~i~# <br />####- <br />a r' `= <br />A '. ~+' ' ~, :ix~####- ~ ###### i ####4# '' - :, <br />_ <br />_ <br />YISUA•L ~.' <br />C " MEASUREMENT}: I <br />y,' C =., '^ 1j rr ti> L <br />, i, is ~ c~ t• ~ _ <br />~ :•~ <br />, c ~ <br />840615: 1p~0 RD J <br />~ <br />~ <br />S <br />+ <br />#~#'~ <br />m <br />~ ~`r1 JI q <br />E~=~i <br />1 ~ <br />~~ <br />~ <br />; ,~Y~# <br />A~ <br />i######` N `. <br />### : <br />i ~ <br />~~$/ <br />I~VAL <br />- - , REOU <br />EM_ENT <br />- <br />rr. >r t <br />~'~SC,~ r' _ T (;~ ~. ~ t I If <br />%A~:P f ~ ~~. - <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER J CERTI <br />`AND AM FY UNDER PENALTY:OF lAW TNAT I HAVE:P <br />FAM WAR WITH THE INFORMATION SUBMITT ERSONALLY <br />ED HEREIN <br />A E%AMINED, <br />ND BASED I ) ~, ! ~ p TELEPHONE .. <br />$ / DATE <br />' - <br />'-i .ui c~ '~ hj '' <br />Karla. Rabtick ,. „ LT' G I <br />-ON MY INQUIRY OF THOSE'INDIVIDUALS-IMMEDIATELY~gESPONSIBLE.FO <br />OBTAINING THE INFORMATION. (.BELIEVE THE SUBMITTED INFORMATI ~ <br />= . ////" - :-. ~ -~~ ;~ ~ 1~ <br />nl; /, n <br />~ <br />`~ <br />] <br />~ ~ _ <br /> <br />~ <br />t~ u ~ <br />Vice~Yresident ~ <br />~ ~ _IS TRUE, ACCURATE~AND COMPLETE ;I AM AWARE THAT,TMERE'ARE SIG, <br />;NIFICANT PENALTIES FOR .SUBMITTING'FALSE'INFORMATION~ INCLUDING; C <br />. <br />'_" . <br />n_ : <br />IA~LiGQ/ <br />6~$ 754=2291 ^ <br />' <br />92 <br />04 <br />23 <br />~ J ~, <br />>: <br />' <br />• -THE POSSIBILITY'OF FINE AND IMPRISONMENT~~6EE 1B. U,S.C~1 `IDDI~AND' <br />.~ U <br />17t <br />S <br />C <br />he GN TURF OF RINCIPAL EXECUTIVE u '"• C <br />• <br />~ - <br />r . <br />. <br />. { <br />B. (iWWtb.wdna <br />ienrvea nMrlPl~'d••11naJIp Jo 7/P,POP <br />` <br />w TYPED OR PRINTED andwmarMUm lmpclrpnmral x/h/neM6monrhiand 7yean.) FICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />UUMMtNI ANU CJIYLrANgI1VN VY AN~VIVIAlIONS(/f{/ln[nR O//C(ICChm[n6hMJ i <br />OIL Ei1GHEl5E: SEE FOOTtlOTE F/,.PAGE 3 OF.TRE PEHCI~.. FOEN,BRLY.DISCYARGBD UNDEH.CO-0035653.:._ <br />~ ~ I <br />useo. <br />0000~/CJ1~123-1657 PAGE 1 OF <br />