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<br />ATION
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<br />N ATIOXnL rOLLU TA XT DIacHARCE ELIM INATIOX [YST[M rNPDES/
<br />D ISCNARGE MONITORING REPORT rDMRI
<br />716 l~
<br />/lRMIT NUM eER RncXnwcr nuMRrw
<br />MONITORING PERIOD
<br />YEAR MO DAY Y[AR MO DAY
<br />FwoM 0 .G TO ( 3
<br />110-11/ r11~1J/ 11i~7s/ r16~ l r1 ~ ) I /
<br />
<br />(1 ! t: 0 R Form Approved.
<br />(S U B A N W QMB kb1PP4o-0004.
<br />H- i h T E ~9RSoval expires 6-30-91.
<br />SUhFACE FSUNOFF TkOUT C%Y
<br />aaa NU UISCHAAGE a~`'Y
<br />NOTE: Read inttruetionE ba}oreleomp~atinp thi[ form.
<br /> (J Card Only) QUANTITY OR LOADING '(I Card Only) QUALITY OR CONCENTRATION FR[OUFHCr
<br />9AM PLE
<br />PARAMe:T[R (Ib.13) (Sifil) ~ (JB~J) (16JJ) (Sddl) NO. pF TYPE
<br />(31•!7) E% wNwl.TSls
<br /> AVERAGE MA%IMUM UNITe MINIMUM AV ERAOE MA%IMUM UNITE
<br />61fiJ)
<br />(61fie)
<br />(6970)
<br />H SAMPLE aaapaa aQaaa aaaairv ( i2)
<br /> MEASUREMENT
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<br />OLIDS, TOTAL sAMPLE QaaQOa t7A4t114 as#ea ( 19)
<br />USPENDEU MEABUREM ENT
<br />J530 1 0 0 ~~P~eit~is°s'`
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<br />OLIDS, SETTLEABLE As aQOaaa aaa#4 aQaaa ( 25)
<br /> UREMENT
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<br />dON, TOTAL 6AMPLE aQaQaa >d0aa# aaaaa ( 19)
<br />(AS FE) MEAEUREMENT
<br />1045 I 0 0 °,~~rstekrl~r, $
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<br />OLIDS, TUTAL SAMPLE CT#aa4a 4aQari4 #a#oa ( i9)
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<br />iSSOLYED MEASUREMENT
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<br />M[/TITLE PRINCIPAL EZEC UTIV6 OFFICER I CLRTIFY UNDER N:XALTY OF Lhw TXAT I RAVE PERSONALLr E%AMInEO
<br />nNp AM FAMILIAR MTX TXE INFORMATION SUBMITT[p X[RCIN ANO BASED TELEPHONE D A T E
<br />ON MY INQUIRY OF THp^E INPVIDUILLS IMYEPATELY RESPONSIBLC FOR
<br />~.~. LoIvG OBTIINING TNC IXFORMATq`I I B[LI[V[ TX[ SUBMITTCO INFORMATION
<br />IS TMIC ACCURAT[ ANO COMPLFT[ I AM AWARE THAT TX[AE ARE SIG /-~ ~~
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<br />M •~ NIFICANT PENALTIES fOR SUMITTIXG FALSE INFORMATION INCLUPNG
<br />~T-\ TX[ Pp551BILlTy OF FINE AND IM%i50NMENT SE[ IB USC f IOpI AHD
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<br />BIONATU RE OF PRINCIPAL E%ECUTIVE
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<br />TYPED OR PRINTED .. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO OAY
<br />.MENT AND E%PLANATION OF ANY VIOLATIONS (Rrlrrm[e ull uuurnmrnb Nn)
<br />:IE-TIhE ANALYSIS F.EQUTAEG AT FIAST L'ISCHAkGE CONTAINING MINE DkAINAGE/SPOILS SPAING aTR-SF.E 004tt. TSS &
<br />OTAL IkON LIhIT$ WILL BE WAIVED, AND SETTLEABLE SULIDS LIhIT APPLIED FOh <=101 h, 2ut;A Pk:iCIP ~VENY-SEE
<br />IF R109 '(R B) OUb d fM . • V [ 1 I cP1 e I T s c .4 1 • Pwoc of
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