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PERMIlTEE NAME/AODRE53pwrrrF.t+Mry/v~rL«rld.UDld~+atl <br />NAME <br />ADDRESS <br />~~x f~~4. <br />~iA ii3 8I42fi <br />FACILm -~ N©. 3 M i NE <br />LO~`~ ~_RSST CO 81$34 <br />.~TFL E. I~FAR, PRFf;il)FNT <br />=;:rrr :. ,pro. ea <br />NATION AI pOLIUTANT OISCHAROE ELIMINATION SYSTEM /INPOESI FMB rao 2040-oooa <br />DISCHARGE MONITORINQ REPORT (OMRI <br />J ~; f t f'1 t-i ; ~~ <br />PERMIT NUMBER ascHAaoE NuMeEA - r I f•.iAL. 1 - ::~ <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO '~~ <br />NOTE: R~~d Ir>.tructtorw b~tor~ t:ompl~tMp thlt, form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION r10, <br />EX fnEOIFENCV SAMPLE <br />Y <br /> ANAtY$IS T <br />PE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #;t ..#->f•., - 6 s c ..i'• _ <br /> REQUIREMENT ~, ~-; ~: ~,: j I`",i ir+i <br /> SAMPLE <br /> MEASUREMENT <br />---- <br /> PERMIT ,r >t . -, ii'.r~ if~r - <br /> REQUIREMENT , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~-#~ r:~ -tit~:~,t:t -f#~fs+#ir `ii I t.' .;r . <br /> REQUIREMENT , !-2:_. _ ~; E~j T , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~i,! i'Ef'ORT ~•~#yF#=f ~t#•~E•;t#•?r -'. iF~#R# .- t_s~.L. I ..~ <br /> REQUIREMENT .~y r U!~ I L Y i' ~ ' <br /> SAMPLE <br /> MEASUREMENT <br />:~ PERMIT ,, __;, .., _ 'kit#~r is #•sf###:¢ ., <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMEN'C <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REOUIREMENT <br />I nrtrl) r r ptne lT o lew Ihel Uh do.v menl end yi e1lKhmenle wen <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFlCER <br />TELEPHONE <br />DATE <br />pnperad under m7 dlre<llon or wper.lelon In rtcnrdante wllh ^ erelem eelintd <br />to aeon Ihy quellUtd ptnonntl properl7 ~rlher end t.yuett the Infarmallon <br />srbmltltd. ^aeed on m7 Inquiry d Ibe pereoa or ptnoer who mange the fJStnn, - <br />~ <br />or Ihoe persom dl rec117 resporolbk fw p1heA1K the InformaUoa. the InformrUon ~ - ~ <br />_ <br />fubmllled h, to Iht bell of m. Ynow4d~e erd betlef. Irvr, amintr, rrd compklt. - <br />r .m ...,. lb.r n,~-. ... ap,ln~.,,r prn.mn rte. n,n,.,lm~r r.t« I~r~r„,.u.,~ <br />bIONATURE OF rAINCtPAI EXECUTfVE -. <br />-. -..•.. <br />TYPED OR PRINTED . <br />~^<t,d~ot ~'+~ ~.2z,r :n.. r n„<,~.; impr7~nnmew r.,. x,-~:.~„r .~~LU•,~x OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXE'LANA I wn yr nn r vlv~n 1 Ivna (/f~-I/~nc• M •rracnminra n~r~l <br />SETTLEABLE SOLIDS LIMITS WAIVED F <br />EASE RE~'ORTING -~ SEE I. B. 1. A. 3C <br />Epq Fam 3320-1 IRe. 3'99 previous editions maybe used This ~s a d-part form PAGE OF <br />