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~'f~RMt11FE MAi4iu gar ~..:-~~, il,~L~.'~. r~i rn~,a, __+,~~ .. <br />NAME ----- „ l `;UIjI~ 1 `J I F`F21`I~ I' <br />ENERGY FLJiI_; C;L:IAI_.~ 1.1`JI-• pI~A118ENUMSER F - FINAL <br />ADDRESS gOUTHF I ELD MINE PERMIT NU R OSCHO TO TR Y B OF NEWL I N CREEK <br />P. O. B n X ~ 59 ,, N PERIOD <br />t:;U 8l.?_26 <br />FL~JRENCE ~ YEAA MO 1lAY' YEAR MO DAV c ,.' '..#. <br />FACILITY gOVTHF' I Et_D t9I NE t0 3 AF## NCI D IS •~ ~-~ =~!~ <br />LOCATION r: r~ 81226 FROM o f ~ NOTE: RNd In <br />FLORENCE ~ ' ~ "~-'~" ~~ <br />V. PATTERSON. MINE MGR pUAW'Tf1Y OR LARDING OUAUTif 6R CONCENTRATION ~ ~YaM TYPE <br />PARAMETER MINIMUM AVERAGE MAXIMUM UNITS <br />AVERAGE MAXIMUM UNRS # # # * ## ( 12 <br />SAMPLE ~F##### ###### i <br />1~ H MEASUREMENT NG E/ Y NS I T <br />PERMIT "` ####~F : : ,, ~~ ~ MUM MAXIMUM 5U <br />E7U40U 1 ~~ U piEAUiREMeNT '~ "• '~., •~ #### ( ~5 <br />EF T G OSS VALU `~ ~ #####~ <br />SAMPLE ###### ###### <br />50LiDS, SETTI..Er1BL.E NGE1~• RAD <br />MEASUREMENT ~, ~ ~~ ~-©RT•. O. 5 4:~ _ <br />0 h PERMIT *#*.~ ~ ##~-# ~t { % k `~` V I L • ML i L ~W; <br />00545 i REQUIREMENT `~ ~ ###### ~ <br />EFFL ENT GROSS VALU #w###~t ###### <br />SAMPLE ###### <br />i OIL AND GREASE MEASUREMENT ' Y <br />• II #' f'' J C.~ . <br />03582 1 0 O : , y 7~ <br />MEASUREMENT ###### ###### <br />t }IRt,) ~ RFA f t'1F.:.IJ 1 F t ~I`I pERM1T REPORT+;• O T~- -`~ _ #•~#•~ MONT <br />~•~}cl~~'~'I 1 C) `> REQUIREMENT Q .' ~ _ ###### <br />G O S VALU ~, ~. ~ 9,4) .~ ~ ~.##### ~##### <br />~ SAMPLE ###~FM"1! ,• <br />L AND GREASE v;` ~ .I ~. #1FrIE. <br />I [7I MEASUREMENT ~ r. <br />VISUAL l _ '~..~.b ~'~~~ <br />(34066 i b O ;., .~,_ ~~'~ ,. ;"` ~., <br />V NT GROSS VALU rs - <br />F SAMPLE .:~: '~ ~.E .; '~ <br />i MEASU ,.. ; f;~. •; ;r ., t ~ <br />REMENT ~'~ ~' ` <br />t:' _ _ a: ~ ~: y" <br />,. <br />~ ~EINEN't ~ ~ x ~ ~~ ~~ <br />~ SAMPLE <br />MEASUREMENT '' ' <br />•,. i~' <br />~ ~ PWIMR ~"` ~~~~~ ~ ~ TELEPHONE ~ DATE <br />REQUIREMENT ;~: ;. ,ad w .mchmaob ware . <br />1 certify under penalty of law that dfie doh """~- ?~ <br />~, ^~ <br />NAMEJTITL,E PRINCIPAL EXECUTNE OFFICER prcparcd under my directtoa or a>psrWd°° in sooo~ ~~~~ --> 7 ~/ / /' r~ <br />y~ /~/~ V to aesurc that qualified peraotmai ProP~y ~ who ~ ~ / O ~ tL...-~ ~ ~ v~ ~ ~ l ~--• <br />lC' /'~ } ' l ~ © .uhmitted. Raid on my inTtirY of the pa(wo or Pa+~~ ~~ao~e <br />or throe penone directly teaptxst~a ~ ~ ~ NATURE OF PRINCIPAL EXECUTNE MO DAV <br />~ ~ 1 /~ submitted ia, to the beet of nry~t ~ ~ ~~~~, OFFICER OR AUTHORIZED AGENT NUMBER YEAR <br />~x~ ~ V ` t ~ I am ewers that there ere eigni <br />including the possibility of floe and htrpriaor~r ~ viodtlooa. <br />~~ TYPED OR PRINTED <br />COMMENTS AND EXPIJINATION OF ANY VIOLATIONS (Reference aH effachfrltxds fnn) <br />D F'OR lOYR,24HR PRECIP EVENT SUBJECT' TO flURDEN OF PROOF REQUIREMENTS IN TI <br />ETTLE.A[3LE SOl_IUS LIMIT WAIVE PAGE 10F <br />~ I. D. 1. D. 00163/0~~~4~~~ <br />EPA Form ~f (Rm'• 91gB1 Previous edflions may be used. <br />Fnrm Annrnvud. <br />