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rERMRTEE NAME/ADDRESSpneFfr i.rwrylvw/(.orrr•wVDf04w+1 <br />NAME - <br />ADDRESS . <br />BOX 187 <br />TO CO <br />FACarrY ~ ;~pER MINE <br />LOCATION t G C O <br />vM1"uan r! nl l AflT4. PA1=4 <br />NATIONK POLLUTANT gSCHMOE ELIMINATION SYSTEM /NPOESI <br />DISCHARGE MONITORING REPORT /O Rl <br />i ;ti <br />PERMIT NUMBER gscHAnoE NuMeEn <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />81 !`: ~ FROM ~ TO . <br />r_rl <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SVBR JC) <br />F - FINAL MOFA1 <br />ACUTE WET TESTING FOR d11A <br />NOTE: R~~d inetructiane b~tw~ completlr*p thb flxm. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FAEOUENCV <br />ol= SAMPLE <br /> EX TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS AHAtYSIS <br />rt <br />'r ; r~ ~ ('. <br />; <br />SAMPLE <br />~ <br />;. _:.. <br />~ _ , <br />,f ~~ # ;~ <br />- z ,.. <br />! <br />~~ ; <br />_ <br />i 1' <br />i 1r <br />MEASUREMENT <br />~~ ~~ <br />^'~ 1~- <br />. <br />r7 ~ PERMIT #####it #~~~## ~ 1170. UQ01 #•!I•##dt~ dE#~•##-Iz ' ~-`~: ~ ; ", ,r i-2AB <br />>;OSS Vi'•: REQUIREMENT , . - MN VALUE <br />r_ 96HFt SAMPLE _ `~ <br />} - _ <br />c MEASUREMENT / ~ ' <br />`:.'' C' PERMIT ..~ z#skit• it~3t~sf# 100. O1 ~-sf~•i~••a# ~r~• ~ •~•a -: - . 2 ~ ~ - .N <br />. REQUIREMENT , :r -a MN VAL_i_'f. <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 /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t «rtlly " " ~`"' ty •w IhN aN dorumttll •nd .n •tt•chmenls were TELEPHONE <br />prep.ted .nett ~~ dlrxlbn •. suprr+/slon In •emrd.nn .la . rytlem eeafLnad <br />11 DATE <br />~- _ <br />to asurt IhN quN115ed personnel properly L.Iher •nd t+•hr•le the Infomulbn / <br />Inquiry of ae prrsoa or per•orn -h• m•n•p Uw system, <br />Jj(.-- :./ . ~/~-- <br />~ ` ~ <br />i~ <br />~ <br />solmllled <br />Srd on m <br />~ <br />. <br />_ <br />~ <br />. <br />y <br />.. <br />or Ibo•t pnrern dirsctly respold lk for plherirq ae In/onet•Ilow. the Inlorm•Ilon ~~~ ~~ ~ /... <br />/ <br />:.~ <br />- (~~ <br />, <br /> <br />/~ ~' sulmllled ht. b the Aefl of my knowkdtt Ind lfeMer, Irw, Ktvnlr, Ind tompkle. ~ ~ <br />` <br />OF PRINCIPAL EXECUTIVE <br />T / • <br /> 1 •m •..rt aN (here •re flLrllnc,nl pen•Ina ror sreMlnnL r•Ne Inrornrtlon, t10NA <br />VRE <br />TYPED ~ PRINTED InAudlnL the po~thnlty of e.t •rd lmprlsorlrnmt r•r kno.lnL +1.1•tlonf. OFFICER OR AUTHORIZED AOENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lAel~rence M erncnmenrs nerd <br />• .- REPORT LCSO - STATISTICAL PIONT ESTIMATE WHICH IS ~fT <br />~ i ,.. <br />• _ ., ~ i Il._ F i1 I tVf'Ci'~ Ii .:._.. ~ I'~~ ~~LJ 1 <br />EPA Ftxm 3320-1 (Rev. 399) Previous editlons rmy be used. ("J %'~ ~? ~.~, r', T~lt~~~a? 4-~t~kfQrin. PAGE pF / <br />