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r'ERMITTEE NAt,AE/ADDRESS p1.rviF.rwg1V.../taerlarl/D(QGrwv <br />NAME ' <br />ADDRESS <br />- DOX 187 <br />",IG GI <br />FACILf1Y ,~;i'PER MINE <br />LocAraN ==~ I G C <br />'~Yf"EON~i G. DU BOIS, PRE <br />NATIONAL pq,IUTANT gSCHAROE ELIMINATION SY9TEM //NPDES/ <br />DISCHARGE MONITORING REPORT (OMRI <br />PERMIT NUMBER gSCHMOE NUMeEII <br />;1~.,`- <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />O Z; ?. __ ~ - FROM Tp <br />S/G"; <br />Form Approved <br />OMB No. 2040-0004 <br />MINOR <br />C SUDR JC ) <br />F - F I t~(AL ItrtOFAI <br />DiSCi-iARC,~E TO REAL C.~i1LCN <br />... .. ~ <br />_ _ . - ~L. <br />NOTE: R~~d kwtruedorw b~tor~ comple+tlny thb form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION rJQ, <br /> <br />EX FpEQUENCr <br />OF SAMPLE <br /> ANKr~a TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ;. ~ ~. f ;: . ~.a~ ~ ~ _ <br /> MEASUREMENT <br /> PERMIT ####-z# E :.,. ' <br />', ,'., REQUIREMENT INS -' t ~;'-. ~ ~ Mta~4 i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - _ <br />~~ <br /> REQUIREMENT '' <br /> SAMPLE \ <br /> MEASUREMENT ~ <br /> PERMIT 1 <br /> REQUIREMENT <br /> <br /> SAMPLE _, ~ i <br />~ ~. <br /> MEASUREMENT I <br />', ~(_. <br />,' ~- <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT \ <br />` <br /> REQUIREMENT \ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />/TITLE PRINCIPAL EXECUTNE OfF1CER <br />A ' `rnn~ r e~ pen, l~ of Lw ~h.l th h d.rumenl .nd .u .Il.~h~.nu »~ <br />,. TELEPHONE DATE <br />N <br />ME pnep.red coder n.~ dlrecrlon a wpe nhlon In .ccord.nrr »IIh • r~.terrr OdLned <br />^ ~ / I <br />" <br />' <br />= L ~ ~. to more Ihat ~uMI1Md ptrwnntl F~~1 L.Iher .nd erW.le the In(orrn.llat J! ~ <br />~ ~ <br />. <br /> <br />/// ~ /j <br />n: <br />i ( ~ . <br />.uhmltled. 6..d e. m7 Irpulry e! the penes or person. »ho m.n.Le uK ryyrnr.. <br />M Iho.e pener~ dlrxty repowlDM for pUerfnL the Inferm.lbn, the Infornrtbn <br />i <br />.! ~ -'~~- •t ~~ <br />- .. _ <br />~, ~ ,,~ <br />J. <br />; <br />L ; <br />I <br />._ wAmlll.d h. to the lwt Mm7 Ynewledre •rd DeMe/. trvr. .rcu nle. •nd rnmpkle. <br />1 •m •...rt tha Ihert •rt 9Rnillr.n~ p.n.m., r..r n,hmtn;n <br />r.le ,nr..~.- <br />.n..n <br />EI(3NATlIRE of -RiNC11Al EXECUTIVE ` <br />( <br />-_. J <br />TYPED OR PRINTED R <br />. <br />~nd~uli^R IM poslhnnr nr nrK .n<I ~mr-ly,^=-^i r.,~ ~,.... ~r . ~.~..~,.,,~ Cr ~iCf A OR AUTHORIZED ApENT CODE NUMBER YEAR MO OAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re+/~r~nc~ aN ittichm~nta h~r~) <br />' , ' :_. :- . r _ ._ ABi_F SOC_ I DS LIMIT APPC_ I rD FnR ;"= l OY'R , ~ 4HR ~'?>=C T p FUEM•:T - <br />EPA Form 3320-1 (Rev. 3199) Previous edltioos may be used r7 (i r, yam? C~ F a 4' ~ O~[ll. PAGE OF~ <br />