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rERMRTEE NAME/ADDRESSpwoV4f..eflyM~./Lerrwnl/t)IQnw./)
<br />NAME
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<br />ADDRESS .. •
<br />_. tsOX 535
<br />wi iERSET CO E
<br />FACIIRY ~r~NBORN CRK ~ ELK CRK MINES
<br />LoCAraN ' ~'jERSET CO 6
<br />-,MSS T. COOPER, EXEC V. P.
<br />NATIONAL VOILUTANT aSCHAROE ELIMINATION Sr3TEM IYPOESI
<br />DISCHARGE MONITORING REPORT /D R/
<br />PERMIT NUMBER ascHAnaE HuMeEn
<br />14 _; .:;.
<br />MONITORING PERIOD
<br />YEAR O. OAY YEAR MO_ DA
<br />. `"- u FROM TO - , .
<br />Form Approved.
<br />OMB No 2040-o00A
<br />MINOR
<br />(SUIIR MH)
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<br />SUtZFACE RUNOFF T'O ELK CREEK
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFlCER ' """' " ` °`""' ° 1i" u'" ml, doronin1ndiY "'.rhn.enu ""` TELEPHONE DATE
<br /> yrep.nrd coder ny dlr,ctlon or eiyer,4fo" In ..:«d.nce ..IIA ..t.tem de.l~ned
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<br />~ - to ae.ree IAN ga.efled ytnonn.l yroy.A~ ptber .nd e,.lu.te the InfarwWlon
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<br /> M tho.e pe.7en. dlrertlf rnyornible far ~.lhetlnj the Inform.Uow. the Infonn.tion ~' ~ •. ' ~ i -
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<br />bIONATL/itE Of -RINC1-Al EXECUTIVE -
<br />TYPED OR PRINTED .
<br />incladln~ the po.dhull. of one .nd imflr5.pnrntnl fer krv,.ln f .Id.elnret OFFICER Olt AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe%ronctr ~N ittachm~nts horn
<br />. :•J F.?'.':L "_EABLE SOLIDS LMT APPLIED FCIR <'=10YR, ~ 4 HR PRr!'?° FVFNT;
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<br />EPA Form 3320-1 (Rev. 3199) P-e\rbus editions maybe used. ~ ~~T15~8.8 ~-P3it fOrtil. PAGE .OF
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