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ERMITTEE NAME/ADDRESS ()naYbi«iYryX../L«rren I/D~i.wxJ
<br />NAME
<br />ADDRESS _ .. -. ~ ri !' ... , ,
<br />). BOX 535
<br />'~i.}i-1ER5ET CO 8143
<br />FACILITY =%<+I'dBORN CRi( &. ELK CRK MINES
<br />LOCi~~ '~!ERSET CO $ 2 43t
<br />'' -'iM1=5 T. CC70PFR. FXFC V P
<br />NATIONAL -OLLUTANT dSCNMOE EUMINATIOH SYSTEM NPOESI
<br />DISCHARGE MONITORING REPORT /O RI
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<br />PERMIT NUMBER dSCHMOE Nl1MSEA
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM TO
<br />Form Approved
<br />OMB No. 2040-OOQ4
<br />MINOR
<br />(SIJBR MH )
<br />F - FINAL. GUI
<br />RUN71`'F TO N FORK GUNt+~ISOt'+i R.
<br />NOTE: Reed k»truction~ b~1w~ compl~tinp thh form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, RtEOUENCY SAMPLE
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<br />E of
<br /> X ANKrsfs TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br /> MEASUREMENT
<br /> PERMIT .~•###:f= ~##### ~ ~-~ IIj, 5 ~##### 9. 0 ~ ._! ItUSITI
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<br />. MEASUREMENT
<br /> PERMIT it####3t st'.i•it-x~•rrQ. = ~•st•It~~t# _.; 7G 'i~;C1=i '~~f1la
<br /> REQUIREMENT
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<br />- SAMPLE _
<br /> MEASUREMENT
<br />45 PERMIT #####~F #:t###~ ###3F## REPORT F2EPORT ~NCci rF?AL'
<br />UEN i REQUIREMENT 30riA AVG ~4I LY i'~ X hiOIUT
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<br />J PERMIT ##iP#3t* ###3E## ##*#~'# 300U 6004 NC~i `:: ': ;_
<br />'JEPJ, ~~; REQUIREMENT 30 A ~`.~~: UA1(_'~' MX h901`~
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<br /> MEASUREMENT
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OfFlCER ' """7 " w"•'7 ° I^+ Ih^1 thb donuntnl ^nd ^N •11LChmmtf nert
<br />TELEPHONE
<br />DATE
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<br />^ttbmluea. s.ed en T7 t,«nlr7 a< the person w persona .ho nrrr.[e the t7st.rrt.
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<br />~ submllted b. to U+e bet oI m7 knowkd[e •nd belhf, taste. ^ccvnte, ^nd complete.
<br />I .,n ....,. ua tner<.rr n[Nnr^"t prn.itles r~r r.~,ertnn[ r.l.e Inr^.,.~^ttn" sIONATVRE OF -RiNCIrAL EXECtJTTVE 1 ~ ~ ~ c.
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<br />TYPED OR pRgr~D .
<br />inctudt"[ ine p. vbiut, or n"t.nd imons~,"n,.~i roe r".,.i"[ .t~t.u.."~ OFFICER OR AUTHORIZED AGENT Cif NUMBER YEAR MO DAY
<br />COMMENTS AND tArl.nrrn t was yr nr. r . wr.n , ,vn~ rnererence M •lrarnmmr~ nerei
<br />. - ii. s);,?' ',_r?~IILE SOLIDS !_MT ~~'DI_1ED FOR <~=_OYP,, 24HR PP,EC'° F'JFNT;
<br />T':... ~ .- lr; . i .. i _i- ~~ EVENT-SEE ~ 4-r~ r-.". .. -:, P 5 .. :•i ~ _.
<br />EPA Form 3320.1 (Rev. 3799) Previous teditions maybe used. fj(> _I;-; __, ; ; Tf11$ i5.8.4-Q3~'1 f~TRI. PAGE C>F
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