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^ Y NATIONAL POLLUTANTJjjjk4ARrE ELIMINATION SYSTEM P <br /> DISCHARGF W.CRMG REPORT ��-�PPraved <br /> O. JSS-RO073 f <br /> i <br /> r ''.I?-CT cna;_ (PREP PLt'NT 1 , <br /> k <br /> PO 90X 158 <br /> f <br /> INSTRUCTIONS rI <br /> 6?3 1. Provide date:.for period covered by this report in spaces marked"REPORTING PERIOD". <br /> 91 €_ <br /> 2, Enter reported minimum,avenge and maxi values under"QUANTITY"and"CONCENTRATION" ¢¢ <br /> j Iz v u Im In Ial In die units specified for each parameter as appropriate. Do not enter values in bones cortnining h <br /> asterisks. "AVERAGE" is avc:oge c. Puted ovcr actual time discharge In operating. "MAXIMUM" �. <br /> j and i MINIMUMn are he coilu values l.d"ed doing the reporting period. e. <br /> f�^0 39b )J ' 1 r 11 jj�� 3. Specify the number of anelyced samples that exceed the maximum(and/or minimum as appropriate) '. <br /> P <br /> _PERMIT NUMBER DIS SIC'. LATII'U UE LONGITUDE permit conditions in the columns loaded ram Ex." If none,.enter o. d k <br /> -J 4. Specify frequency of analysis for each parameter es No. analyses/No. days. (e.g., "3/7"is eyN)va- <br /> Ieni to 3 analyses perfumed every.clays.) if continuous enter"CONY." s` <br /> 12a•211 Izt-231 Izz•341 Ize•2T1 Ize•2Y1 130•!/1 Y P ("grab" applicable. q cY C <br /> - 6• specify sample a or"—hr. composite-)ae If fre frequency was caadnuoua, <br /> _ enter "NA". 5 <br /> REPORTING PERIOD: FRUM g —�•'MO it 1 Y TO 9 YEAR NO 1 DAY 6. AppiDPri aie signature to tegCi red on bottom of this form. 4 <br /> DA 7• Remove carbrn' and retain copy for your rucords. <br /> YEAR <br /> 8. Fold along dotted lines, staple and mail Original to office specified in pennit t! <br /> ' 1!z-!TI _. ��— _V la.-et) Ia0•Tot F <br /> (3 card only) QUANTITY (acerd only) CONCENTRATION FREQUENCY I' <br /> 1!r•.61 1.0_E11 IDPE 11 lez-631 3 .5, _ (46.531 la.•011 :J2.0]: DF, SAMPLE <br /> PARAMETER HO. <br /> MINIMUM AVERAGE MAXIMUM UNITS Ex' MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE ! <br /> REPORTED it Itk / •` <br /> FCO'; INCON.)OIT <br /> M PcnMIT MGti f rD <br /> `., a It # It # it It # # # It # # # # + # # # tt 1/"l IN <br /> � :SU •• CONDITION <br /> t' REPO CITED # It It # # # It 4 # it # # It' # # # 16o 3 # # 8 it <br /> OLIDS, T"ITAL DI_�S <br /> j t;,a�s',,L�_I�I — - KG/D;1Y MG/L <br /> PENMIT <br /> 7 J 11, _— CONDITION G +I # # q it # It 9 # # # - !► # 0 # It It a; It # 1/90 GR <br /> SC'L TC;S t TOT t'L SIJSp REPORTED It # # It # tt It # It tt A # ik # It <br /> Co <br /> . r (cUSp! t f EnI KG/DAY NG/L ---- <br /> PERMIT # # # # # # # 0 # # # # t} It # 0 # # # s <br /> i5-53 EON DITIDN 3n 1/9i1 CO — <br /> y <br /> K01dr TOTAL(4S FEA REPORTED w It # /< It # # It # {} # # # It p <br /> �� --- - --- KG/DAY --- H6/L — <br /> C PERMIT # #CONDITION # If # ;f # It it it # It It # 3.5 7.,, 1/90 CO j <br /> ..IIJ fiJ <br /> 8 w I: Sea <br /> FH> r IELt) REPORTED # It {} p # It # # It a # # .3 # It <br /> su <br /> SU <br /> •t PERMIT <br /> u4;0 CONDITION a # o # # # # +t # It # tt 600 w It ;f 4.Q -_ i19i1 GR <br /> GIt_ 6 &?EASE9VII;IJAL REPORTED # It Y It # It It # t 0 It a # It it it It V'1 E <br /> PE RM.T— <br /> A; 2 CONDITION # p # It tf 5 # # # Is # # # # 1Q It It N It # 10 1/90 VI <br /> REPORTED <br /> PERMIT <br /> :�_,j CONDITION <br /> REPORTED <br /> ,1 PERMIT <br /> CONDITION <br /> I NAME OF PRt11C1PAL EXECUTIVE OFFICER TITLE OF THE OFFIr:ZR DATE <br /> .1 �. I certify that I an,familiar with the information contained in this <br /> �,' ^T G C,r report and that to the best of my knowledge and belief such Infer 1J. )fl Wu -�CJ`•s"'� y <br /> �5 ,jaftN �} aYECL2YVC 11fcE 6'��ai11�Ni l(JL.1 / motion true, complete,and accurate SIGNATUREOFPRINCIPAL- EXECUTIVE <br /> y _ OFFICER OR AUTHORIZED AGENT <br /> LAST N —_FIRST MI TITLE YEA MO DAY . I <br /> � <br /> EPA Form 3330-1 00.73) ORIGINAL PAGE OF 1 1 � <br /> n0y IS SETTLED MINE WATER FROM L.Se WOOD MINE 43 ANY SINGLE GRAB CANNO <br /> T EXCEED 45 MG/L FOR TSS <br />