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NATIONAL POLLUTAI4jdhk�HARGZ ELIMINATION SYSTILM <br /> • DISLHARGW. IITORING REPORT Approved <br /> WO. 1 58-R0073 <br /> '.-C.T C(1,AL (PPEP PUNT <br /> CA-'1-P1)i\I�-ALE INSTRUCTIONS <br /> 1. Provide dates I.,period covered by thi4 iep.,t in space.marked"REPORTING PERIOD". <br /> Co '416?3 2. Enter reported minimum, uveragli and maximum values under"QUANTITY"and"CONCENTRATION" <br /> I. 11 II specified to: each pa'alpele, as appropriate. Do not enter values in boxes containing <br /> .1Iellstfs.an a"AVERAGE" <br /> AVERAGE" is average q—tputed over actual time discharge is operating. "MAXIMUN" <br /> and,hIIN,MU.4-are extreme values obsIarved during the reporting period. <br /> 396 3. Specify the lum&ej Of Gnn1P'.kj that exceed the maximum(and/or minimum as appropriate) <br /> ST <br /> Permit conditions In the columns labeled"No. Ex." If none,enter"0". <br /> PERMIT NUMBER L 4. Specify frequency of arOysi,I for each parameter as No. onAlyses/No. days. (e.g., "317" Is equiva- <br /> 420-211 122.23) 124-2.1 124-271 428-2v1 tao-311 lent to 3 analyses performed every 7 days.) If continuous enter"CONT." <br /> S. Specify sample type("grab"or'�—III, composite")as applicable. If frequency was continuous, <br /> enter "NA" <br /> REPORTING PERIOD: Fit.. k8j I TO I AS W 11 1 6. Appropriate*signature Is required on bottom of this form. <br /> 7. Remove carbon and retain copy for your records. <br /> MO DAY YEAR. M DAY8. along dotted lines, staple and mail Original to office specitied in permit. <br /> IoA-6.1 (09-7D) <br /> CONCENTRATION <br /> ...'d—1y) QUANTITY FREQUENCY <br /> III.,u SAMPLE <br /> PARAMETER im-51 1`64-bs) 162,431135-4tl 1 OF <br /> NO. NO. TYPE <br /> MINIMUM AVERAGE MAXIMUM UNITS EX MINIMUM AVERAGE MAXIMUM UNITS Ex ANALYSIS <br /> REPORTED It <br /> F L 04 1 N C()W)U I T <br /> PERMIT t-IGD <br /> 5.1 CONDITION it it 0 Ill 11 ft It x tf x It 0 p If 1/7 IN <br /> 5.)LTJ59 TIITAL DISS REPORTED It <br /> PERMIT KG/DAY '4611- <br /> CONDITION It it it It 1"90 GR <br /> aOL.Ti--59 10TAL SUS p REPORTED it It It If tf <br /> U-tJCPE`40F!'0 K y <br /> PERMIT <br /> 30 1/90 CC){ <br /> CONDITION <br /> RON TOTAL(AS Fr'-) REPORTED it tt d u 0 it tt # it it it it It <br /> PERMIT KG/DAY -- MG/L <br /> CONDITION * It It if 7.i` CO <br /> REPORTED u # # # it it <br /> PERMIT <br /> 4 * * it q 1/90 GR <br /> CONO.TION <br /> rilL 6 GC�FIASF,VISU,11- REPORT" 0 * * * <br /> PERI!IT * * * * It 0 10 1/90 V1 <br /> CONDITION <br /> REPORTED <br /> PERMIT <br /> CONDITION <br /> REPORTED <br /> PERMIT <br /> CONDITION <br /> NAME 07 PRINCIPAL EXECUTIVE 0 TITL E Of THE OFFICP.R DATE <br /> !certify that I at,, faniliar tvIth the information contained <br /> 10 this <br /> c of all. <br /> report and that to the beat at lay knowledge and DWI infor- <br /> jettij mation Is true, camplatro,and accurate. SIGNATURE OF PRINCIPAL EXECUTIV <br /> LAST FIRST MI TITLE YEAR MO DAY OFFICER OR AUTHORIZED AGENT <br /> EPA Form 3320-1(10-72) PAGE OF <br /> ORIGINAL <br /> 00-4 IS SETTLED !MINE WATER FROM COAL HAS-IN MINE ANY SINGLE GRAB CANNOT <br /> EXCEED 45 MG/L FOR TSS <br />