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PERMITTEE NAMEIADDRESS(7,-ih. rfaAYry No-WLaeavia ((D(dWvw) <br />NAME <br />ADDRESS <br />O. BOX <br />NERSET CI) 8I't <br />FACILITY "BORN CNK 14 !ELK CRV. MINES <br />LOCATION `1ERSET CG 81,4 <br />'AMFq T cnnPFR. FYT=C' V P <br />NATIONAL POLLUTANT DISCHAROE EUMINATION SYSTEM (NPOESI <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMDER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />MINOR <br />(SUER MH) <br />Form Approved.. <br />OMB No 2040-0004 <br />Z <br />)NIS <br />NOTE: Road kietructione before c' plating this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FAEOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ??#iE r##3E tr## :. s N? I fd:ry 1 ' <br /> REQUIREMENT MAX I UM UN -r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT *### ##at#sF t? ?5 :,RAi3 <br /> AEGUIREMENT jrlL -_ (? r MUNTi <br /> SAMPLE <br /> MEASUREMENT <br />} PERMIT ####it# ###### ###ii## REPOR REPORT NCE1 ?,-",AB <br /> NT <br />R <br />I <br />M <br />rj EQU <br />RE <br />E 30DA AVG' DAILY MX NJNT <br />TQ T r.l. SAMPLE <br /> MEASUREMENT <br /> PERMIT r-: x r . ,< o ?• #9[iF### 3000 6000 :ONCE/ <br /> REQUIREMENT 30 A AVG, DAILY MX rIQNT <br /> SAMPLE <br /> MEASUREMENT <br />82 1 PERMIT i 0 ONT I i3 <br />i_UEN, REQUIREMENT ;J31 -,AX i E:idT <br />I(,I ( SAMPLE <br />REAT;' MEASUREMENT <br /> PERMIT REPORT REPORT ; ; ', ?+ -: << ,` ####s(# a <br />LUENT REQUIREMENT <br />`I? AND GREASE SAMPLE fi <br /> MEASUREMENT <br />PERMIT #ttn#= i?EPDKT ??? ns:#it#it #aF##i?# ?,; '' ?';'=;l.A <br />REQUIREMENT NST MAX MON ` <br />1 errllty under Pena ly o law that this document and all attachments were NAMEfTITLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE DATE <br />Prepared under my direction or superoslon in accordance with a system ded ned <br />- <br />? to asaun that qualified personnel Properly Lather and eeatua,. the Information <br />ltl <br />I <br />i <br />f th <br />- <br />b <br />d <br />b <br />d <br />ao <br />m <br />e <br />aw <br />on my <br />nqu <br />ry o <br />. <br />e pr s or persona who manage the sysltm, - / <br />(? I 411, <br />o <br />th <br />di <br />tl <br />re <br />dWe f <br />ih <br />i <br />th <br />I <br />f <br />r <br />ew penerr <br />rec <br />y <br />spolt <br />or p <br />er <br />ng <br />e <br />n <br />ormation. the Infornwtlon <br />aubmllled h <br />to the bell of m <br />tl»wlea <br />e and D <br />Uef <br />tr <br />ra <br />t <br />nd <br />l <br />t <br />? - <br />y <br />g <br />e <br />. <br />ue, ar <br />n <br />., a <br />comp <br />e. <br />. <br />e <br />' 1 em aware that then are WoneaM <br />rnaltles for mbmlttin <br />false Inf <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />r <br />tion <br /> p <br />g <br />o <br />ma <br />, ARE <br />TYPED OR PRINTED Including the posatWllly of fine and ImpWaonment for knowing rlolatlocm OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />] <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aN attachments horel <br />r!_EA%' r 50L I DS 1_111T APPLIED FLIP 24HP PRFC T T' T ' 'cr. T <br />NT -c? .. 4 P. 5 <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. TENS. IS &.4-p&ft, form. PAGE OF