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PERMITTEE N AME/ADDRE SS pwryl. F.rwry Na.'L«mi- UDWO' "r1 <br />NAME <br />ADDRESS <br />BOX 18I <br />rG C <br />FACILITY I PER MINE <br />LOCATION E G C <br />-FINtn n nt t nn7t^ Ot:]f <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM rNPOESI <br />DISCHARGE MONITORING REPORT /DA?IRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />8 FROM TO <br />rfcM <br />Form Approved. <br />OMB No 20404004 <br />MINOR <br />(SUBR <br />JC) <br />F - F <br />I„IFT T INAL <br />ESTING FOR 0231 <br />NOTE: Read Instructions b*foro completing this form. <br /> <br />RAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY <br />of SAMPLE <br />PA EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> r <br />: A <br /> PERMIT #### „ " 100. OOI tt#; s sf### . <br />, <br /> REQUIREMENT MN Vial.. UE: <br /> SAMPLE <br />iP, LL MEASUREMENT <br />1 U PERMIT ?s ## ## ### i 1 #sf # tE ?t 1 i ::. `r u` A <br />_ REQUIREMENT MN VALUE <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEnME PRINCIPAL EXECUTIVE OFFICER "•'y ° Lw that Mh document and all attarnrrwreb veers TELEPHONE <br />prepared under my direction or Pupervhlon In aeeordante with a system dedgnted DATE <br />, <br />_ to assure that qualified perwnnei property gather and evaluate the information <br />Eased on my Inquiry of the person or persons who manage the system, <br />submitted <br />. <br />the Information -? <br />f <br />lherln <br />the Information <br />- <br />tl <br />"bl <br />d <br />, <br />g <br />? <br />y respo <br />or p <br />or Moss person <br />irec <br />e <br />•'/ Ui. <br />. <br />/ subtdned b, to the best of my knowledge and belief. true, accurafe. and rompiete. <br />r <br />EXECUTIVE <br />PRIN <br />W <br />i - ' - _ -Al- 1 am aware that then see sfgnlne mt penalties for submitting fate Information. EIONATURE OF <br />C <br />AL <br />A <br />HO <br />I <br />D <br />ENT A A <br />NUL45ER <br />YEAR <br />MO <br />DAY <br />TYPED Oft PRINTED including the possibility of floe and Imprisonment for knowing violations UT <br />R <br />ZE <br />AO <br />OFFICER OR CAE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fReferanco M wrrecnmwnrs nwrwf <br />PEPOFT `.CSO - STATTSTICAI_ <br />POINT ESTIMATE <br />WHICH IS r• <br />Previous ed,t ons mar beused <br />EPA Form 33:'0-1 lRev 3 x '991 " . This iS a 4-part.form. PAGE OF I