|
PARAMETER"
<br />(3137) '?
<br />=
<br />M,
<br />.,a
<br />. 1 '"
<br />(3 Card Only) , QUANTITY OR LOADING
<br />(46-53) - (54 -61)
<br />(4 Card Only) . QUALITY OR CONCENTRATION
<br />(3849) •- (46 -53) (54 -61) '
<br />o
<br />EX
<br />(62-63)
<br />FREQUENCY
<br />OF
<br />ANALYSIS
<br />(64-68)
<br />SAMPLE
<br />TYPE
<br />(69
<br />AVERAGE'
<br />.- MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />t lI
<br />UOu C 0 1 0 0
<br />'. F f' L U E t1 i CROSS Y & L U F
<br />SAMPLE -
<br />MEASUREMENT w
<br />C1Xtr: } #i5
<br />r
<br />b % 3 : %.�vi
<br />r "'
<br />ti%•r.
<br />a# `; ,
<br />—
<br />:t•: ': fi :t
<br />-
<br />r
<br />NCE/ .
<br />OONTN
<br />EAL
<br />6.,$i' »+ ' •
<br />i tt'.I3+1i!!0!!
<br /># ?if :
<br />�
<br />9.0
<br />. MIAXZ!!U44'
<br />" PERMID 4•
<br />REQUIREME`NtI,
<br />:�'
<br />= ,I .IG1?CIf) :;
<br />"f , .,.
<br />�` ,�. �
<br />:;+?# IGLI 4.:::::::::
<br />.^,; iq
<br />'
<br />.:11..j0S, SE:iLEE -LE
<br />( _
<br />1. J j 4 5 5 1 0- -0 -
<br />F F t U E t +'. GROSS S 3 V A L U i
<br />SAMPL
<br />MEASUREMENT " ,
<br />dYa ## fit:+
<br />• ^. -'
<br />w,
<br />tl #�b' :�
<br />,
<br />t� t,�
<br />****44:::
<br />,� =: ## 3
<br />•
<br />hL /L
<br />p
<br />NC$/ -(
<br />t�02fTH
<br />EA l
<br />-- PERMIT,' 0
<br />REQUIREMENT :1
<br />*;.!***44 :
<br />r ... ;r ' •t
<br />' ' ;: a } 'r.
<br />,EgI�11a9,•'Jr7� A :: 1 :.tL:
<br />-. it .. ,; v ,
<br />;•... .
<br />, wiit%a'.t'4, # -
<br />fi 4.
<br />'X ":
<br />:dDCIP # , *Yi 1
<br />©. •
<br />fir
<br />OILY' ;X
<br />IL ANL C,REASc,
<br />r i„, E 0 N E i(T R'-v $ A `V 1 y s ;, tl
<br />1 .055b 1 :0 _ 0 •.
<br />r S
<br />..�'FLUP:NT GROSS VALUE
<br />SAMPLE F:-
<br />MEASUREMENT r.
<br />041*4
<br />F
<br />„ tt. .
<br />' 44. l 1:4 s:t ::i
<br />t �i
<br />: ;� !► � : L I
<br />**it;***
<br />iJI40.**
<br />.
<br />-
<br />' •
<br />-
<br />rt iellf ilia
<br />'%' ”" e!',
<br />�� =
<br />y
<br />+ii"/ioi ig'
<br />,. _I
<br />1Qr4.r
<br />I Mk ml
<br />C
<br />/� (y f
<br />MN1'lNG
<br />k
<br />0 T
<br />R
<br />AP
<br />, .
<br />. PERMIT:• ': : -',.
<br />R
<br />M•N .k
<br />. P
<br />,I 1 ' ' d ,:n i
<br />, a ^. ' s •�,,�:
<br />y
<br />' 4 P *i` (1
<br />, C. .:
<br />,, ,I, ',` ;,
<br />t cL C i. I tI C C :�1 U U I T C Ft
<br />! i10 , T h . A i H ENT PLANT
<br />` °O
<br />t o O50 1 0 -0 -
<br />FFLIJEt.T 0 HCSS YALUF.
<br />SAMPLE"
<br />MEASUREMENT::
<br />. 0-i)
<br />-
<br />a C7' i NO .',
<br />1
<br />-
<br />DISCHARGE
<br />t"r,D ...
<br />•d 1 � 1 •.Y„ =.
<br />- , ..
<br />, -t.'1:).fi
<br />' 4 :7 4'. f t. 1 t %.$
<br />-
<br />t • 44 4 .• y=
<br />•�:
<br />-
<br />::zr��
<br />', •0-
<br />r `'
<br />20#?,*IP)
<br />= t;'
<br />,.. >F **ldtl
<br />, . 5 ;
<br />'r ,.
<br />P,`L'I�
<br />;> t,
<br />Tbr
<br />:: PERMIT,' •G
<br />REQUIREMENT
<br />"
<br />pog'�` -
<br />Dh i�iV:
<br />,R$POR ?,
<br />IL ' l kX
<br />.. OLI JL TOTAL =
<br />a
<br />702 1 _ 0 -p
<br />:. F F t, U �. t: (' COS VALUE
<br />- SAMPLE ::
<br />MEASUREMENT:
<br />0 - 0 #(1# ##
<br />- ' 1
<br />:Oa #z
<br />l3
<br />;3 ty r,' Ct
<br />; r >r+7'iY; #4 :r,:
<br />' G47:+ =a =a
<br />.
<br />4-A
<br />A • •
<br />'1 h / L
<br />-
<br />•• PERMIT-
<br />REQUIREMENT C
<br />. fiQt11�� ..,'
<br />' - ? ' ,' %
<br />'
<br />% 4tTi1�If.1:3 Y1'i
<br />' ,1" , - , ,i'
<br />- , ' }«4,!1. 44
<br />t� "
<br />r 1 *#4 41
<br />v
<br />�',�OR li
<br />D L Y X
<br />t
<br />LhLY :.CitiAti
<br />• 1 ,
<br />.. I L A C GREASE
<br />�"�vAL
<br />., G 6 1 --c - o
<br />:.t FLU::!;: GROSS YALUi'.
<br />SAMPLE
<br />MEASUREMENT ;
<br />.7% XA I ti 41
<br />to . % '-
<br />'- .. -
<br />1.
<br />=1
<br />N!7 =0
<br />****
<br />1 ? 1 t} O :y 4.3
<br />;: 1 : :::: # 3"1, r
<br />*
<br />' *
<br />*
<br />!-' PERMIT] • t
<br />REQ T UIREMEN
<br />.. ,,.' w
<br />.,;,+: >� fi. xf
<br />-1. ' "'
<br />,..,,;'... �:.� •
<br />() . • ;4 ' r ° YES
<br />�. M
<br />IG �iI #; gyp
<br />`
<br />� � :� g ii"
<br />4 1.tYi :ti
<br />. . 1 ,_ , .
<br />t' # ti 1d
<br />= 4
<br />L
<br />. ,.
<br />41 C E / ;1
<br />lIrT'i
<br />i G' A I.
<br />r
<br />SAMPLE ,
<br />MEASUREMENT :.
<br />j .:Y
<br />..1 ,,,, Y ♦ •
<br />.
<br />-
<br />-
<br />•
<br />1e .,, , ..* ti
<br />P ERMIT-
<br />0 ' -. »� w ,;
<br />PEOUTAEMEN1j t'
<br />:� Y0- • r t e , ;
<br />: w • -1 4'
<br />I.
<br />,
<br />,1
<br />y n 1
<br />f
<br />� ,.
<br />L.'' h. ; i;
<br />, ti: :3
<br />z
<br />g4 l :1'
<br />,b
<br />&
<br />f
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER
<br />I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED
<br />AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN, AND BASED
<br />ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION
<br />IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG-
<br />NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
<br />THE POSSIBILITY OF FINE AND IMPRISONMENT, SEE 18 U.S C. I 1001 AND
<br />33 U.S.C. f 1310. (Penalties under these statutes nray Include fines up to 110,000
<br />and orstarlinwnimprisonment of between 6 months and 5yrars./
<br />•
<br />(■,-i
<br />TELEPHONE
<br />DATE
<br />--
<br />-
<br />r
<br />r
<br />' -
<br />74-52
<br />91
<br />04
<br />29
<br />3rIan P. Dtmfee -
<br />Manager r, i.:
<br />C C ( . . , � '
<br />J • U '
<br />NATURE OF P RINCIp/CL EXEC IVE
<br />OFFICER OR AUTHORIZED AG NT
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />.
<br />... IV 1 WY• r O p ritr Q "
<br />PERMITTEENAME/All SS (Include F'•
<br />Amato Name /Locann rent) •
<br />NAME I' I_ •_ Y COAL CC NULL, nL .'r _ ' __
<br />ADDRESSCOUN:Y ROAD AA__ � -
<br />LOCATION .._ ± 7 4 ' -
<br />FACILITY
<br />ATrt : CENNIS .STEVENSON, PRESIDENT
<br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />EPA Form 3320 - (Rev. 9 Previous editions may be used.
<br />A
<br />NATIONAL POLLUTAN
<br />DISCHAI
<br />(2 -1
<br />000000213
<br />C'
<br />1,
<br />FROM
<br />PERMIT NUMBER
<br />HARGE ELIMINATION SYSTEM (NPDES)
<br />NITOR NG REPORT(DMR)
<br />(17 -19)
<br />005 A
<br />DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR
<br />'I L
<br />MO
<br />• 1
<br />DAY
<br />It I YEAR
<br />MO
<br />DAY
<br />Y ? L
<br />(20-21)
<br />(22 -23)
<br />(24 -25)
<br />TO
<br />(REPLACES EPA FORM T WHICH MAY NOT BE USED.)
<br />(26 -27) (28 -29) (30-31)
<br />IF NO CCCUR5 REPORT wWO DISCH!HGE ". OIL AND GREASE; SEE FCCTNCTE F/.
<br />F:– FINAL
<br />STORMWATER DISCHARGE
<br />pproved.
<br />o. 2040-0004
<br />Approval expires 6 -30 -91
<br />t1z4OR MOH' KC) '�t4TR,1
<br />NOTE: Read instructions before completing this form.
<br />00105 /900+10 - 1'402
<br />PAGE OF '
<br />,
<br />
|