1987-12-01_PERMIT FILE - C1981017 ‎(145)‎

• Permit No: C1981017
• IBM Index Class Name: PERMIT FILE
• Doc Date: 12/1/1987
• Doc Name: 1987 Annual & Hydrology Report ‎(part 22)‎
• From: Mid-Continent Resources
• To: DRMS
• Media Type: D
• Archive: No

PERMITTEE NAM'/ADDRESS (Include NATIONAL POLLUT-- T DISCHARGE ELIMINATION SYSTEM(NPDES) Form Approved
FacilityName)Loc different) ; D►SCHA ' MONITORING REPORT(DMR/ OMB No.2040-0004
NAME I 17-19
Approval expires 9-30-85
ADDRESS
I PERMIT NUMBER DISCHARGE NUMBER
I ( t I
-- ---=----------- MONITORING PERIOD
FACIUTY—• 1 i
—� ------------ YEAR MO DAY YEAR MO DAY
LOCATION i I FROM TO
(20-21J (22-23) (24-25) (26.27) (28.29) (30-31) NOTE: Read instructions before completing this form.
(3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION FREQUENCY
PARAMETER (46-53) (54-61) (38-45) (46-53) (54-61) NO. OF SAMPLE
(32-37) EX ANALYSIS TYPE
I t AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS>< 62.63 (64-68) (69-70)
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.. REQUIREMENT yd4., •i ,, + ,1 - .,NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CSRTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY exAMINED TELEPHONE D A T E
ANO AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASSD
ON MY INQUIRY OP THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION - ,
• IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG-
NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
-� THE PossIBILITY OF FINE AND IMPRISONMENT. SEE IS U.S.C. I ISOI AND- SIGNATUN'E OF PRINCIPAL EXECUTIVE
]] U.S.C. I 13IS. (Penalties under these statutes may include fines up to$10,000
TYPED OR PRINTED andJor maximum Imprisonment of between 6 months and 5 years) OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY
CODE
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attach mentshere)
EPA Form 3320-1 (Rev. 10-79) PREVIOUS EDITION TO BE USED (REP1_P.CC> C-A FOPPA T 40 `-Vlil'-H MAY NOT OF Ul, D P ;-- or
UNTIL SUPPLY IS EXHAUSTED.