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

ERMITTEE NAMEtAODRESS (Include NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM(NPDE$) �orrnApproved
acilltyName/Locatior 'erent) I DISCHARC ONITORING REPORT(Db1R) 4B No.2040-0004
2-11 17-19 proval expires 9-30-85
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4 + (20-21 (22-23) (24.25) (26.27) (28.29) (30.31) NOTE: Read instructions before completing this form.
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! AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64.68) (69.70)
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IAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OP LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E
AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED _
ON MY ING UIRY OF THOSE INDIVIDUALS IMMEDIATELY BESPONSI.LB FOR
OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION
` • - ^ IS TRUC, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ABE SIG- '
NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING '
THE FOSSIBILITV OF FINE AND IMPRISONMENT. SEE 1. U.S.C. g ISCI AND SIGNATUPi'E OF PRINCIPAL EXECUTIVE
as us.e. g Ian• (Penalties under these statutes may include fines up to$10,000 "
TYPED OR PRINTED I and/or maximum imprisonment of between 6 months and 5 years) - OFFICER OR AUTHORIZED AGENT AREA CODE NUMBER YEAR MO DAY
OMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
h'
41
PA Form 3320-1 (Rev. 10-79) PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ^AGE GF
UNTIL SUPPLY IS EXHAUSTED.