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

PER,TTTEE NAME/ADDRESS (Include NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved
y�ctf"y Name/Lo on if digerem) DISCHAR ONITORING REPORT (DMR)
NAME--r (J 1+-T j�,! ! — ---------- - (17-19)
OMB No.204Q-0004
Expires 2-29-84
ADDRE"— ^5 Iyi_)X 11�•i ---- I •/, 1
i 1i{ti FeY"i;oltl f# I P i T 1 PERMIT NUMBER DISCHARGE NUMBER
----(—( {+_1 6':1 --------------- MONITORING PERIOD
fAq—'LIT--------------------- YEAR MO I DAY YEAR MO DAY
LOCATION FROM ,. A I 1 TO r
(20-21) (21-23) (24- 5) (26 ) (18-19) (30-31) NOTE: Read instructions befor*completing this form.
(3 or Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION
PARAMETER (46-53) (54-61) (38-45) (46-53) (54-61) NO. FREQUENCY SAMPLE
(3237) EX AN SIB
TYPE
AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 61-63) (6468) (69-70)
SAMPLE
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NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E
AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED
ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION 4 ij '
IS TRITE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG +• .r '
y - ^w NIF ICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING
( � : } I THE POSSIBILITY OF FINE AND IMPRISONMENT SEE le USC 1 1001 AND SIGNATURE OF PRINCIPAL EXECUTIVE
33 U SC 4 1319 (penalties under these statutes may include fines up to Slo.(Joa Y'
TYPED OR PRINTED and or maximum Imprisonment of between 6 months and vears) OFFICER OR AUTHORIZED AGENT A A NUMBER YEAR MO DAY
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
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tiT I It h'h• L f f I,IYI 1- f h � � I � 1 -
--PA Form 3320-1 (Rev. 1 O-79)PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF
UNTIL SUPPLY IS EXHAUSTED