Laserfiche WebLink
PERMITTEII E/ADDRESS (Inchrde NATIONAL POLLU DISCHARGE ELIMINATION SYSTEM 1.`l'1)1 J) orm Approved. <br /> faal/q ham arson 1/d0jerenl) DISCHA MONITORING REPORT 11)SIR) OMB No.2040-0004 <br /> NAME—_MID—CUNTIN_LNT_COAL L CLKE CU (.' 161 (1719)_ F — FINAL Approval expnes9-30-8b <br /> ADURESS BOX 158 CUQUOU �3 y6 2Z tom___ SECT 10 CUR=10YR24HR <br /> CAKDUNUALE CU 8 i6Z3 PERMIT NUMBER DISCHARGE NUMBFR <br /> ------------------------- MONITORING PERIOD <br /> E&Q-6MY———————————————————--- _YE ART—MO DAY YEAR MO DAY <br /> LOA CTION FROM O TO —� MINOR <br /> AT (N: UUUGLAS 6QWMAN tNV CI,OkU (20-21) (22-23) (24.25) (2627) ( xw) (ro-il) NOTE: Read instructions before completing this form. <br /> (i Card Onh) QUANTITY OR LOADING (4 Clod Onl)) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (54-61 (38-45) (46-53) (54-61) NO- FREQUENCY SAMPLE <br /> OF <br /> (32-37) - EX ANALYSIS TYPE <br /> >< AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (6263) (64-68) (69-70) <br /> PH SAMPLE ' '**# <br /> MEASUREMENT <br /> 00400 1 0 PERMIT * **** *** ** *** WEEKL GRAB <br /> EFFLUENT GkOSS VAL UEREQUIREMENT **#_ <br /> SULIUS! SETTLEAbLt SAMPLE **** ** ** ***IR <br /> MEASUREMENT <br /> 00545 1 0 PERMIT ****** ***** * ****** REPORT 0.5 ONCE/ GRAB <br /> EFFLUENT <br /> GROSS VALUE <br /> REQUIREMENT <br /> OIL AND GREASE SAMPLE <br /> FREON EXTR—(,RAV MET EASUREMENT <br /> 00556 1 0 PERMIT ****** x�**** **** ****** REPORT 10 WEEKL GRAB <br /> EFFLUENT I f,,` EQUIREMENT ** <br /> FLOW1 N LONW IT OR SAMPLE <br /> THRU TREATMENT PLAN <br /> EASUREMENT <br /> 50050 1 0 PERMIT 1 PORT REPORT ****#* ****** ****** **** WEEKLY INSTA <br /> C REQUIREMENT <br /> C Ml,U <br /> SULIUS, TOTAL SAMPLE �R�IF** <br /> UISSULVEU (MG/L ) MEASUREMENT — <br /> 70295 1 0 PERMIT ***** ****** *** ****** REPORT REPORT QTRLY GRAB <br /> F=F L' EQUIREMENT #**# <br /> UI L AND GREASE SAMPLE * *** ***** **** ***** <br /> VISUAL MEASUREMENT <br /> 84066 1 0 PERMIT R EPORT ****** YLS=1 ****** ****** ****** **** WEEKL VISUA <br /> EFFLUENT GKOSSEQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> ON INQUIRY NF THOSE <br /> OB OF <br /> INDIVIDUALS IMMEDIATELY T RESPONSIBLE FOR <br /> TAININ ING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION /V 'V IS TRUE ACCURATE AND COMPLETE 1 AM AWARE THAT THERE ARE SIG <br /> ��=��. / NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING _ / 1� �/ <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE 18 USC S 1001 AND SIGNATURE OF PRINCIPAL E CUTIVE <br /> 33 USC 11319 rPv IR— u fi, rhv.v aln o., n ulwh• /rn,. up h, $1111) r un u <br /> TYPED OR PRINTED and^i ma umu^"nlp""""n,nl'•1 h,lu vvn6m�,nlh.nnA i.ra^' OFFICER OR AUTHORIZED AGENT AR A COD_ I NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Relerenre all all..,hmenlc here) <br /> IF NO DISCHAKGt OCCURS KLPCKT "NO LISGHAKGE".SALINITY SHALL bL MEA;,.AS TUS=70295 MG/L. <br /> OLG NOW 2 PRAM. NU SFitEN: E40uo=0, 576=0.A SHtcN :64066=1,, 556=GRA1j SAMPLE. <br /> ;-"A Form 3320 1 (Rev. 10.79)PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ( 4 PAGE OF <br /> UNTIL SUPPLY IS EXHAUSTED U-�J I G/1UU6t;o-1646 1 <br />