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NATIONAL POLLUTANT !ARGG LLINII:ATION SYSTEM
<br /> DISCHARCE JORMG REPORT "ri''-pft Ved
<br /> ZING. 15d-RUU73
<br /> I I4II)-CT COAL. (f rit_U PANT
<br /> PO BOX 1S8
<br /> CAPBONOAt L INSTRUCTIONS
<br /> 1 L CO ��E??3 I 1. YmvnJe dates ter period CO VCrEJ by Ulib repolt in spbcae muair,•d"REPOR I'lKG PERIOD".
<br /> "2. Emer tupurtod minimum, avolirge rind maxunuol values under"QliANT1TY"and"CUNCF:I:TRAT(GY"
<br /> Iz m to-IeI In•1eI in b,e awls apeafud for curb p.,ramelur as appropnute 17o nun enter values in inner cnnta,nmiL
<br /> — ----------� ------ -- ----------- aster: kb. "AVERAGE" ib bver Lie computed Over uolual tune dnbuhargo is operalinh; "MAH :UM.
<br /> and "MINIMUM" are eatieme values observed danng the repurtllli,perao t
<br /> CC 00 0 n ;C)6 ill r 1 1 O I 1 3. Specify the numbs of analyze,]numpie,U,al exceed the«ula.n.on.(and/or n:uNmic r ab rrppropn5te)
<br /> —�� permit con Jiucn::in the columnr labeled"Nn. EX." 1(none, enter"U".
<br /> S7 PL'RMIT NUMBER t GIS SIC LATITUDE LONGITUDE r
<br /> --_----,
<br /> _—__________—_�—____---_ 4. Sp uci(y frequency o. analysis fur each pannuoler.,s No. an any:.es,NO daya (a.g, "3/7" tb equlvr-
<br /> Im•zu Izz�z nl IZA xm Ize ni is-znl luu•au icnt to 3 oriWyvcs porfuoried ov.ay 7 days) If continuouu onter"CON
<br /> 5• Sdu'Ify rumple type("ylrab"or"_—hr cwnposi(e") as applicuble. If frequency we&coutiau.ub,
<br /> Tfa L eater "NA".
<br /> 1�4
<br /> REPORTING PERIOD. �1j rll �1 11 � & AVp n pt required o foam.DAY
<br /> siuture is reqred n boll..m of this fo .
<br /> LAY TO 1�EA MO_COA� 7. Remo vr, op and ru to uT COpy Cnr your recorri b.
<br /> PROM YEAR _MO
<br /> y—_-_.--- 8• Fold uloug clotted Iin•e s, .,[a/.l.'..uJ mall Orlgrnui lu office ap ecn6rJ to pormlt
<br /> _414_771 _ .cA ea'___
<br /> (I ru d city) QUANTITY (z aa'J"'tyJ — --CONCEN£RATION------- — FH UEO Er:CY
<br /> F(�*`� rl atl-s5_ •—_•—_ lie_L51 le4-e II __ I.r�•u] Vib-Y0I SAMPLE
<br /> (++: P.c RAM ETER —___--. —____--_----- _�TS 1__—_ ___-_A'_-.__—
<br /> E{ NO —_I--_-_____-- NG TYPE
<br /> MINIMUM —AVERAGE MAXIMUM UNITS EX MINIMUM AVERAGE MAXIMUM UNITS
<br /> FLDIti IN CONDUIT RcvonTED it it it # i< tt is n u sr
<br /> ^, t_ PnnMlr 4 it U it # it —A it it �-- -- .? St # # # # fI It # S} >lr 'ir - -r -r
<br /> SI .J'.. COtl JI r1UN u R //r IN
<br /> k. Stil.IuSr TnTAI, DIES REPORrCD fi
<br /> (�!l�+mil a.L Cr)it 0l llO rr _ ir-)—.,
<br /> / — —-- - MG/L? SCLJr D1 _------Pt O it t Ya it it fr -
<br /> - -1-/-r — - GR
<br /> —--
<br /> i JJLIiJr,y TOTAL SUij(J NEP ORT ED
<br /> (SUSPENDED) --- ------ ---- - --- -; ), ------ -- -- ^.G/L' —I---- -- �---_ -
<br /> PEnEnT -
<br /> --t-�y-t� — --------- -it ;, ,: It �-� ,. �_ ,t ;t tt ,{J � it w :t ;t< 1r # a _ 36 ---- — - f I-1/7----- Co
<br /> --_
<br /> CONDITION ./'`
<br /> ( �ROnoTOTA1_(AS FE) REPORTED 4 it w 0 } it it iI it it (} tt
<br />} ---- ------ - ------ ------- K G/O A Y --
<br /> Y 6RI.nT \ _
<br /> 1.• i ia ' �i01 u45 3-5---- - -!. �---- ------ 1/7--- -- Co
<br /> -- IZ
<br /> PH•FIFLD —
<br /> NcGORTED i) r. >t it it i it a # ;r it q >< ir�a M
<br /> - ---- ----------- - ---- -------
<br /> — —__ ----- -------. SU -------- \y StJ - -
<br /> PEnEn r 1/7 Gr2
<br /> )04 v coND,nor.
<br /> OIL 6 GREASEgVISU41 RtPOHT ED V 3 it ;r A iF it 1t
<br /> f 1/7
<br /> /r It
<br /> —_.{}_1t.•i: it it it tt it it 'it tr # lit it it ��"1 j'7�_\,_ _— - _-__ �_—__
<br /> i�11V.1Z CONDITION
<br /> 1 He:POr17 EU
<br /> _
<br /> PLRMI T
<br /> CONU11 IQ"
<br /> r' nE1'OH"1 EI]
<br /> ERMII -----s_
<br /> C O H.n T W II �_-----
<br /> NAME OF PRINCIPAL EXCCUTIVE OFFICER TITLE OF THE OFFICER DATC ,J \>
<br /> - - ------ ------- — -- t certify /hat f am ian-,tN,ir wi Or the mfonaahon contnitiud in this �i..—�(—.---�.----'--�—_.--__--- —— --I--- - t -c.
<br /> j(M r,� �-_L_ report aUd tt.Ot to the be,(of try knuwled�jo Rd bc,haf u a bd,it,tor -
<br /> f�"i �( t I"'—Ct I ('l�I I f�i'" �� SIGNATURC OF PRINCIPAL. EXECUTIVE
<br /> mation It, trio, eoanp/eta, and accuralo.
<br /> — PIHST— — MI _ TITLE -- YEAR MO OAF OFFICER OR AUTHORIZED AGENT
<br /> LAST
<br /> FIm4T ----.—__—
<br /> EPA Ferm 33i0.1(10.72) PA GC OF
<br /> ' ORIGINAL 1 1
<br /> tiG1 I: (I;cF•'fi:l.i Yq';,,? .`+ r,FA ?ll'I(i'r'F F,t3,! C:-,tL PL
<br /> At'.. A;1Y SI!,16LC Ct')1,F1 (:�i�'';OZ' EAC, .ED 4-) "!:1/1_ FU T: ,
<br />
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