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PERMITTEE NAMElADDRESS Undadr fari6ty :\'antr/1 uratinn iJUifferrn4 NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME ~,.., a r~+^* F D DISCHARGE MONITORING REPORT (DMR) <br />~.s.Li~~ <br />ADDRESS <br />9 2007 PERMIT NUMBER DISCHARGE NUMBER <br />NOV <br />FACILITY MONITORING PERIOD <br />LOCATION Division of Reclamation, YEAR MO DAY YEAR MO DAY <br />Mining and Safety FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />:::iiJilr~ 1•lF1 t <br />F - FINkI_ DEi <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - P F ;: •- -~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ~ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER l cvtif~ under prnatr) of law That thh d«vmrnt and all altachmrnh weer <br />i <br />h <br />d <br />i <br />d TELEPHONE DATE <br /> prepurad utdar nn dimtion or wprniion in accordance w <br />t <br />n .ystrm <br />n <br />Rnr <br /> to awwre that quaiifiad penannrl pmpa•ri~ 4athrr and r,aluule the information <br /> submitted. Nased on m} inquiry of the petWrn or Ix•nom who manage the ,),tem. <br /> or tho,e penon, dirrcth respcm,ibM for gathering Ihr informmlion. Ihr inGKmation <br /> submitted is, to Ihr Iw•,t of m~ Lnnwl v1{;e and Ixlkf, true. accurate, and complete. <br />i <br />i <br />f <br />l <br />i <br />f <br />ti SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I am aware that there arr,ignifieant pmoltir, for.uhm <br />u <br />ng <br />a <br />,r <br />n <br />ormn <br />.m. <br />imiuding the p.+,ibilit. of fine and impri.onmrnt for Anowing,iolaUom. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLArvanUn yr AIVY vluL.a,I IUns (Hererence au aaacnmenrs nerel <br />EPA Fp~rn 33201 ~,He•. "s'-?9~ Pre:~i.~~~a -.::.!t.unc .•.- ,_ ,--, Ti11~ IS a ~-hal-l IOI-Ill. PAGE OF <br />- - - - --- <br />