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PERMITTEE NAME/ADORESS (Iwe~i i^Nhry N~w/Lorrlen l/U(Qi..nl <br />NAME <br />ADDRESS <br />~iIA CO 81~ <br />FACILITY ~ ~ N0. c MINE <br />LocATIDN , '~~ I A C 0 81 <br />_LIAM A. BEAR •JR. , MINE MI <br />Form Approved. <br />NATIONK FOILUTANT O+SCNMOE ELIMINAT70N 5YSTEM (NPDESI OMB h10- 2040-0006 <br />DISCHARGE MONITORINQ REPORT (OMRJ <br />- i i {,dLt; iii! i i <br />PERMIT NUMBER a4CNAA0E NureER - P I NAL DE! <br />'':JTF TD DEER TRAIL DITCH <br />MONITORING PERIOD ___ <br />Y MO DA YEAR O DAY .- i ., . <br />FROM TO --' <br />NOTE: Reed Inet)uctio~e be/ore eompletfnp thle Iwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FneeuENCr <br />of SAMPLE <br /> EX TYPE <br /> ANAIr~s <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />~. _. <br />. - . ~ .:. SAMPLE <br />MEASUREMENT <br />- _:. = ~ ~Y ,- _ <br />l , <br />Y ~ . <br />_ :.i PERMIT r -, .. - _ <br />U~'- IJ~; REQUIREMENT _; .. ~~A AViY i ' L-''~` t.t~;. - UOUS <br />_ <br />UIJ'. SAMPLE <br />MEASUREMENT _ . <br /> PERMIT .. „ ,. ~ ... _ ,_ ~ , , <br />. REQUIREMENT I t~fS T trA k !'~ ~y <br />' SAMPLE <br />MEASUREMENT _ <br />'"- " `~ <br />~ - <br />• <br /> PERMIT ~~ i _ , , ., <br />. ;~F".: REQUIREMENT 30D~~ /itJG irX"r~^-EOra ~ t~tt7M1tTt-i <br /> SAMPLE - _ <br />~~ MEASUREMENT <br />:6 f l~ PERMIT ~ ~- -, ,. _ _ <br />` , ~ 1 - > .-~ `,;_ REQUIREMENT I t`+S i MA X <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />R <br /> EQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 nrt~l) u tr ptn^ 1) 0 1^w Ih^1 Ihb dorumtnt ^nd dl ^ttsrhmmb wtnr <br />TELEPHONE <br />DATE <br /> PRP^r~d rneer,n) dlrttlbn or wPer~lflon In ^nord^nte rllh ^ s)ftem dal~rwd <br /> 10 asuR Ih^1 gY.nnte penonne+ Properly ~^IheT ^nd of ^lu^It IM Inrerw,^Ilort <br /> ^ubmllted. et.te en m) Inqulr) of ux penes or ptrr^ts who m^w^Re IM rystern. _. <br />'~ <br /> or [ho^t peneru d+nctl) re^po,Mbfe for ~^Utr1n~ the Infenn^Ilaw, the Inforn,^Uon ~ ~ <br /> tubMtled b• to the heft or mr lnewW~e ^nd btxef, Irne. ^reunte. ^nd complete. <br /> <br />I ^ <br />n <br />I In <br />s .r <br />l <br />nlnt^wt <br />Itle <br />b <br />rlu <br />hlfe Inrn <br />m <br />tl <br />u <br />ro <br />iIONATURE Of -RINCIIAI EXECUTIVE - _ <br />TYPED ~ pR~~p ~ <br />^..n <br />^ <br />e <br />e r <br />~ <br />pen^ <br />s <br />r ^r <br />n <br />ni <br />r <br />^ <br />on, <br />Includ+rK IAe pmdb+xl) or nee.nd Ilnprlsonmrnl ror 4no.+ni rtOl.tlnte~ OFFICER oR AUTHORI2E0 AGENT p' A NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPtANATiON OF ANY VIOLATIONS (Re/erence N! •ttecnments Aerel <br />? NSTRUC <br />lNS - I. C. 10, Pts. 10 <br />EPA Form 3320.1 (Rev 3/99) Previous editions may be used '~~~ 1 S ;' Cis :+s. s 4-Dart fGrm. <br />