Laserfiche WebLink
-ERAIRTEE NAMEJADDRESS p~.rrbfrwryN../ter«la+(lDfOrr+~J NATIONAL POIlUTM1T DiSCHMOE ELIMINATION SY9TEM /NPDESI <br />NAME DISCHARGE MONITORINQ REPORT /OMR/ <br />ADDRESS '. L i v l_` . c f'! l t, i <br />I30X 483 PERMIT NUMBER DISCHMOE Nt1MIDEA <br />`' I ~' ~ ' ~- MONITORING PERIOD <br />fAaLITY ~. E NO. 2 MINE <br />YEAR MO DAY YEAR MO DAY <br />L~'''~ "l I A C O 8111 __' FROM - TO i _ <br />TAM ~. RFAR .1R MTNF M(;R <br />Fcrm Approved <br />OMB No 2040-0004 <br />CHRONIC WET TESTING F'OR <br />- -~ - <br />NOTE: R~~d k>•hucda+s b~lw~ compl~tln0 tl-h fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FaEOVENCw <br />of SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE • <br /> <br />- MEASUREMENT <br />•"'. PERMIT ####-~# #####~ REPORT ~####•~ ~-##### r•:,~ --, <br /> <br />,, <br />-. ::ELI!: REQUIREMENT SINty~iAMF' i'i'• <br /> SAMPLE •~ <br />• ~ • MEASUREMENT <br /> PERMIT #####~ ~-~#### 1G0 ~•####~~ of##-tF~rit- ;~- _ <br />- L~ELt=:. REQUIREMENT MN VRL_',iir <br />rp r ;~(,~. SAMPLE <br />~r'. MEASUREMENT • <br /> PERMIT <br />' iF##•It•#:: #i?#### F?EpORT ~###••i~#~ #####it• ~1'~1_.Y' bl~iP-_ <br /> REQUIREMENT SIS+~SA!'•tr•~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. ., ., •- 1 t~Q ~~,~; .~. ~ .~ r _ ,- •. ~ ;?, .-~(•1T - <br /> <br />_ :!,• REQUIREMENT h1N VAL_l.1r_ <br /> SAMPLE - <br />i,; ;r.~ MEASUREMENT <br /> PERMIT ~ i2EP0~!T •~,`^..Sr{. ~ `i Y{ ~: ~ i?i_Y' <br /> REQUIREMENT ~ I !~lG3AMi' <br /> SAMPLE t <br />. ~, .c,; ,t ~ MEASUREMENT <br /> PERMIT ~ n, fZEPOP'r ~ •- - ~ -_ <br />.,~,.; , ;'(- :' :: i ;~yl REQUIREMENTC S i NG5f•,: ; <br /> SAMPLE <br />,~, :~._ t.=.., ~•;~ MEASUREMENT <br />PERMIT #iF~.~~ ~-, r-, ,- ~ f~.. ##sb- +' , <br />REQUIREMENT a I N65Ah1P <br />--- <br />AME/TiTLE PRINCIPAL EXECUTIVE OFFICER ' "^"7 " `r pe""7 ° I•w Iha wb d«vmem .nd .n al.chmenb sere <br />TELEPHONE DATE <br />N <br />pr<p.red under m7 dlnKllon a tuper.fyon In a'cord.nce wllh . t7ftem ddtned <br />lo tusare IAN qu.tlfled perwnnel -~DeA7 plher .nd eeWNe the InlornuLbn <br />eub~lled. ltwd on m7 Inqulr7 ar the person or penwr who m.n.xe the ryclem• <br />a Ihare penom dInMI7 rerpondbk for plhcrlrr~ the InrormNlew• the InformNfon - - <br />rubmllled h• to the bat of m7 knew4d~e .nd DeUef, Irw..ccunle, .nd complete. <br />61ONATURE Of /RINCIPAL EXECUTIVE ~ <br />M1 <br />~ ~ ~- <br /> 1 .m.w.re u.l lbere.n fltN <br />ciN penNtla ror wemlltlnf robe Inrontrtbn, <br />NpEp OR PRINTED Incfudln= the porelble17 or flee ^nd lmpr4uonrnent for -nowln~ .IdNbro. OFFICER OR AUTHORIZED AOElfT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRderenee sM •tt~chm~n-a h~r~l <br />!, r••r c ~=~f !~ T~ ~tF !_ ETI-I~~L T TY DER I vS ~c ,',:FFF-FC T'~ , +:~Rr~wT~~ AID <br />~'j •• -~. - ~~in::" iiQ Yt,l. - i._- -- _:i1Y ~•i-: {=ilG"i [+! TV `:r+11; <br />EPA Form 3320.1 (Rev. 3199! Previous editions maybe used. • ~ ,Tlus• Is: a, 4-pzrl forTn. PAGE `OF <br />