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PERMITTEE NAME/ADDRESS Undudr Facility .~'amr/location if 1N(frrent <br />NAME <br />ADDRESS • ' ' ~' <br />~i T•iAIN STR1=~7' <br />,'! D C <br />FACILm ,._ ~~:, z TI7 CF~NY(]t~l MINE <br />LOCATION "T C3hd C <br />-~?I~: ~T?nIIvGiUlti, IhINI= Mp <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESJ <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />~, YEAR MO DAY YEAR MO DAY <br />FROM TO <br />JAt: <br />Farm Approved. <br />OMB No. 2040-0004 <br />~F1F~1S <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT S...r..n ~ ..- ': - <br />•• L. ' . -..- M ~-: 1. . <br /> REQUIREMENT ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ., :r .. :. .... ,... _ _ , . .. <br /> REQUIREMENT _~:.-~C:r', t;'•:'::> :i:; i ~ ," i-z ~ : L.; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ... ~ ~ , .. <br /> REQUIREMENT i•' is '••tr i•~ i ?-i <br /> SAMPLE ~ ~\ <br /> MEASUREMENT ,1~ <br />`' • <br />- <br />- <br /> PERMIT .. ~~ }} <br />/ ` .. , ... ~ ;, ._ <br /> REQUIREMENT G' ~ i'',: •.;C::,;.I . i <br /> SAMPLE t1 • <br /> MEASUREMENT <br />:_; PERMIT ....... .. ... .. _ _ <br /> REQUIREMENT +'~1_li~< i'-; <br /> SAMPLE <br /> MEASUREMENT <br />- <br /> PERMIT .. .~ -.... ,. <br /> REQUIREMENT I TVS - ~ i; Gt: i'~i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - , _. . ,. .. .. . <br /> REQUIREMENT c-: -:A :: y';> ~`:_ti ~ !_ `• tit y, <br />NAMElPITLE PRINCIPAL EXECUTIVE OFFICER I `' "'!' °pdrr prnalh .d law that ihi. dt><umrnl and all attachnw•nla were <br />arrd undrr m <br />direrttnn or .u <br />•n kum in xrnnfam•r with ~ oNim ded>Zmvl <br />r ~, ~/;~ <br />• ~ / / TELEPHONE DATE <br /> <br />,' ~,- `.~.,.. ~ (~ -~J(, ~ - ~ J ~; ~ ~ ~- <br />r ~ p <br />y <br />q <br />rp <br />to x+~urc Ihet yualifird prra~wnel pn.Prrh Quller and r. aluutr Ibr mf rmati.m y/ <br />~ <br />~ <br />~ <br /> <br />~~ - cuhmittrd. Naed on m~ inyuir} of the perwn or penun. whu muwge the .~~slrm, <br />nr thnr prnon. dirrctl. re.pm.ihlr fnr ttrtlrrrintc thr infurnutthm, the inrwrnwtion ~ `Y.~ ~; I - <br />/V{~-~ ~- <br />`ro Vt/ ~' `,t iq jr({ f - <br />_ it <br />) yi <br />~/ <br />~)' <br />(/ <br />f <br /> <br />/ ~- <br />~ C • ~ ~ ~ ~ <br />euhmiucd r, lu the IMM of m, knnwlydPr and hrlier. intr. aaruratc. and cumpletr. <br />ware thin there :rc. .iEndi~~.nt <br />cnaltir. Gar whmillin <br />rule m6,rmation <br />I xm <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />~ V ~\ <br />' <br />(~ ~ <br />TYPED OR PRINTED p <br />g <br />. <br />a <br />indudlnK thr pn.ihihh ~d fim and iny.ri~numrnt (..r kn~~win4 ~~~~!•'wm,. OFFICER OR AUTHORIZED AGENT CR A NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />" q;?,.= SO! ?n~~ L. ''rT? APPI.I%~U FOF ~=IOYR, 2~1 HR "RECIF <br />• ~s <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ~liS 13 A 4-(tafl Irtrm. PAGE OF <br />