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pERMIfTEE NAME/ADDRESS pnrWrseWryN.wrLoenow IJD(Qirenr) <br />NAME T€~AP~'ER I'~II~dY{~IG, ~l~lf._~. <br />ADDRESS T13 c~E~~ ~~ P`i I ~~ <br />~. ~. ~I~~ ~8~ <br />C~t~6I~ SCI S~.E~2~ <br />FACILITY T~~~~~~ MINE <br />~ocATION G R A I ~r C CI t~ ~. Er ~ S <br />,aT~-n3• ~~,vMn~,lt~ r T117 T,~,1"3T~. S~E~~~/f'M <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM rrNPDESI <br />DISCHARGE MONITORING REPORT IDA4R) <br />PERMIT NUMBER DISCHMOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM .~ U' TO ~ / ~. ~ <br />Form Approved. <br />OMB No. 2040-0004 <br />M z ivo~ ~ <br />t Sl.1Ft ,fC } <br />~ - ~" I NwL_ f'iG~'f-~T <br />~Ci~.#~ T~ ~A~i ~~,~a-'T f3t,#Z?~a~i~i ~UL~I-i I <br />### t+ft3 ~SISCI-iAROE t~ ##~' <br />NOTE: Reed irntructitxa b~ltxt+ compbtittp this town. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCr <br />of SAMPLE <br /> EX TYPE <br /> ANarsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />[~gL Ai~l~ t;~t~ASlr SAMPLE ?i~ir##~~-# ( ~/.j.) 3E###?°# #3P#~#1'?°r3~ ?:#3S### <br />~ I SUf~L MEASUREMENT <br />c'34QEsb 1 d Q >eEan+ilT ##-~-~#~r 12~PC1RT 5=1 ~~-~~## ~~~##~ ~###~~ #~~~ I`JGEf jI:~;U~?t <br />~'F~'L.tJ~i~dT GR®SS VAL.U REQUIREMENY;, II~ST MAX i'•1i~=0 #### MQt~iTM <br /> SAMPLE <br /> MEASUREMENT ,~_ ~-°'~`-- <br /> PEfiMIT <br />T <br />R <br />Lf <br />R ~- ~- <br /> EMEN <br />EQ <br />I <br />......... .. <br /> SAMPLE <br /> MEASUREMENT <br /> PERKr11T y!~ ~- <br /> REQUIREMENT'>' ~ <br /> SAMPLE I <br /> MEASUREMENT 1 <br /> PERMIT ~~ ~ <br /> REQUIREMENT <br />.,,,,, <br /> SAMPLE ,,._ <br /> MEASUREMENT i <br /> PERMIT' <br />'~ <br /> ilElltJ.laEMENrt` <br />- <br />;::::<.;> ~ <br /> SAMPLE <br /> MEASUREMENT j <br /> <br /> ~EQVIitEMEN'f <br />............................ <br />_ _ .... <br /> SAMPLE <br /> MEASUREMENT <br /> ;PER MIT <br /> ~E(lUIREMENT <br />NAME/TITIE PRINCIPAL EXECUTNE OFFlCER ' """y ° er pem ly o aw that, thb doavmenl and NI attachments weR <br />errglon In aceordanR wllh s s <br />stem desl <br />re <br />aRd under m <br />dlRCtlon or au <br />ned <br />/~ <br />/7 /f TELEPHONE DATE <br />~ <br />~ / C' <br />7~ ~ G • <br />~ p <br />p <br />y <br />` <br />p <br />7 <br />to assuR that quaNBed personnel ProPeHl ether and evaluate the Inrormatlon <br />submlttad. Baxd on mr i~pulry of the person or persom who mana`e the system, ~~ <br />\~ <br />J <br />/ <br />~ <br />/4~L <br /> <br />.. <br />~ r <br />t <br />..l <br /> <br />or those persoro dlRCtly resporolbk for ~atherl~ the Inforsnallon, the lnformatlon yi <br />_J( <br />L <br />w <br />_ <br />i <br />~/ <br />~~~ ~~~~ <br />i <br />~~ <br /> <br />u ~ / ~ ~, <br />l <br />" ~ <br />wbmltted Is, W the best of my knowkd~e and Delver, true, accurate, and arompkle. <br /> <br />SIONATiIRE OF PRINCIPAL EXECUTIVE ~~ <br />~ <br />!/ <br />~ <br />w <br />S, I am awaR Thal !TICK aR SI~nlBpnl ptnal80 fOf sYbmIItIO~ raL7e InrOrmaU011, <br />TYPED OR PRINTED Indudlnt the ponlDllity of Bne and Imprisonment ror knowln~ rldadons OFFICER OR AUTNORI2ED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AN0 EXPLANATION vF ANr vwLP- 1 wns /rra~rmc~ sn ~rracnm~nrs nr~/ <br />TSS ~< TOTAL TF~C33~S LIr~I ~'S I~JILi_ ~E inIAIU~I3, ~C S~TTL~ADL~ da~L.TIiFa LII'~iZT A~°1,._I~£D ~~R ~'W1OYh, ?4~~ ~'C~I~CIW ~V~f~IT- <br />S~~ I31."Rfl~ld a1= F'E~F~rJ~' R~QUTR~.1"!~i'e33T3 tJi'dI}l~t~ I. ~'~. ~. Tl~a C~I~i~lIT[7RIiVG - 1. T3. ~. <br />EPA Form 3320-1 (Rev: 3/99) Previous editions maybe used. (~~g~,^•,L'j / p'1~hL~b,LP4-p~i~}fyrttt. PAGE ~F <br />