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PERMITTEE NAME/ADDRESS rlnrludr Facility A'ame/location iJAJJoau) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />NAME ~ , ~ f L , _ _. DISCHARGE MONITORING REPORT (D R) <br />ADDRESS '' <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY ; ;~,, , , ? r .i l~; ?ri ;. i ~ }= MONITORING PERIOD <br />LOCATION i_~ ~ ;J ,_, YEAR MO DAY YEAR MO DAY <br />FROM TO <br />I _Ihi~l~ ; l" WADE, MINE f~9A1•dAG~-- <br />Forth Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. FREQUENCY <br /> <br />OF <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />' SAMPLE <br /> MEASUREMENT <br /> PERMIT .... .. •.. .... _ - <br /> REQUIREMENT - - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .:. ~. .- - - ... <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~. >; ;. r .. • -... „ . <br /> REQUIREMENT <br /> SAMPLE <br />, ;_i ~:=•~ . MEASUREMENT <br /> PERMIT <br /> REQUIREMENT +•'IV ` ~" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .r ... >. ~..: ~ ,. •- .. ,. . _ , <br /> REQUIREMENT _'•r~f'it•' <br /> SAMPLE ~~ • <br /> MEASUREMENT <br /> ~ = - ,. , _ ,... <br /> PERMIT <br />REQUIREMENT t•';.• ~.~ '.:r ~~' <br /> SAMPLE <br /> MEASUREMENT <br /> T _ - - .-, - , ~ ,. <br /> PERMI <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I a•rtih under penult) orluw that thi. doranxnt and au atlachmmt. weer ~ ~~-" <br />~ TELEPHONE DATE <br /> yrrpared under nn dira•tinn or .uycniaimt in accordance with a warm draitcmd ~ <br /> to n.nrc that yualifnd prn,nmel yroperly gatlrer and r~aluud• the informn[km i , <br />~ <br />- - --- --_-~ .uhmiutd. 8aw.d un m~ inyuin of the perwm nr prrwmn wha munnge the nj ctem. _- ;, <br />~ ~ : <br />--' ' ur tlu,er prntm~ dirrctlr rr.pun,iblr fur gathering the information, the infurnwtion <br />~ <br />• <br />/ and complete <br />to the h <br />ktwwled <br />e and bdirf <br />true <br />accurate <br />dlt <br />d f <br />ct of m <br />b ~ > <br />~ ~ ~ <br />~ <br />~~ I~ . <br />g <br />. <br />. <br />. <br />eu <br />n <br />r <br />., <br />r <br />~ SIGNATURE OF PRINCIPAL EXECUTIVE ~' - - <br /> <br />TYPED OR PAINTED 1 tun swore that there are.ignilkant penultir. Grc tuhmitting fal.c information, <br />includin the ihiliN of fine and im rt onment for know in I datiwru. <br />g Pm<' p s g" OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA-HUNS (Hererence an arracnmenrs Here/ <br />:F <br />F <br />- _ ~ . y - - - -- PAGE OF <br />