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PERMITTEE NAME/ADDRESS rlndudr Faitur .'t'ome/lra•aAUn if Uiffrrrnh NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES)
<br />NAME DISCHARGE MONITORING REPORT (DMR)
<br />ADDRESS
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<br />FAC-Lm ,:: • :., , MONITORING PERIOD
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<br />LOCATION ; ~ L A :• O E' FROM TO
<br />I...ANC E WADE, MINE MANAGF.~
<br />Form Approved.
<br />OMB No 2040.0004
<br />5R °~P1 I tvE Li* NG 7R I D TO Tl
<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I nrtif. under penalq of law ,hat thisd~w•un,rnt and ull atlachmen,<Herr
<br />rrparrd under m~ diredNm nr wpeni\inn in wcordancr aiW o syaem dr\iyned
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<br />In us\ure Ilwl yualiriad prrvmnrl pruperl~ yt,rher aced e, aluale Il,c infurmalltm
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<br />__ _ __ _ mbmittd. Ftuxd nn m~ inyuin of thr prrmn ur q•r.~m. ~tui manage for c~atem. ~
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<br />\uhmittrd i\, w thr I,r+t of nn knowlydGrc and Ixlirf, uve. urcurvte, and cnmplde
<br />SIGNATURE OF PRINCIPAL EXECUTIVE _
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<br /> I om awurr tha, them are siQni~cum prnaltic\ fnr.ubmittinK tube infarroa,ion,
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments Here)
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