Laserfiche WebLink
PERMITTEE NAME/ADORESS tlndudr F'arililr :~omr/ltxatinn if Giffrrrnu NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY ;•i} ; ~ .__:; ;•; ; , ~•_ MONITORING PERIOD <br />LOCATION ~ ENC ~ ~ ~~ S I _, • YEAR MO DAY YEAR MO DAY <br />FROM TO <br />=iRGE V PAT"I'ERSDNr MINE i`'i'.T' <br />~._ ._. Civ.1 <br />SCHG TU TRIG DF MEWL X I'1 ~- ~ 1r>`vC <br />NOTE: Read Instructions before c~ leting this form. <br />MCI ~ ~ <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r .... •, ~ r ., ~ . : <br />' REQUIREMENT - ''~,=:X f-i'.i:•` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~•:::: - -- <br /> REQUIREMENT i•i x i '" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .: i.- :: >. x : ~.. _ .. .. ~ ~: ,~ .. _ , , • .:. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT T r I sr .. _ ....... ;. ,.... ... .....:.... _ .. _ :-, <br /> REQUIREMENT ~~~~ j ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , . .. ., .. .. .~ .. ., <br /> REQUIREMENT '` <br /> SAMPLE <br /> <br />MEASUREMENT _ <br />'~ <br /> PERMIT /' _ <br /> REQUIREMENT ~ (~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I `a•rtif~ under penalty rrf law that thi+d<KUmem and all attarhmenl+ wrrn <br />ti <br />i <br />l <br />d <br />d <br />di <br />i <br />i <br />d <br />ith <br />d <br />d <br />i <br />/~ <br />' TELEPHONE DATE <br />~y ' ~'!.~ ,~ S ~ ~~ prepare <br />un <br />er m~ <br />rec <br />on nr supen <br />on <br />n vccnr <br />anee w <br />a +y <br />rm <br />pnev <br />s <br />ea <br />to u.+urc that :pwlified prrvmm9 prt:perl~ Kather anA e+vluvte the fnfnnnatHm ~i <br />~' ~ <br />v ~J~ <br />~ ''") ~' <br />~-~t wbmitled. Rx+ed nn m~ inyuin ::f 1br prnun or prr+:m+ wbn mana¢r the +strm. ` <br />~ <br />j ~ Ci{~r <br />(.L~ ;,r <br />~• ~ <br />`' / <br />~ - :a- th::+r penunc dim11} re<pnn+ihk f.u KvtlxrinK the informvtion. the ink:rmatNm ~~ " <br />2 J <br />/ ^ C~' -, ~ ~l <br />X <br />t` " ` ~' •- I ~ <br />' ' wbmiuad is, to the heal of my Atwwlyd rand hrlia•f. [rue, accun[e, and cum to <br />~' ~ <br />1 <br />i <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br />- q tJ-+ <br />/ ~ G ~ / t ' J ! -) <br /> <br />TYPED OR PRINTED am vware that thrrn am +iKnificam prnaltie+ for cuhmiu <br />nK fal+r informutina. <br />inchding the pac+ihilify of fine and impri+onment for knowinK ahdation+. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMtnI, ANU t)<YLAIVAIIUIV Ut ANT VfULAlIV1VJ lHererence an arracnmenrs nereJ <br />IR F_V~NT SULiJECT f <br />JF REC3UIRf=MENTS ZN PART <br />EPA Form 3320.1 (Rev. 3/99) Previous edRions may be used. ~~ 1 6L Tats 1!I 8 ~-parl IOrn' <br />