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PERMITTEE NAME/ADDRESS r/neladr FrrrilUT:\'emellorafian i~UiJJ'erenu NATIONAL ~'-MUTANT DISCHARGE ELIMINATION SYSTEM NPDESJ <br />NAME .. DIS tiARGE MONRORING REPORT (D R) <br />ADDRESS - <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY ; ilJri ,i L :i~ Pl I f'~)= YEAR MO DAY YEAR M DAY <br />LOCATION A C U FROM TO <br />LANG ~ !„t~1DE . MINE Mfitl`JAG <br />Form Approved. <br />OMB No. 2040.0004 <br />F - F I F~iAL <br />6R'<f~l Z t~l~ I)R iVv i l7 TU i TLE DRr~1 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION I,IO• FREQUENCY <br />Of SAMPLE <br /> EX TYPE <br /> ~ ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ - . _ ~ - _ rr ._. ._ • . r •.~;* .~~ ,~~ . , <br /> REQUIREMENT '~:~i`~=•. A`•,'i': Dr:+: f•1 r. '•~?RI~• <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~. ~r - •~ :: •sl_ .k -'. ;.., a a '. i rC <br /> REQUIREMENT ~. (-~V`~ DAIL'r <br /> SAMPLE ~ " <br /> MEASUREMENT <br /> PERMIT .. n r .. - . <br />., REQUIREMENT -'.'b Lf•~ I i_Y P`t;'. _ i=:i?FJ is <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT •#•.;t•>fi~•# - ~I~~._._ <br /> REQUIREMENT =, .', ,". li(•~I!"'r f~l;~ , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,.-tl• ~ a-~t•Tf•~ a j'. ..~t- ,_~'_lr <br /> REQUIREMENT = air; ~~", fi'JCr nF; I ._Y tv1 ~; <br /> SAMPLE <br />;~{~. MEASUREMENT <br /> PERMIT ~.~ s•~ ~•>F-:r .. 11,. ,. ; <br /> REQUIREMENT - ~ _, : -Y Mx: <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT _ _ -, ;t~l rc f.L _., . •~ <br /> REQUIREMENT , 'FDA AVO I~Fi I L v !^ X <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t `~'"'t` u~rr prndh of mw that this daxvmem and aB attachmrnfs weer <br />o <br />r <br />r <br />d u <br />de <br />m <br />dir <br />4io <br />n <br />ni <br />i <br />• <br />with <br />t <br />i <br />d <br />d <br />i <br />d TELEPHONE DATE <br /> p <br />epa <br />r <br />~ <br />n <br />r w{w <br />s <br />~m <br />n ace <br />r <br />am <br />a sys <br />rs <br />Roe <br />e <br />n <br />ra <br />r <br />em -- - -._ <br />~ <br /> to a+turc that yualifiad prn.mnd properly gatlrcr and raaluatc the infurmatSnn , <br />__ _---~ - - -. -._ -- submhted. Bawd on my inyuin ad the person or perwny who man.rXe the ycstem. - .- a <br /> or thayr prrw.ns direytly resp.nyiNe for Rathrrin}t the iafarmation, the infnrmalbm ,._ ' <br />- yubmittrd iy. to the brq of my km.wlyd~e and belief. tn~e, aaruralr• utd rwmplde. < r /~ y ~ <br />~ (] <br />~ ~ <br /> nitinmt penahir. fur wbmmm <br />I am aw srr that then are .~ <br />fat+r InfmTnatimt SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED t; <br />. <br />c <br />inrludinR the po..B~ilin of fin. end uupri. wuvnt f•n ~n~~,.m:, voFatims. <br />OFFICER OR AUTHORIZED AGENT AREA <br />D NUMBEfl <br />YEAR <br />MO <br />DAY <br />AIVV t)CYLAIVAIIVfV VP AfVT <br />Irreverence an anucnmenfs nere~ <br />_ PAGE OF <br />• ' ~=Tfiis is .~ 4-tort tfTnn. <br />