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FERMITTEE NAME/ADDRESS (I,eeYJri«~WgN«t/Ler~rrow (/D(QGrenr) <br />NAME D3Cx3L3W i°IINIIV~C: I_i,..C <br />ADDRESS BANI~QRN G~? }t . qt EL}~+, i R I~, M 1 t+IES <br />F'. Q. I3iJk a;35 <br />Sqi"lEl~~aE~' CG 8i~•3$ <br />FACILITYiaANl3~f~1~I {~RI.4 °t ~~K k`I~"t~C MINES <br />~ocATwNSC3~lERSET t"f:.1 SI~3~ <br />.4TThi• .I:n1aiI=•~ 'I" f'I'?t'iS~FR. F4'irr'` U R <br />Form Approved. <br />NATIONAL POLLUTANT DISCNAROE ELIMINATION SYSTEM. ((NPDESI OMB No. 2040-000 <br />DISCHARGE MONITORING REPORT IDMR1 ~ ~ NCIR ` <br />Gl7GC~S~L~I'~~ t')S~ A {ai.F3jfii' i''fH7 <br />PERMIT NUMBER o1scNAAaE NuMeER fi= -- ~'" I ~}~;,.,, Gt?~~! :fi S <br />MONITORING PERIOD SEI;If'~?~i~J ~ ~t71~iI~ I ~~ ~~~ ~..REE~ <br />YEAR MO DAY YEAR MO DAY <br />FROM t:_ TO ~. ,~ #•~•rc i~1C.t ~:{5~~.4-3ARC~: E~._,1 ### <br />NOTE: Reid Irntructiorn b~tore complotiny this form. <br />PARAMETER tlUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />©I~. r"~!`~D GREASE SAMPLE a:##•sr## { ~~) ####i%•~: ####•k# ###•!i•#••Y~ <br />~,: ~ SUAI.. MEASUREMENT <br />540~1~ ~. i] /J PERMIT ` #•It~•a-cif REPORT kr,.s' =1 #~ ttit~tt-~ ~•#ir~ jtit ~-#~: #-I~{t- :### NDEd 1 IJA <br />E~'FLi.}LNT GRASS VALV REQUIREMENT <br />::..:....:. . ... INST MAX (ICI={~ •~~:~.~# MQNT <br /> SAMPLE <br /> MEASUREMENT <br /> < PERMTl' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ;:PERMIT <br /> RELIUIREMENT>, <br /> SAMPLE <br /> MEASUREMENT <br /> ''PERMIT ': <br /> REOUIREMEN7 <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT <br /> EtEdUIREMt=NT` <br />:.: ,:: , , _.. <br /> SAMPLE <br /> MEASUREMENT <br /> :PERMIT - <br /> REQUIREM~NT <br /> SAMPLE <br /> MEASUREMENT <br /> '`f~ERMiT ;' <br /> AEQUIREMLNT. <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER t Bert"r ° `r p`""r ° `'° u"""`' °oain1n1id i1l ""``""`"~' `r"` <br />pnp~ied under m~ direction or mper.Mon In acordann with ~ s7stem del`nad TELEPHONE DATE <br /> to auurt thN quNlOed perwnnel P~~7 Pther rnd evNuole the InformHlon <br />,~ ~~~ ^ - L_ <br />/~'~rL <br />G V'r'P i I subMttcd. Geed on mr inquiry of the person or penom who mam`e thr aystrm, ~ <br />0 <br />or lhox penoro diraety respoelbk for ptherinE the Inform~Uon, the Infornullon /~~ <br />(„A <br />~<}~ /, <br />~ f <br />` <br />D Q <br />m <br /> <br />~X ~~ . `~ <br />~r r ~ ~ ~`~` <br />Y <br />wDmltltd b. to the hnt of m~ knowkdEe end heNef, tnq oceuntq end mmplele. <br />l <br />lll <br /> <br />SIGNATURE OF PRIN Al EXECUTIVE <br />/v ~ <br />/~~ <br />7 ,/,~- <br />rf ~ <br />(/ ~~ <br />' ~n <br />1 ~m ~wsre 1h~t then ire s <br />ant penaitle for mbmlttln~ hbe inform~tlon, <br />TypED OR PRINTED Ineludlnt the po:,ibilitr of ene and Imprt~onment for knowlnt rld~Uoln. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /R~l~r~nc~ sl/ ~ttachm~nts hero/ <br />T.r..aS Y,, TQ'1'AL IFtOl4 LIt'IITS WIL..L f3E WI~I~JED, AhtJ aET-(°i._EAL'~s~~ S~L_IDS L.fi'{T APPLI~C? 1='UR r=1C?!`R, ~~!•H'=~t ~`~tECIP EtitEN7', <br />SE'TTL.EAL~L~ SpE..IDS LIMIT tMA'{ I3E WAIVED FOR >>~:~'t'R, ~4k#R EV~fi3'T-SEQ. I. A. ~., PP 4•--5, Afi~D I. A. ;~, P. S FQR R~C'If~TS. <br />C 6.f vJ w 4 1 Y L S +., 1 ._.. .t. sJ T .... .• .. . 'y. V . J...-. w S .... r . <br />EPA Form 3320.1 (Rev. 3/99) Previous editions maybe used. T~11S.JS.1~.4-Di~CL OTItI. „ F <br />