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PEflMITTEE NAMEJADDRESS dnchrrlc' Farllet<• A'am<~ L,xml~m ijD,JferenU <br />NAME •4;.. ;- : `r' ~ i Ni: . <br />ADDRESS <br />-~17 rS5 <br />I ~. : - ,-rt c , <br />FACILITY <br />LOCAT10Nf-; a~~1~: ~ L ~t` <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDE$) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />RECEIVED Form Approved. <br />OMB No. 2040.0004 <br />Pi 1 tYVTt <br />c ~u>;~ APR 21 2008 <br />F - F' <br />Division of Redamatlon <br />Mining and Safety <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> ~ TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAX <br />IMUM UNITS <br /> - ~ ~ ~ / <br />~ ~ ~ " ~ <br /> MEASUREMENT .~ ~;; <br />~ • <br />::: PERMIT .. _ . , <br />_: <br />- <br />- <br />F . i_~J:. REQUIREMENT .. '' - ~ <br />;,,i :,;~ <br />,~.,[ <br />r:-i <br />- SAMPLE ' <br />c`;: •: ~ 'c ' _ _ MEASUREMENT <br />?1 1i <br />_ , <br />~ <br />- <br />~ • - <br />+rb iJ <br /> <br />r_: F ' - REQUIREMENT - ' <br />- . SAMPLE <br />~ ` ~ " I <br />U ~ <br />r' ~' <br /> MEASUREMENT <br />'~"` PERMIT '~ -J <br />- - REQUIREMENT <br />h <br />~ SAMPLE <br />`f ~; <br />O <br />j C-~ <br />V , <br />:n I <br />i <br />7 <br />. <br />i MEASUREMENT . . - <br />r <br /> P>:RMIT ~ - y <br />;~ <br />'r : - REQUIREMENT <br />_ SAMPLE <br />~~ .. i ; <br />( <br /> MEASUREMENT ~' ' '` ~ <br />' <br /> PERMIT ~ :t •r - a -t :r a •, .} .,;~.~. , t. ~-,~: <br />T~ F - REQUIREMENT ' <br />_ SAMPLE <br />~ <br />• <br />l 7. <br />~ t ~~' ~ : ~~ <br />• <br />f <br />i <br />' <br />' REM <br />MEA <br />NT c,c~:~ <br />j <br />T. ~ <br />3 y r, <br />~.,. ,,, ~-I : <br />.. „ <br />I <br />r+; <br />T SU <br />E <br /> i .. .. -a m L r, • .. • :'•2 ~ , H . <br /> PERMIT _ .. I°ff )''I''": , <br />- ~ REQUIREMENT <br /> SAMPLE <br />~ J / <br />~ <br />~ ' ~ <br />G I <br />~ ~ <br />- <br />'~~`• ~ <br />i ? .' MEASUREMENT ~ ~ , ~ <br /> PERMIT ~ ~ ~ - ._r ~: .~ i ._ .~. <br /> REQUIREMENT ' ' ' ~ ' <br />NAMEi(TITLE PRINCIPAL EXECUTNE OFFICER ~ crndy under penalh' of law that this dkutnrnt and all a[tnchmrnts were TELEPHONE DATE <br /> prepared under my direction or supenisioa in accordance with a s~•strm drsigned ' <br />r <br />~ <G jS' ~C. ' f <br />to assure that yunlifird pesnnnel properly gather and rvaluatr the infi,rmatwn <br />submntrd. Based on my inyutry of ttx pc,son or persons who rnannge the system. _ <br />"% <br />_ ,, <br />-Ld -~~- <br />- ~ <br />• <br /> thr miurtnanon <br />athrring the mfomtutrca, <br />ons diratl <br />omiblc R,r <br />[h <br />s <br />er <br />rc '• _ ~ _ <br />"`_- '~ <br />i . <br />p <br />g <br />e p <br />s <br />y <br />or <br />u <br />l <br />t <br />h <br />d ~ ~'~ ~ ~" ~ ~ ~?` <br />i- .~ t <br />~' ~ cnn,p <br />rbcl; we. accurate, an <br />e <br />c <br />submiaed u. [n thr best of my knowlydee and <br />' SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br />` <br /> or suhn,ining false infomwtion' <br />1 am aware thnt there ttrc significant pcnalncs 1 <br />c <br />ti <br />i <br />t f <br />k <br />l <br />~ <br />(fi <br />d OFFICER OR AUTHORIZED AGENT AREA <br />DE NUMBER <br />C YEAR MO DAY <br />TYR~D OR PRINTED nowing <br />intpr <br />snnmen <br />or <br />,o <br />a <br />on <br />including the Ixnsibility o <br />ne an O <br />tvVMMG141, qNU t1CYLA1VH 11V1`I yr N177 vtvvlttvna Incrm cna.c on osaa..~~... <br />EPA Form 3320.1 (Rev. 3199) Previous editions may tie used. <br />1 <br />..~...,~ <br />- HR REC I P. FVi=NT' - SEF I . A <br />,c.~AMPLIN.^, INSTl~UCTI©iV5 <br />3. FOR REf3VIh?EMirf~tTS <br />r~. ice. <br />Tt11is is a 4-pact form. <br />