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FEFIMtTTEE NAME/ADDRESS(/rafrJr ireyYry N~ea/reearrow i/D(Qiw.v) <br />NAME <br />ADDRESS <br />~lJh ti•~~ <br />"JIA Cla 814$ <br />FACI~m :: I E NO. 2 MINE <br />LocATaN '~,.: ^~ I A C:O 8 2 428 <br />~LIAM A. DEAR JR. , MINF i'9GR <br />NATIONAL NOILUTANT fHSCHMOE ELIMINATION SY9TEIN //NPDESI <br />DISCHARGE MONITORING REPORT /DMRI <br />PERMIT NUMBER ascl+AnoE NuMeElt <br />MONITORING PERIOD <br />Y O DAY Y MO D Y <br />FROM TO - <br />Form Approved. <br />OMB No. 2040.0004 <br />MINOR <br />(5UDR MH) <br />F - FINAL DEt <br />DSCGH QF 5R TQ ©UMNISC3N RIVER <br />NOTE: Rssd Instructions bslws comolstinp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, ntEOUENCr SAMPLE <br /> or <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANAIrSIg TYPE <br /> SAMPLE :: ~ ... <br />___ MEASUREMENT <br /> <br /> PERMIT # ~3t ~_... , .. =;f~#itl; it-tt~#~f:-•x- ,~ •.: _ ,. .,•=;'- <br />_ :'~?~ _ ,.. REQUIREMENT iPJ>•rY MAx ;:~=-i~ <br /> <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REOUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> '' PERMIT <br />RE <br />U <br />REMENT <br /> Q <br />I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REOUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' Ceft"r ~ r peon I] u. Ina ehh donimenl end w wacneeeenu Overt TELEPHONE <br />d DATE <br />pRpared co <br />er m~ dlreceMn er wper•1lon In aceordante wlln . r~ateen del~ned <br /> to rare In.e ~ua11Md personnel proprAl ~alner and rraluale Int Inlonelallon <br /> rnDmlllad. bared on m~ Inqulr~ or Uie person or persorle woo anr~e Uee frseeeee, <br />r (b <br />t <br />al <br />A <br />~ <br /> ore persoro <br />y repoM <br />o <br />ret <br />k roc plnerln~ IAe Inrormauon, the Information i <br />. <br />- wbmllted b. to the bet or m~ knawled~e and btMer, Irw, rmerete, and rompk/e_ ., <br /> 1 rm ewers tbrl Inert arelptlfkanl penaltle for eubmllrln~ hbe InforreeeHen, 610NATURE OF FArNCJ-Al EXECUTrVE <br />TYPED OR PRINTED IMWInt the pordDlUt) or fine rod ImprNonmenl for tno.InE HWruoeei OFFICER OR AUTHORIZED AOEMT CODE NUMBER YEAR MO DAY <br />.....~~.~". ~ ~ .,..., ~... ",...... _.. _. - -- - - - - - -- ... _.._ ~ w. w. _,.. w w.. _.._.......w.,... r..r w, <br />`S L_t °i._IES ~~ ~; ?4HR PRECIP EVFR€T I5 CL.AIMED. rF CLAIM APPRO~%'=D 13Y I"l~3CI?, <br />-. i•' :'~c ?_ t.i "LEA`: - .. ~ __ r`i _. c. .+,. i .~ ,; <br />EPA Form 3320-1 (Rev 3+99) Previous edi?ions may be used L - Tf11S-iS 8 '~-O~r~, fQfRI. PAGE OF <br />?~. ~ .. -. Lra-ICr <br />