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1'ERMITTEE NAME/ADDRESS(Iwd~JrferWryN~+/!.«.rrew t/Dreirw+d, <br />NAME - <br />`i~ <br />ADDRESS. <br />~:;~ i 4:.i:: <br />~~~=~LISAD>r co <br />FACILrTV '`^'DSIUE NDRTFi ?~ SOUTH MINF <br />LocAnoN ,R I~ALISADE v0 8 <br />:.~ ! St7N L. KIDDER, ~. P. <br />NATIONAL POLLUTANT dSCHMOE ELIMINATION SY9TEM INPOfS/ <br />DISCHARGE MONITORING REPORT (O R! <br />PERMIT NUMBER dscHMOE NUMt1ER <br />MONITORING PERIOD <br />Y AR MO OAY YE DA <br />FROM TO <br />fo!m App!pywld <br />OMB No 2040-0004 <br />NOTE: R~~d Irntructiofr b~tor~ cornpbtiny thb form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION n1O, <br /> <br />EX fREOUENCY <br />of SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ ~ ` i' <br /> MEASUREMENT ' <br />- PERMIT <br /> <br />REQUIREMENY r.t , ..,, , <br />f•1 .i ~ .. <br />.. • . <br />- -' SAMPLE <br />n, r r _ <br />~ <br /> MEASUREMENT <br />`- <br /> PERMIT <br />REQUIREMENT <br />- <br /> <br />` ~ 'j l•t , SAMPLE <br />MEASUREMENT _ <br />' • <br /> <br />;`) <br /> PERMIT ; <br />~ <br />r' ' <br /> <br />• ~~/~~~- <br />,T <br />REQUIREMENT . , . <br />` `' ' ' ; <br />~ <br />. <br /> SAMPLE <br />- MEASUREMENT <br /> • <br />' PERMIT ' <br />~ REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />1 crll T u r pen• ly a ler lhN IAH docvmrnl .nd .11 elt.rhmnrb were <br />d TELEPHONE <br />NAMEfTfTLE PRINCIPAL EXECUTIVE OFFICER <br />~ <br />~ <br />el <br />lw <br />er.l <br />l <br />o I <br />lln . <br />t <br />d <br />l <br />r <br />d <br />DATE <br />PRP,r <br />~, <br />T~ <br />n o <br />fuy <br />s <br />o <br />n .rrnr <br />.nn w <br />:T, <br />.ln <br />ef <br />~ne <br />rer <br />~` <br />to enure Ihsl ,u.HfMd perfonnH PropeA7 (.l Mr •rd e•du.le rM Infnrm.tlon <br />11 ' t <br />l <br />" <br />( <br />- sobMlled. 6reA on m) Iequ <br />r) of Ile Person w penoro whe m.nge the fyrum, <br />-'~,~' ~. (l, ~ L~ ~ <br />~ <br />.~ ~. , :-mac ~ <br />~' V ~ L - M <br />dbk f <br />l <br />~ <br />; <br />. <br />_ <br />~ respe <br />or llox perfero dlreel <br />a plberln~ Ile Inforrrrllow, IM Infornrllon <br />t <br />/ • ~ <br />/ <br />~ <br />' <br />_t~ , • 1 •_ + fulMttcd b, to Ile left of m~ <br />newMd~e .nd leYef, lrw, .ccvnle. .rld tomPlele. ~~ <br />- <br />iIONATVRE OF -RINCtrAL EXECUTIVE <br />t lA <br />l <br />Jp <br />wl <br />dtl <br />l <br />rtH <br />hb <br />I <br />f <br />ll <br />li <br />f - <br /> <br />TYPED OR PRINTED 1 .rn sw.re <br />rre .re f <br />p <br />ri <br />Pen <br />n <br />r <br />.. <br />or a <br />rr <br />nE <br />n <br />onrr <br />on, <br />Inr~MI~V°W1111tTofpne.ndlinpAfonrntnl forknowln~ Ho1.Wrn <br />OFFICER OR AUTHORIZED AGENT A A <br />CODE NVMEIER <br />YEAR <br />MO <br />OAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fR~f~r~nc• s/1 slticnm~nfa h~r~! .~.~ <br />UPENDED SQLIDS (TSS), TOTAL IRON AND/0 <br />EPA Form 3320-1 (Rev. 3/9'9) Previous editions mny be used <br />