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PERMITTEE NAME/ADDRESS !Include FacWq .'Vase/Location if iNfjerentn <br />NAME <br />ADDRESS <br />.,FF <br />FACILITY <br />LOCATION <br />CO 9I42>; <br />'N, VICE PRES. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />( SUBR I'1H ) <br />F - FINAL <br />MINE DRAINAGE TO GU <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUE14CY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _. <br /> REQUIREMENT U. AV(- <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r I <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I -,tif> under prnelq of mw that thi%d«,tment awl all attachments weft <br />di <br />o <br />smio <br />o <br />ared <br />de <br />ctio <br />s <br />e <br />i <br />ac <br />da <br />e with a s <br />tr <br />desi <br />d TELEPHONE DATE <br /> prep <br />un <br />r nn <br />re <br />n <br />r <br />up <br />r <br />n <br />n <br />c <br />r <br />nc <br />ys <br />m <br />gne <br /> to assure that gmdirted personnel properly gather and esiduate the information <br />submitted. Rased on my inquir% of the per.nn or pemm. who manage the system. <br /> or those pers ms dircrtly resprnsihk for gathering the information. the informaiiem <br /> submitted r. to the best of my knowledge and belief. true. oerurote, and cromplete. <br /> <br />I <br />aw <br />e that th <br />si <br />iri <br />t <br />altks ru <br />s <br />b <br />itti <br />f <br />ls <br />i <br />ro <br />tk <br />t SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED am <br />ar <br />ere are <br />gn <br />can <br />pen <br />t <br />u <br />m <br />a <br />e <br />n <br />rma <br />a <br />. <br />ng <br />including the pussihdily often and imprisonment for knowing siolations. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. This 1S a 4-par( form.