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FERMITTEE NAME/ADDRESS p-ho&F r*oy VemWL«eeroa I/Diff .np <br />NAME <br />ADDRESS: <br />F I? $0 fr?i. <br />RAONIA CC <br />FACILITY ;-, ,-IW I E N0. MINE <br />LOCATION: ;13N! A Cc <br />TI 1 AM A RFAR JR l"IIf? <br />NATIONAL POLLUTANT 04SCHMOE ELIMINATION SYSTEM //NPOES1 <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHMOE NWOER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUDR MH) <br />F - FINAL DELI <br />SR;DEER TRL OTC OR UNMD TRIB <br />xi <br />NOTE: Read kwtrvctlone boforo comphtlny this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX f#EOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE it n <br /> MEASUREMENT <br /> PERMIT ##il?r# f t t t 7 t L i_r_KLY T( <br /> REQUIREMENT MAX I MUM <br /> SAMPLE <br />LJ!)cL MEASUREMENT <br />- <br />' 30 I C; PERMIT <br />#±r#:t?s <br />f:? <br />3f t { ; <br />5 <br />fJCI`/ <br />- <br />',JFNT CROSS VALl-'E REQUIREMENT MONTH <br />.1 SE 1 TL.' v,; I j r- SAMPLE <br /> MEASUREMENT <br />1 0 PERMIT '#et# #:s ri#itiF tt .. =s- ##ik##it REPORT h?UR _ r', .'- <br />_`r FLUF_?JT GRl REQUIREMENT SODA Ate(=; DA:L`r MX MONTH <br />RON, TOTAL SAMPLE „ - <br />(A5 r MEASUREMENT <br />1 PERMIT 7t #t? rt x## f# >n sr -")00 6000 O NCE/ RAB <br />NT CROSS REQUIREMENT <br />(jDA <br />aZl <br />Y MX <br />:- <br />MONTH <br /> _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r'f#### #iF###iF fi# }#a t +i ####aF ' Q t.:.. f.l _1i;.'? <br /> REQUIREMENT INST hrirrk <br /> SAMPLE <br />- •I R r .? I:, J MEASUREMENT <br />O i? PERMIT REPORT REFCN <br />Up SS t?.. REQUIREMENT 30DA <br />Ahv i SAMPLE <br />'AL MEASUREMENT <br />------ <br />PERMIT c ... )=F „,r r .. , -. <br />W <br />REQUIREMENT <br />r ceriuly r er Pens" y o few that tAb document and all ett.chments were <br />TELEPHONE <br />NAME/fiTLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />Prepared under my dl-11- er super+istoa 1. a ,den_ with a System ddgned <br />to ae'um IAst queefied personnel VOW, 7 gather and ee.luste the Infnrnutlout <br />submitted. leaed On my inquiry of Me person Or permes who mensge life 2"lem <br />- Or tirade Persons directly respordbN for fathering the lafornvtloa, the Informellon - <br />submitted it, to the bar of my kaowtedge end baW. true, smunte. end complex. - <br />m th <br />t there ere sl <br />nifleiat <br />enaltie <br />br <br />SIONATVRE OF PRINCIPAL EXECUTIVE <br />' I <br />w <br />f <br />ub <br />ittin <br />f <br />Info <br />tf <br />TYPED OR PRINTED g <br />P <br />em s <br />a <br />a <br />s <br />or s <br />m <br />g <br />a <br />e <br />rme <br />on, <br />Inducting the Possibility of nee end Imprisonment for knowing elolstlon& OFFICER OR AUTP40RIZED AGENT COflE tNUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRefaronce aN attachments hore1 <br />r-- r- ,r-,. In T•'" ^l '•rrrl -T- "I.. QT;vt i.,3 <br />Y <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used a This is a 4-part Corm. PAGE OF <br />l