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PERMITTEE NAME/ADDRESS (Include Facitirr;vamelLocarian t(uf/eren) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS ..+L. r <br />X37(. PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY C: sy MINE L L1f"OLE X MONITORING PERIOD <br />YEAR MO DAY YEAR M DAY <br />LOCATION 1= N C O FROM TO <br />KARO, MANC .. .:t <br />MIND <br />(?UI3 <br />F - <br />U8CH <br />Form Approved. <br />OMB No. 4V40-0004,-@ <br />X, <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 v?rtiry under penalty of law thol this document and dl attachment, <br />werr <br />d <br />d <br />di <br />ti <br />i <br /> <br />TELEPHONE <br /> <br />DATE <br /> Prepare <br />un <br />er my <br />rec <br />on or caper%p <br />on in accordance with a system designed <br /> a, assure that qualified pvn nml properly gather and evaluate the information <br /> .ubmitted. Bawd an my inquiry of the person or persons who manage the s. +lem. + `??? <br /> ..r thaw perueas dim-11, rnpumlble for gathering the information, the information <br /> .uhmitted is. to the hrN of my knowledge and belief. few, accurate, and complete. , <br /> <br />I am xaare mat dwre are si <br />nificant <br />enallies for submitlin <br />fal <br />inform <br />tio $IGNATU E OF PRINCIPAL EXECUTIVE t <br />TYPED OR PRINTED g <br />p <br />g <br />w <br />a <br />n. <br />including thr p,-aiilih of fine and imprisonment for knowing sitdatiem. OFFIC jtR OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br />T 5,5 <br />IRUI <br />S AND EXPLANATION OF ANY VIOLATIONS (Reference all affachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 3