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PERMITTEE NAMEIADDRESS tlnclade Facility .Yaatr/L6Cd ioa iJDiff rnu NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME l° DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />?L k PERMIT NUMBER DISCHARGE NUMBER <br />'-EN MONITORING PERIOD <br />FACILITY C A MINE COMPLEX <br />LOCATION YEAR MO DAY YEAR MO DAY <br />D F N CO f71." FROM TO <br />Y V.AIYfi. RPfI AmATTnm MAINIAr.•r <br />Form Approved. <br />OMB No. 0400004 <br />1-11 IgVrS <br />(SUBR <br />F - F <br />PSCHO <br />N)TE: Read Instructions before t;omoletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ. 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 /> 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 I certiq under pennlth or law that this document and all attachments were <br />d <br />d <br />di <br />i <br />i <br />i TELEPHONE DATE <br /> prepare <br />un <br />er m? <br />rect <br />on or superv <br />on in accordance with a s%stem designed <br />s <br /> to assure that qualified personnel properh gather and es aluate the Information <br /> submitted. ltws d on ms inquiry of the person or persons who manage the tsxtrm, l <br /> or those persons direcd) respuri0ble for gathering the information. the Information 1 , <br /> submitted is. gas the best of ms knowledge and belief, true. aceumte, and complete. 1 <br /> I am aware that there are signUleant penalties for submitting false information SIGNAT RE OF PRINCIPAL EXECUTIVE - <br />TYPED OR PRINTED . <br />in, lading the pssibilit, "f fine and imprisonment for knowing violations. OFFI ER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />EPA Form 3320.1 (Rev. 3/99) Previous edidons may be used. 00412 'T'his-ls' 4-part- form. <br /> <br />