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PERMITTEE NAME/ADDRE': - :ATiONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />,i YrdEN CO 6, FROM TO <br />JOY KARO, RECLAMAT10N MANA;' <br />MINOR <br />Form Approved. <br />OMB No. 2040-0004 <br />41 a <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY 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 I <br /> <br /> PERMIT r. - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />' <br />? <br /> MEASUREMENT ( (i t { r <br /> PERMIT r rf i. .,. t <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r- w <br /> REQUIREMENT <br /> SAMPLE r <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT , -- -• f ( ,•. I <br /> PERMIT <br />7 <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rertiN under penult) of tae shut the% document and all attachment. were <br />d <br />d <br />di <br />ti <br />l TELEPHONE DATE <br /> prepura <br />un <br />er m? <br />r" <br />un or wper,is <br />n in uvcordance with a system designed \ <br /> to assure that qualified prnonnel prnperl) Rather and v%ahwtc the information <br /> whoulted. Itawd on my inquiry or the perwn or perwns who manake the %%?Iem, <br />i <br />A <br /> or thusc per.ons dir", rt punsible for 1Wtbering the inrormali,n. the infurmatemt <br /> wlbmitled h, to the I" of - Anowlcdw and belief. true, accurate, and complete. <br />I am aeare that tht-m are siknificanl prnuhies for suhmilting fats information $IGNA RE OF PRINCIPAL EXECUTIVE <br />v <br />TYPED OR PRINTED . <br />incbrdine the j-ihili4 or fine and impriwnnrc•nt for Anawing tiolation, OFF ER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DA <br />%,UMMC1.11 0 MRLJ r-Ar6H1YN I IU19 Ur nl\ r rlvtJl t 1v1•IJ (flelerellce en n"ac""le"Is "ere/ <br />`+:'ED r'C1R PRF'"TP *=VFNT 7'_19-.)FAT f'Irr?ttRt`EN rlF <br />EPA Form 3320-1 fRev 3,99) Previous editions may be used. T'h-rl?'tb'a 4-p8it form. PAGE OF