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PERMITTEE NAME ADDRESS <br />NAME <br />ADDRESS , MINE <br />f- Brix 128 <br />A ?J <br />FACILITY HORIZON MINE <br />LOCATION ` A C O <br />.wrw.e- MANIA/ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) 'T i P•I ;.JR OMB No. 2040-0004 <br />(SUDR i IH <br />PERMIT NUMBER DISCHARGE NUMBER { - F I NAL MNTRS <br />MONITORING PERIOD ACUTE WET TE5TING FOR 013A <br />YEAR MO DAY YEAR MO DAY <br />E31 FROM TO r- I . " . <br />co NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE r... ;t u it• c . ) <br /> MEASUREMENT <br /> <br />-• PERMIT #''r.:: #trfi#s i -# ;fi0 n'-j[tI sr##k## it 3?;-• # EP- i,?('{I- P,ALi- <br /> <br />-''=I. ` ?? J55 V"-,.: <br />REQUIREMENT PIN VALUi_- F7 1L I ANtIUA <br />r SAMPLE <br />-, MEASUREMENT <br />' r+ PERMIT JOG 0001 # i y4 A # # # ii # t <br />r} L fi; (i REQUIREMENT x I'ii I VALUE ANNUA <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <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 />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I ce-N under penalty of law that this docurttcnt and all attachments were TELEPHONE DATE <br />prepared under my direction or supervision to accordance with a system designed-.}_?•, <br />:o assure that qualified personnel properly gather and evaluate the information <br />submitted Based on my inquiry of the person or persons who manage the system, j <br />- <br />- - <br />w <br />-? or those persons directly responsible for gathering the infomution, the information - - <br />`- <br />j <br />' <br />- <br />submined is, to the best of my knowledge and belief, true, a curate. and complete. SIGNATURE <br />OF PRINCIPAL EXECUTIVE <br /> I stn swore that theca are si6mificant penalties for submitting false information, <br />i <br />s <br />f <br />k <br />i <br />i <br />l <br />ib <br />li <br />f <br />i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OIL P INTED ng v <br />. <br />ty o <br />fine and <br />mprisonment <br />or <br />now <br />o <br />at <br />on <br />nduding the poss <br />i CODE <br />COMMENTS ANU EXPLANAI IUN Ut- ANT VIULM 1 IVPL1. (nvrvrrorrcv arc auacrnncrna rivy v/ <br />?POP.T LOWEST DIL.UTION t% EFFLUENT) WHICH IS LETHAT TO <br />-PORT <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 0: 047 / O *4 jS@ 4Taq fprltl.