Laserfiche WebLink
PERMITTEE NAMEIADDRESS (include FaciGtry :Yamellocation if ix ferntl) <br />NAME _ <br />ADDRESS •'- <br />EOX 628 <br />LA CO E31 <br />FACILITY HOR 1 7 ON N Z N F <br />LOCATION L A C Ol ° 1 <br />LANCE WALE, MINE MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY. YEA MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINL P <br />?SUDR <br />F - FINAL Fite <br />5R&M I. NE DRNG TR I S TO TUTTL..E DR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> 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 r i'J i. v D '; r=s L' L <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . _ . 171-7-UP <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - . , r - <br /> REQUIREMENT Y MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ?"J51 ;`lr3t;( GE(11 <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT r. <br />17 -W -r <br /> <br />c _ <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I rrrtif) under penalh of law that It dtammerd and all attachments were <br />prepared under my direction or supervision in acanrdunce with a s %lrm dt+igned <br />- ' TELEPHONE DATE <br /> to assure that qualified personnel properly gather and evaluate the information -'--T- <br />__, %uhmilled. Bawd on my inquire or the Firm-n or persons who manage the system. _- <br />__ - or those Persons dlrecti? responsible for gathering the information, Ihr Information <br /> uhmitord h, b. the bell of my knowledge and pellet, true, atcuratr. and complete. <br />1 am aware that them arc si <br />nirkant <br />enalties for submittin <br />false information SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED - g <br />p <br />g <br />. <br />including the possibility or fine and imprisonment for knowing slolution% <br />OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is a 4-part form. PAGE OF