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PERMITTEE NAME/ADDRESS !Include Fari6rY Namellarafion if thffaeatu NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />13 DX PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY La MINE MONITORING PERIOD <br />LOCATION HORIZON YEAR MO AY YEAR MO DAY <br />LA CO 81 FROM TO <br />LANCE WADE, MINE MANAGER <br />Form Approved. <br />OMB No. 2040-0004 <br />rlN TR <br />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 <br /> MEASUREMENT <br /> PERMIT { # c- t REPORT q c NC E.11 r <br />• REQUIREMENT :ir)DA AVO D(.' , t MOP. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT F,t=PCJRT RLr= JRT <br /> REQUIREMENT, 30DA AVG DAILY I'^ _ <br /> SAMPLE <br /> MEASUREMENTI <br /> PERMIT REPORT R`;. i <br /> REQUIREMENT A t-IV:-; rife i L' 1°, X : { '' <br /> SAMPLE <br />.. MEASUREMENT <br /> PERMIT <br />j <br />,- <br /> REQUIREMENT i <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 />NAMENITLE PRINCIPAL EXECUTIVE OFFICER I srrtih under p•nalq 41- that this document and all attachments were <br />ti <br />vi <br />with <br />y <br />t <br />d <br />d <br />d <br />di <br />i <br />i <br />d <br />i <br />d TELEPHONE DATE <br />prepan <br />un <br />er tnv <br />on ursuper <br />on <br />n accor <br />aner <br />a s <br />s <br />em <br />es <br />ttw <br />rec <br />s <br />to assure that qualified persnnnef properil, ttather and rsaluale the Information <br />_ _- ---"' _ submitted. Bawd on ms inyuirs of the perm or pervms aho manage the system. I I. <br />or thine Persons di.", responsible ror gathering the Informatir, the inrormation <br />and complete <br />%uhnritted is <br />Io the tx st of m} ktweirdge and Wkf <br />true <br />actturute <br />, <br />, <br />, <br />. <br />- / <br />. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />• <br />- ' <br />I am aware that there arc significant penalties for wbmittinp raise information. <br />TYPED OR PRINTED includinX the p-sibilits or rine and imprisonment for knoising violations. OFFICER OR AUTHORIZED AGENT A <br /> <br />REA NUMBER YEAR MO DAY <br />CODE <br />GL)MMtN I A ANU CAMLANAI IVN Ur ANT YIVLA I IVNJ Inerererrce an attacrrrrrerrts rlere/ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used