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PERMITTEE NAME/ADDRESS i Include Fardit.y ituar/tOl'atlon if Differrrlt) <br />NAME ._._ <br />ADDRESS - ?? '- <br />X 628 <br />C0 8 <br />FACILITY ZGN MINE <br />LOCATION LA co 6 <br />LANCE WADE, MINE MANAGE <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />VIN T R5 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />1 NO. FREQUENCY SAMPLE <br /> <br />EX O <br />TYPE <br /> . ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT M I N I MUM *1+; f 1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - ??- : `- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT w s t f .? <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br />- <br /> PERMIT <br />77 <br /> <br />t. <br /> <br />-IF <br />TIP <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ? k <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />41- IV -P 'w <br /> REQUIREMENT ` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br /> REQUIREMENT 1, A T L Y <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certifi under pe"Itt of law (hut this ducumrnt and a1I attachments were <br />pn•PumA under m? direction or supenision in anutdunce with u s-tern designed <br />- TELEPHONE DATE <br /> <br />-- to assure that qualified Persrmnd property gather and evaluate the information <br />b <br />d - ---- - <br /> su <br />mitte <br />. Based on m% inquiry of the per.on or pt•nnns who manage the s.%strm, <br />' <br /> or those Persons directly resp insibir for gathering the infornutUon. the information <br />- <br /> <br />1 wbmitted is. to the hest of ml knowledge and belief. true, ",curate. and avmPle(e .?. <br />1( ? <br />-' <br />I am aware that there are vignirtcunt peooities rue submitting /utse infurmaliun <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTS . <br />including the passibiliq of flnr and imprisonment for knowing violutiuns. <br />OFFICER OR AUTHORIZED AGENT AREA <br />DE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMEN 15 ANU EXNLANA I ION Ul- ANY VIOLA I IUNS (mererence all attacnmentS here) <br />DS LIMIT AF <br />I t4G <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used This- is a 4-01st f6rm. PAGE OF