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PERMITTEE NAMEIADDRESS tlnclude Facilint Nome/Loeation iJDjf`aenn NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS - <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY YEAR MO OAY YEAR MO DAY <br />LOCATION j FROM TO <br />Form Approved. <br />M I NOR OMB No. 2040-0004 <br />F - FINAL IMNTRS <br />SR&MINE DRNG TO TUTTLE DRAW <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 />:i SAMPLE t <br />i MEASUREMENT <br />t } _i.• i PERMIT <br /> REQUIREMENT I1'ti iAx <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />TELEPHONE <br />NAMEfMLE PRINCIPAL EXECUTIVE OFFICER I certify under penally of law that this document and all attachments were DATE <br />\ <br />prepared under my direction or wpet,kion in accordance with a system dt iRned - <br />_ to assure that qualified per onnel properly ppther and "aluale the infurmatlon ?- <br />- submitted- Rased on my Inquin of the person or penons who manatee the >atrm. <br />- ^--- or those penons direwth resprmsihle for gathrring the information, the information <br />-- - submitted b, to the hest of my knowledge and belief, true, accurate, and complete- <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />1 lst I `? <br /> I nm aware that them are significant penwltles for wbmilling false information. AREA <br /> r6rmmenl for knowing sh,lations <br />sibility of ftm• and im <br />i <br />l <br />di <br />the OFFICER OR AUTHORIZED AGENT NUMBER <br />ODE YEAR MO DAY <br />TYPED OR PRINTS <br />I . <br />nc <br />u <br />ng <br />pos <br />p <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />DS LIMIT APPLIED FOR 10YR/24HR PRECIP EVENT - SEE I.A.2, <br />RUCTIQNS - I- C. 10, PG 20. 30 DAY AV© IS HIGHEST MONTHLY <br />EPA Form 3320-1 (Rev. 3M) Previous editions may be used. 00550, This, is a'4-part form.