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PERMITTEE NAMEADDRESS <br />NAME <br />ADDRESS . • .. , _ 1jt.t Ill I NE <br />1. BOX 628 <br />?CAA GO 81424 <br />FACILITY ,4 iii I ZON MINE <br />LOCATION I C b A GO 81424 <br />L- ANl: F WAi?F. f9 T PdF MANACFR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved' <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040.0004 <br />PERMIT NUMBER DISCHARGE NUMBER FINAL <br />MONITORING PERIOD 1 2A <br />YEAR MO DAY YEAR MO DAY / <br />FROM TO 'le <br />NOTE: Read Instructions before comDIetinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. ENCY <br />FREDU SAMPLE <br /> ? OF TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 100. 4t c:##ic## siib##i?# r EMT- RAB-3 <br />- REQUIREMENT MN VC-- ANNUP,! <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i00- 0O C)" ###ii it# x##k#3i t:,4 E M i - ,<, z-3 <br /> REQUIREMENT : i ; i[J VALUE tt=1JT I14NNtJf; <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I •-nlt. inder penalty of law that this document and all attachments were <br />d <br />d <br />di <br />t <br />i <br />i <br />i <br />d <br />th <br />d <br />d ? TELEPHONE DATE <br /> prepare <br />er my <br />un <br />rec <br />ion or supen <br />s <br />on <br />n accor <br />ance wi <br />a system <br />eiigne _ <br />_ <br /> totsure that qualified personnel property gather and cvaluatc the information 1_ <br /> submticil. Based on my inquiry of the person or persons who manage the system, - - <br /> or those persons directly responsible for gathering the information, the information <br /> submitted is. to the beg of my knowledge and belief. true, accurate, and complete <br />. <br /> <br />SIGNATURE INCIPAL EXECUTIVE <br />r 1 <br />! - " <br />- \ <br /> 1 am aware that there arc significant penlties for submittin <br />false information <br />TYPED OR PRINTED g <br />, <br />including the possibility of fine and imprisonment for knowing violations OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> . <br />COMMENTS AND EXPLANATION Or ANY VIULAI IUNS (Hererence all attacnments here) <br />n EPOF, - LOWEST D I'. ' ?T T f?[ 1 ! -< EF-FLIJENT i WHICH Tr-1 11"'"1.?AL TQ <br />TY TEST REPD-?, <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. •. Thi* jssa 4-p#q fUml. PAGE OF