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PERMITTEE NAME/ADDRESS iInclude FaciGty.Vente/Location i) lhfJerentl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY ;fir? , Z -:w I'411-4 F MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />LOCATION w C ' : FROM TO <br />ANC,E WADE, MINE MANAC c <br />Form Approved. <br />Pi I NOR OMB No- 2040-OD04 <br />(SUER MH) <br />F - FINAL f iivZR? <br />5R&!i''II N; <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 ` <br /> REQUIREMENT ;iii.; Iti <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a a A <br /> REQUIREMENT - L <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT I-1 a <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT 774177- <br />: t <br /> REQUIREMENT <br /> SAMPLE <br />- MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />ii MEASUREMENT <br /> PERMIT <br /> REQUIREMENT A : L' <br />NAMENITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty or law that this document and all attachments ocrr <br />d <br />d <br />di <br />tt <br />i <br />M <br />l <br />ith <br />t <br />d <br />i <br />d TELEPHONE DATE <br /> on or supers <br />wcoc <br />prepare <br />un <br />er my <br />r" <br />sion <br />aricr w <br />a sys <br />em <br />es <br />gne -- <br />_ <br /> tu asurre that qualified personnel prnprris other and esalwle the information - r <br />• <br /> submitted. Based on my inyuirs of the p rson or persons who manage the system, <br />'- or those persona direats responsible rim gathering the information, the information <br />t, - submitted is. In the two of my knowirdge and belief, true, accurate, and complete. <br />I <br />th <br />t th <br />i <br />if <br />lti <br />f <br />b <br />itti <br />f <br />l <br />i <br />f <br />li <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />-' ' <br />-? <br />TYPED OR PRINTED amt aware <br />or su <br />a <br />ere aft s <br />gn <br />icant Pena <br />es <br />m <br />a <br />se <br />n <br />orma <br />cm. <br />ng <br />Including the po,;sibility of fine and imprisonment for knowing siolatiotts. OFFICER OR AUTHORIZED AGENT CODE I NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 00501 /