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fERMITTEE NAME/ADDRESS (In "FarIMyNesew Lewdej" ((D(fW%w) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM fNPOE$) <br />NAME DISCHARGE MONITORING REPORT /DMR) <br />ADDRESS <br />[ <br />- <br />BOX PERMIT NUMBER <br />C-11E WNABER <br />VI <br /> MONITORING PERIOD <br />FACILITY !_ANE CE1)v`l iliV r1iIIE. YEAR MO DAY YEAR MO DAY <br />LOCATION A CO ?, - -. FROM TO <br />TFR WWTTI FT1f2F. MTPJI= MRf: <br />Form Approved. <br />OMB No 20404004 <br />MINOR <br />..; • <br />(SUBR DW) ,„•a ,• 4, . <br />F - FINAL <br />UNDERGROUND M <br />INE TO E SALT CH <br />NOTE: Reed {rntructlone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX -EOUENCY <br />Of SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br />?1 <br />a (7 <br /> y <br /> PERMIT g![ #at - #dt 9.0 iEEKL T NSI <br /> REQUIREMENT c?} t (, •1 MAXIMUM <br /> SAMPLE <br /> MEASUREMENT <br />r PERMIT .:it >r sr 3<i ?f r " 3 70 Irl;'. i <br /> REQUIREMENT i .,I1A ,=IVG DAILY MX SIG; Mf-'N i r <br /> SAMPLE r ; <br />(f-. - MEASUREMENT 7 3 <br />1 PERMIT t :: #4t it iflt# :k##t-s 3`;: .. 7000 NCE% GRAB <br />N REQUIREMENT w:?LiA DAILY MX '..'C= i if. •; t. <br />ID SAMPLE <br /> MEASUREMENT <br /> PERMIT st ; ,Y # # It3E #9E 10 (P ! 1 I C ';'= AB <br /> REQUIREMENT I NST MAX (r F. r4T <br /> SAMPLE <br />REMENT <br />MEA <br />c A i t`iEN - <br />SU <br />t l PERMIT t K fi <br />_U1=N REQUIREMENT t1r? L ;' MX <br />AND SAMPLE - <br /> MEASUREMENT <br /> PERMIT r r rsc <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMERiTIE PRINCIPAL.EXECUTIYE OFFlCER et ' > ` Pen' y ° sue that this dorument a all snachmenb were <br />TELEPHONE <br />PrsP•rid sneer my arsctlon or sups <br />reMon In accord.net with . aynem ddgned <br />DATE <br />v? to saute that qualified Personnel properly ether and evaluate the Information _ y IV <br />J l?t ' ` submitted. Bred on my inquiry of the person of persons who manage the system, f ?' <br />or those persons chmely r s"ble for gathering the Information, the Inr°rm.t>en <br />d I& to the best of m <br />sub <br />itt <br />Pete Is <br />e and b <br />li <br />f <br />t <br />t <br />d <br />l <br />l <br />t r / <br />/ <br />1 <br />y <br />g <br />m <br />e <br />e <br />, <br />rue, secvrs <br />e. an <br />comp <br />e <br />e. <br />e <br />w <br />h <br />i <br />ifi <br />t <br />f <br />I <br />r <br />tk <br />SIGNATURE Of PRINCOAL EXECUTIVE / <br />I <br />t th <br />ttl <br />f <br />b <br />ltti <br />h ? <br />TYPED PRMiTED am s <br />ere are s <br />pena <br />m <br />ng <br />s <br />e <br />n <br />°rme <br />an t <br />a <br />gn <br />can <br />es <br />or see <br />m, <br />Including the pnnlblYty, of fins and Imprlsonmrnt for knowing v M.U ns OFFICER OR AUTHORIZED AGENT CAREA I ODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference &# attachment: here/ <br />7 QZOD DEPORTED. OTL & !;-,FAST - SEE I. P, C. TD-1 MONTTORT <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. ?', ' : ?Sta?4-P$Ek tOliTl. PAGE OF