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FERMITTEE NAMEIAODRESS 17we6& fwrtlry N-rrL«doi- ((D,.'bwv) <br />NAME <br />ADDRESS 1 i f t_ <br />BOX 493 <br />;NIA CC <br />FACILITY T E NO. 2 MINE <br />LOCATION , U A cc <br />Form APPM- <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPOESI OMS No o 204 2040 d- <br />DISCHARGE MONITORING REPORT (DMR1 OMB 0004 <br />aJR <br />=)UBR MH> <br />PERMIT NUMBER DISCHARGE Num"T _ FINAL DLL ; A <br />MONITORING PERIOD , i DEER TRL DTC OR UNMD TR I B <br />YEAR MO DAY YEAR MO DAY - <br />FROM TO <br />NOTE: Read ingtructlone before completing this form. <br /> NO F <br />C AMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . 0 <br />F <br /> EX 7 TYPE <br /> L <br />yS. <br />S <br /> AVE RAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT t? <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />tf REQUIREMENT ; . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT EPOP SPORT DICE/ RAL <br /> REQUIREMENT !_Y MX 11 NT'! I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. ,y .? n #### iF i? a ?.:f i(•i, } tt I;' 1 <br /> REQUIREMENT I ! <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT i , . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT R`F-POP- - EPOPT <br />I _. REQUIREMENT r, t .11,111-Y FIX <br /> SAMPLE ; <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER I R^''y " r pena'y ° law that thb document and sit sIt-h-ts were TELEPHONE <br />prepared ruder my dlmeti n er supervision In a rdarw-e with a systern designed DATE <br />to swum that quaMMsd personnel pro"A) gather and erahiale The Iwforwsalion <br />submitted. Shed m my inquIry of the prrson or peraoen who mulage the sysirm, <br />' <br />or thaw penes directly mpewsible rot, gathering the Infomnellow. the Informative _ -- ` <br />submitted y, to the bnt of my kno UnIge and btikf• Trot. at.' mfe, and complete_ <br />IGNATURE OF PRtNCMAL EXECUTIVE , <br />. <br /> I am aware That then are slgniflowt pendths fm submitting fat. lnttrmnetlon, S A A <br />NUMKR <br />YEA <br />MO <br />TYPED OR PRINTED Including the possibility of saw and lmprhawewe f for knowing elolsoons. OFFICER OR AUTHORIZED AGENT ODE R DAY <br />COMMENTS AND EXPLANATION OF ANY VIVIA I iVN, frrere/encl an atracnmmtw nwrq <br />4R r. T-"TF. JO r71..A MFI; Tr" C -ATM APPROV=D SY WOCD <br />EPA Form 3320-1 (Rev, 3/99) Previous editions may be used This is a 4-Pert form. PAGE OF