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PERMITTEE NAME/ADDRESS i1naude FxiGfr :\'amellimurion it ixfferenf) <br />NAME <br />ADDRESS IF NO 2 MINE <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />I <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Forth Approved. <br />OMB No. 2040-0004 <br />CC U13R MH ) <br />F - FINAL DEI <br />cFs n t_: rt tf+;'?si?Tn rP T fi /Ht•3hr' RD CRY <br />NOTE: Read Instructions before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty urlaw that this dti umem and sill nitachmeaN were <br />re <br />ared under m <br />direction"su <br />enision in accurdame with a s <br />stem d <br />si <br />n <br />d TELEPHONE DATE <br /> p <br />p <br />7 <br />p <br />y <br />g <br />e <br />e <br /> to assure that qualified penmind pnfperly gather mid evaluate the inrormatiat <br /> submitted. Rand mt my ingnirv of the person or peraais who menage the system. <br /> or (hint penfmy di-di respon0hlr for gathering the information, the Inrnrmatinn <br />- submitted i, to the he.t or m% knowledge and Helier. Irue. "curate. and complete <br />-- - 1 am aware that theft am si <br />nificant <br />enalthr for submittin <br />falw information SIGNATURE OF PRINCIPAL EXECUTIVE - - - <br />TYPED OR PRINTED p <br />g <br />. <br />g <br />including the gnsibilits of fine amt imprisonment fur kmiwing yiolatiims. OFFICER OR AUTHORIZED AGENT AROEDA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This 1S 8 4-part fOflTl.