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PERMITTEE NAME/ADDRESS (lncludrFtic!!ip Namc.YeKalrNiifmffcienU <br />NAME <br />!r. riGY", INC. <br />ADDRESS .;,)rN TION MINE <br />3 JACKSBORO HIGHWAY <br />H I TA ALL_S TX <br />FACILITY BON JV4CTION MINE <br />LOCATION , ANGO C 0 <br />.hJT;PA P t IT.R V . PRF,' T nFN- <br />f 1a71ULA-1 POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />^ MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO j• <br />Form Approved. <br />OMB No. 2040-0004 <br />r IOR <br />F - FII.; <br />5EDI PONI FCl CARBON JIJI',? Y i;I <br />01 <br />t <br />NOTE: Read instructions beforAco oletina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> EX OF TY <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE i s - r ., a: 1 <br /> MEASUREMENT <br /> PERMIT + 9. O !NC=/ <br />iNSI t <br />,F per, t REQUIREMENT #;•i:" r . ; ; I 1 tlJf'1 MAX I •i:lM f Ii71`i? f <br />_. c SAMPLE ,: ti f- c r k :( it ,; ? 5 ) <br /> MEASUREMENT <br /> PERMIT c#f=#*?t #k. jraF ?t' rs sr##?Eit# REPORT O. 5 W..E- :RAP <br />1--L-UEN(- REQUIREMENT t au 30LiA AVO +Il 1' :1X i1fL_ MON i <br /> SAMPLE s: s 3: 't is : } .2c? *',r c i 1 `-"r ) <br /> <br /> MEASUREMENT <br /> PERMIT #4### #s:=l?### i it ##fs##s ## LO -0N1•Ir GRA <br />VALt., REQUIREMENT u IN' ( !"IF.}: 011:NII <br /> SAMPLE <br />t ,,, <br />. a•' J ?-RER iPik..i MEASUREMENT / <br />r:0 C PERMIT REPORT RErOR'T <br />? #tFe'# ###sflEii ?E##### Ji s-fir i?i? f i Ifs <br />'t i_+ :Nr v F. USS ai REQUIREMENT ;3CiDq r??C. L"A1:L_-Y' 1 `i1 =i Xr, i'iC71J <br /> SAMPLE c• :. , r it x fi ( L cy <br />DIE-SOLVED MEASUREMENT <br />10.? 11t, ;. PERMIT +?tr##v Ilt.trtr? ?stliE ir?r#s >`? REPORT REPORT fi:L Rr",1-• <br />^R?QSS •..' REQUIREMENT #{ 30Ak,G [')" ?T .Y MX M--: <br /> SAMPLE R# p A !` <br /> MEASUREMENT <br /> PERMIT ii '=r # F1= r'RT is##?# !### It##?r# ::fx ?S( <br /> REQUIREMENT <br /> SAMPLE <br /> MEASURE T <br /> MIT <br /> QUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this documcmi and all attachments were <br />di <br />i <br />d <br />d <br />i <br />i <br />i <br />d <br />i <br />h <br />i TELEPHONE DATE <br />u ?/ prepare <br />un <br />er my <br />rect <br />on or superv <br />on <br />ance w <br />s <br />n accor <br />t <br />a fystem des <br />gned <br />+ 1 `v - S Y to a&sure that qualified personnel property gather and evaluate the information ? 1 <br />Fyn;u!•I f"?II , ntbmitted. Rascd on my inquiry of the person or prnom who manage the .ystem_ <br />or those persons directly responsible for gathering the information. the int?imuitiw ) <br />_ <br />c! .^ to the bat of my knowledge and belief <br />tau <br />submitted is <br />accurate <br />and corapicte v <br />(s/ i?pl? <br />_ <br />INC . <br />, <br />, <br />, <br />. <br />1 am aware that there ate si <br />nificant penalties fix submittin <br />false informaton $ GNATURE OF PRIN IPAL EXECUTIVE <br /> <br />TYPED OR PRINTED g <br />g <br />. <br />including the possibility of fine and im <br />risonment for knowin <br />violations OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> p <br />g <br />. CODE <br />L;UMMC14I 10 ORNU IMAM-AVIMI IV19 Vr RI9 T ?IV6AI IWIMJ (r+Qlara/INa air aglaWlIlMillai rlara) <br />b- FOR. i0 -Yi,': :'ECEIP EVENT, SUBJECT TO BURDEN OF PROOF REQUIREMENTS IN <br />) EPA Form 3320-1 (Rev. 3199) Previous editions may be used. r? Q ra 1 ?U???i9 a 4-p3it? irm.