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PEIIMITTEE NAME/ADDRESS (7-" Far+ItryNawa?Lec«tan yD(fww.t) <br />NAME <br />ADDRESS <br />KEFZ Lush co 8 <br />FACILITY =-OWYO MINE <br />LOCATION ..-KER CO E <br />LLY D. SANDERS, VP OF OP <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM (NPDES/ <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER 04SCHAAGE NUMBER <br />MONITORING PERIOD <br />YEAR O DAY YEAR MO DAY <br />FROM -• ? TO <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Read k%structiorr bafwo complat" We form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ` L) LD ?D ZL? ± '.'? <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />:30DA AVG <br />DF11LY M <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 /> <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rend.. err Pena I a s. that thb doconrnt and all .nachrrtav+u were <br />TELEPHONE <br />DA <br />TE <br />% <br />' prepared under my direction a supes.ttlon In accordance with a system dedpwd <br />toR thot ya.fined perwnnel property gather and evaluate th.Inrorm¦tlon <br />/7 f, <br />!? L submitted. Baaed on my Inynlry of the person or persons who manage tM s <br />stem '• ?/ <br /> y <br />. <br />or those penorw directly responsibir for gathering the Information, the Information ? <br /> <br />1. <br />-Z) 1 (j/ <br />4/ <br /> submitted b, b the best of my ?newledte and belle/. Irw, accurst.. and complete. / <br /> I <br />ln <br />d <br />i <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> am aware that there aver s <br />tn <br />car <br />penelda roe subm <br />lnng False information, AREA <br /> <br />TYPED OR PRINTED <br />Including the possibility of fine and Imprisonment for knowing .Idatinni <br />OFFICER OR AUTHORIZED AGENT J <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference 0affachmontshere] <br />4HR PRECIP EVENT IS CLAIMED. IF CLAIM APPROVED BY WOCD. <br />a _ D MEASUREMENTS - SEE I. A. 2, PG. 3 FC' - <br />-'.?RTP.i.Y SAMPLXI<!C' rNST'P.UCTIONS - I. C. l <br />EPA Form 3320.1 (Rev 3.99) Previous editions maybe used r" t 3 ! ''N1?lI'g'a at=pays {pntl. PAGE OF