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pERMITTEE NAME/ADDRESS ()r.r" FaNhry)lama?Lec«row t(Pto6 ,) NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM (NPOES1 Form Approved. <br />NAME DISCHARGE MONITORING REPORT IDMRI OMB No. 204G-0004 <br />ADDRESS <br />/,31 S I 'A i PERMIT NUMBER psCHMOE NUMBER tiN!? <br />FACILITY OWYO M I NE MONITORING PERIOD <br />YEAR M DAY YEAR MO DAY <br />LOCATION '_KER CG) FROM TO <br />Y SANDERS, VP OF (] NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, <br /> <br />EX FREOVENCr <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSTS <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 />MEASUR <br />MENT / <br /> E <br /> PERMIT <br />- -. <br />_ ;) <br />- <br />'G `' iA! REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br />UEP, " REQUIREMENT n . I ; r? 7 <br /> SAMPLE <br /> <br />T <br />ASUR <br />ME VA <br />- <br /> ME <br />E <br />N <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE I <br />A <br />' <br /> MEASUREMENT / y / N - <br /> <br /> PERMIT <br />r. '.' REQUIREMENT T1-4ST <br />_ <br />T SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />AEQUIREMENT <br />L <br />NAME/TITLE PRIM PAL EXECUTIVE OFFICER tnrtry " r pen. y ° aw that Wti dw mrot and aN o1whemmts were TELEPHONE <br />Prepared weeder my dlrertfow or wPrr.hien In a rdann .flh a system dedtnr f <br />r; £ ` to assure that gM.flned personnel Property gather and evaluate The InrmMmatton DATE <br />anbmltted. 6owd on my Twqutry of the Ptnon or penotta .Iro mawage the syrtrm. <br />C <br />? <br />or flow persona directly reporolble for gathering the Information, the Inrormallnn <br />/ ,!•?' ^ /?' 7 <br />' .'•,l? sub illyd K to the bet or my krro.ledre and belief, true. Kc ratr. and complete. <br />YN " <br />SIGNATURE OF P"INCWAL EXECUTIVE <br />rfft <br />l <br />"J <br />b"Itl <br />tit <br />I <br />r <br />h <br />h <br />f <br />f ; - C` <br /> en on <br />p <br />can <br />rrg <br />re <br />n <br />orm mon, <br />I am a.an t <br />at t <br />pena <br />es <br />or m ARE <br />TYPED OR PRINTED Incl"ns the pomlblYy of flat and Imprhonrnent for kno.fng vidatlerm OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION O F ANY VIOLATIONS (Reference aM attachments hors) <br />4HR PRFrTP EVENT IS <br />CLAIMED. <br />IF CLAIM APPROVED RY WgCD: <br /> <br /> 2, <br /> ? 3- <br /> 7 11S iS.3 4-pat/ form. PAGE OF <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used