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PERMTTTEE NAME/ADORES Si7.&UAiet4kiy Js.WLerrren4/D(p4+nr) <br />NAME <br /> <br />ADDRESS 1 <br />FKER G, <br />"-OWYO <br />1 <br />MINE <br />FACILITY <br />LOCATION ': K. ER C <br />;-LLY D. SANDERS, VP OF <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPOES) <br />DISCHARGE MONITORING REPORT (DAR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO I DAY <br />FROM TO <br />Form Approved <br />MINOR OMs No. 2040-0004 <br />(SUBR JC ) <br />NOTE: Read Instructions before completing this 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 <br /> MEASUREMENT <br />,.: <br />1 <br /> PERMIT <br />'FDA AVM <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 /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />1 "11.1y under penally o ow that this document and all attachments were NAMF <br />TELEPHONE <br />liTTLE PRINCIPAL EXECUTIVE OFFICER DATE <br />, <br />Prepared under my dlrertloe or super.lslow in accordance with ¦ system de?f?ned <br />/7 t to atture that qualified personnel properly gather end evaluate the Inftwmatlon <br />R <br />i <br />submitted. <br />ated on my Inqu <br />ry of the person or person who n oge the syo rm, <br />or those persotw dtrxtly responsible r« gathering the Informauow, the Information <br />_ submitted Is• to the het of my knows due and belief. true, accurate. and comitwe <br />; <br />?sl JJ-}L-?? <br />L <br />_ <br />% i <br />. <br />5 4 <br />Nn <br />1 T!'- f <br />th <br />t th <br />ar <br />c <br />rm <br />lel <br />f <br />b <br />r <br />t <br />I <br />f <br />SIGNATURE OF PRINCWAL EXECU•TNE - <br />r <br />itti <br />ti <br /> am awe" <br />a <br />ere <br />e <br />r,n <br />p <br />a <br />" <br />or su <br />m <br />ng <br />a <br />n <br />r <br />a <br />orma <br />on, <br />t AKA <br />TYPED OR PRINTED including the pndbl9ty ornne and Imp <br />oonment for knowing elolsoom OF tallk OR AUTHORIZED AGENT CODE NUM8ER YEAR MO OAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fRs/srsncNr all att?chmtrntahsiaJ '4HR PRECIP EVENT IS CLAIMED. IF CLAIM APPROVED BY WGCD: <br />'EMENTS - A. 2: r•l r. - . <br />I ONS - <br />EPA Form 3320-1 (Rev 3/99) Previous edtbons may be used t f "?If' `tIS TS a Ja-?iI fOTrn. PAGE OF