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FERMITTEE NAME/ADDRESS (Imr"FeeWry lfooWLoe.rronIND4ff-arr) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPDESJ _ Form Approved. <br />NAME DISCHARGE MONITORING REPORT (DMRJ OW No 2040-0004 <br />ADDRESS <br />-/_,1 SZ A T i PERMIT NUMBER DISCHMIGE NUMBER <br />FACILrTY ':..OWYG MINE MONITORING PERIOD ?.- <br />LOCATION `KER YEAR MO DAY YEAR MO DAY <br />FROM TO <br />-i;,LY 1). SANDERS, VP --F NOTE: Road Instructions b*for* completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREGUNCY <br />EX SAMPLE <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NA ENTITLE PRIN PAL EXECUTIVE OFFICER I erm y" r penalty ° '" `b'-1 aHd«,r7n"*' me sa."Kn?en? "eR TELEPHONE <br />prepamd artder my titre or svpervd= ccordan.. with a system de!linea <br />/ 1.4e m that 41u.ened PrM.-t properly gather and e.duele the W-matlon DATE <br />ebmdlled. Reed on my loqutry d the p.reatt or persorm who man.ge the system. _ <br />1 <br />or Ihore prrsoe dimity resporMble for plheAng the Inro-stion• the Information <br />.4 <br /> <br />. <br />submitted b, b the bet of ml knowledge and better, true. a.tlrrate. and complete. <br />l /v ( /,Z 1" <br />iIONATVRE Of ?RINCNAL EXECUTIVE <br />l <br />lB <br />M <br />i <br />, <br />t <br />/ <br /> I am a+.r. that then am s <br />gn <br />c. <br />penalt <br />es for ntbm <br />ng robe Inform atlon, <br />tt AREA <br />TYPED PRINTED <br />OR tn.tadlni 1b. poeWbl8ty of rim and Impe+sonment for Itm Ing Wado w OFFICER OR AUTHORIZED AGENT NUMBER <br />CODEI YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (RoforencsoNsttachmsnrshors/ 4HR PRFCIP EVENT IS CLAIMED. IF CLAIM APPROVED BY WQCD, <br />?ANTS - SEE - <br />i Mt7 i hd>>Y'RL• <br />EPA Form 3320.1 (Rev 3/99) Previous editions may be used nIS iS a 4-part form. PAGE OF