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PERMITTEE NAME/ADDRESS p-e,r F.OiyN..?L«ato w IfD(nw) <br />NAME <br />ADDRESS - <br />0. BOX 187 <br />_, ; I G co 81 <br />FACILITY :,-.PPER MINE <br />LOCA 710N I G co 81 <br />VMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM_ INPOES! <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM - TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUDR !. - <br />F - FIN;,-,; MOFAT <br />i7SCHG Ti_ i:. i i ?'ifl CH <br />NOTE: Road kwtructlorw boforo compioting thlo form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />Of SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />TT- r- SAMPLE <br />! x: <br />"V <br />c;IJAL MEASUREMENT l <br />( <br /> PERMIT :s P F. 4i It#9E i£ it#il Ifs iE k;z t r h S A <br />\IT r-•I: l,l REQUIREMENT i NST MAX <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' "' " `?""y ° I,w drat en <br />prepared under my direction a sup k aceamertt and all .ttachrnents were <br />s on in occordsn with • ayatem dtalgned TELEPHONE DATE <br /> to More that qualified personnel properly gather and e.aluate the Information <br />wh <br />b <br />ill <br />d <br />n m <br />in <br />uir <br />f tM <br />w <br />th <br />t <br />B <br />d - <br />- <br /> <br />?' .. - m <br />o <br />y <br />q <br />y o <br />penoa or prrsom <br />o <br />, eoge <br />e 5" <br />em, <br />fu <br />e <br />. <br />oar j 4 <br /> or those persons directly reapetrrbk for gathering the lnrowmat,tm, the Information <br />/ <br />/ <br /> to the bet of my knowkdge and belief <br />trot, accurate, and compl te <br />submitted it ? • <br />`? ? / / <br /> . <br />, <br />a SIGNATURE OF PRINCIPAL EXECUTT/E . <br /> 1 am aware dial then ¦n Significant penalties for submitting fal r Informadon, <br />TYPED OR PRINTED I K Ing the poarbtute of erne and Impffoonment row knowing etot.uo"a OFFICER OR AUTHORIZED AGENT CAE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fReforenco aN attachments here! <br />I?! E SOLIDS LIMIT APPLIED FOR '-tOYR, 24HR PRFCTP EVENT- <br />- AON I TOR I NG <br />This Form 3320-1 (Rev. 3199) Previous editions may be used. is.a4-part orm. PAGE OF