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PERMITTEE NAME/ADDRESS (include Facidir.vanelLocation rf(tifferent) <br />NAME <br />ADDRESS PIi <br />rt :. CC? 8 I <br />FACILITY i0R1 r'_!!lf\ M I I?E_ <br />LOCATION i GU 1 <br />._ANCE WADE, MINE MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <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 />I I NCB<< <br />SU <br />FINAL MN rR <br />"R&MINE DRNG TRIO TO TUTTLE OR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE t; <br /> MEASUREMENT <br /> PERMIT r .r HEPOR, <br />-4 REQUIREMENT T^45T MAX C <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 I certify under woodt) or law that this document and all uttachmend weir <br />pn?arrd under my direction or w <br />ervi ioa in accordance with u s <br />stem deri <br />ed TELEPHONE DATE <br /> p <br />y <br />d -- <br />?- <br /> to avwre that qualified personnel properly Rather and evaluate the information ' <br />-- <br />-- --- ?` submitted. Bared on m). inquiry of the perum or pentmy who manage the syytrm. - - '• ' <br />` or there persons directly responsible for gathering the Information. the information - <br /> <br />• whndtted is, to the hem or my knowledge and Helier, true. afftimir. and complete. <br />- <br />? fake Information <br />I am ¦wafe that them Oft significant <br />enalties for submittin SIGNATURE OF PRINCIPAL EXECUTIVE ' - - <br />TYPED OR PRINTED P <br />g <br />. <br />including the rxmibillq of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT CODA NUMBER YEAR MO DAY <br />GVMMtNIJ ANU tAF'LANAIIUN Ur- ANY VIULAIIUNb (Helerence all arracnmenrs here) <br />LIMIT APPLIED FOR IOYR/24HR PRECIP EVENT - SEE I.A.2, <br />'TIONS - I. C. 10, PG 20. 30 DAY AVG IS HIGHEST MONTHLY <br />EPA Form 33M l (Rev. 3199) Previous editions may be used. 1 - = T is-ii'a 4-part fOTni.