Laserfiche WebLink
PERMITTEE NAMEJADDRESS Include Facifity.h'ame/Locarion if Oif /rent <br />NAME <br />ADDRESS I NE <br />• ??i3 <br />FACILITY i Z ON f'i i N-1- <br />LOCATION <br />i? <br />LANCE WADE, MINE .-iAN <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />8 FROM TO <br />ER <br />Form Approved. <br />MINOR OMB No. ZMO-0004 <br />(SU13RC teii-i) <br />F - FINAL. MNTRS <br />5R&MINE DRNG 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 ?. K <br /> MEASUREMENT <br />- <br /> PERMIT i ?• t V, "..'r, 'V 17 17 77 r; Z <br /> REQUIREMENT 3P T R GR T F <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r n <: <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT A r- , <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 certif. under penult of law shut this document and all attachments were <br />e <br />klo <br />a <br />d <br />d <br />di <br />e <br />tio <br />u <br />c <br />i <br />ac <br />o <br />d <br />ce with <br />te <br />d <br />si <br />d TELEPHONE DATE <br /> prep <br />re <br />un <br />er my <br />r <br />c <br />n <br />r <br />up <br />n <br />n <br />n <br />c <br />an <br />a sys <br />m <br />e <br />gne <br />r - <br /> to assure that qualified personnel properiy gather and esaluate the informatina - <br />., - --- ---- submitted. Bused in ms inquir) of the person or persrms who marwge the s.?tem. •, :L- ? _, <br /> or ihtnr pemms dimlt responsible fur gathering the infornution. the inforntallun <br />. i submitted is. to the best of m't knowledge and briler <br />true. accurate. and complete. . / : - <br />- -- , <br />I <br />th <br />t th <br />e <br />i <br />nifica <br />t <br />ltie <br />f <br />b <br />itti <br />r <br />d <br />i <br />fu <br />ti SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINT CD am uwam <br />a <br />er <br />arc s <br />pena <br />s <br />or su <br />u <br />e <br />rmu <br />on. <br />g <br />n <br />m <br />ng <br />n <br />Including the posaibdity of fine and imprisonment for knowing siolations. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev 3199) Previous edition may be used. 0036 "MISis a 4-pant fot'm.