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PERMITTEE NAME/ADDRESS rlnclude FariGty Name/Locarion if D ifferearl <br />NAME L. i <br />ADDRESS <br />bssf 2S <br />61424 <br />FACILITY HEIR <br />LOCATION v ;. 1424 <br />LANCE WADE, MINE MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />t"'t I NOR OMB No. 2040.0004 <br />( SUBR <br />M,- INTERLM l'IN R5 <br />5R&MINE DRNG TO CALAMITY DRAW <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUE14CY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />s >r Sr 4r <br />r <br />7 <br />7, T, .- .. T 1 01 1. <br />Z. : <br /> REQUIREMENT I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 1.97w- 77, <br /> REQUIREMENT .:'v%,P ;-tV <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT + <br /> REQUIREMENT <br /> SAMPLE <br />• c_ ._ , :. L. MEASUREMENT <br /> PERMIT <br />- <br /> REQUIREMENT :- Dr'. . .3 Dt i ] 1_ v it;• ` <br />: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT y <br />' <br />' <br /> REQUIREMENT ; ii-, T I <br />DA .( L <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crrtifi ,-der penaut ,flaw that this diwument and all attachments wen <br />i <br />h <br />d <br />i <br />d TELEPHONE DATE <br /> Prepared under mi dirertion or supervision In mvordarwr w <br />n s)strm <br />es <br />gne <br />t <br /> to assure that qualined Personnel properly rather and evaluate the inrormation <br /> submitted. Rased on my inquire of the Person or persons who manage the ssstrm. <br />` or ehox pcrvons directly mp,nsiblc for gathering the Information, the infurmal}oe <br />1 <br />. <br />. to the bast of m <br />accurate <br />and complete <br />submiurd is <br />knnwied <br />c and bellef <br />true <br />, <br />, <br />?" - . <br />, <br />} <br />g <br />. <br />, <br />. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />- <br />- 1 am aware that there are significant penalties for submitting foist Information, AREA <br />TYPED OR PRINTED i including the posslb,ilitl of floe and impri-nn rat for knowing Ooletiom. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIVLAIIUNS (xererence an anacnmenrs nere/ <br />LIMIT APPLIED FOR IOYR. 24HR PRECIP EVENT - SEE I. A. 2, <br />rIONS - I. C. 10, PG. 20. 30 DAY AVG IS HIGHEST MONTHLY <br />EPA Form 3320.1 (Rev. 3189) Previous editions may be used. This is a 4=pail 1.