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PERMITTEE NAME/ADDRESS Ifndade F'aci&y AttwAocatlon if thfferent! <br />NAME <br />ADDRESS <br />5LDX 628 <br />LA C; <br />FACILITY HORIZON MINE <br />LOCATION _A C <br />I ANr'F WAnF. MTNF MAN <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 M DAY <br />FROM TO <br />Form Approved. <br />OMB No, 2040-0004 <br />MINOR <br />( SUBR MIA) <br />F - FINAL <br />SI°t&MINE rjRNG TO CALAMITY URA <br />P1 ,ITRF <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />L <br /> MEASUREMENT] <br /> ?.x <br />PERMIT REPORT <br /> REQUIREMENT 30DA AVG ).)-' ILY MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT gat :f it T.4 IT <br />t Jr <br /> REQUIREMENT uA ur+IL Y i <br /> <br /> SAMPLE <br /> <br /> MEASUREMENT - <br /> ? <br />' r?_. <br />t:• < <br /> PERMIT r. <br />. _ . <br /> REQUIREMENT Y MIX <br /> SAMPLE --? <br />_; L. MEASUREMENT % <br />) PERMIT <br /> REQUIREMENT ?T)A AV Dry I LY f tX <br /> SAMPLE 1 I I - <br /> MEASUREMENT f <br /> PERMIT ' <br />JjTfr- <br />r <br /> REQUIREMENT -10DA AVG OA I LY N X <br />J''JT} <br />rl <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT C,DA AV3 )7t,ILr' MX ; <br /> SAMPLE - <br /> MEASUREMENT l <br />PERMIT x-.; t ...... ,. r:. K - ' <br />REQUIREMENT C; ", [•. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under prnaHs of taw that this document and all attechmenls wets TELEPHONE DATE <br />Prepared under my direction or supersWon in accordance with a srstrm designed - <br />tn nswre that qualified personnel properly gather and e%aluale the information % <br />- <br />wbmitted. Haled on my inquiry of the perWnt or Persons who manage the systrm. <br />or those presnns directly respoaMhle for gathering the informatiom, the information' f - <br />- .uhmill,d is, In the Iwrt of nn knowledge and hellef, true. accurate. and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />' <br /> I am aware that there are significant penalties for suhmitting false Information. <br />wi <br />t f <br />siolntio <br />h <br />i <br />ili <br />f fi <br />d i <br />i <br />k OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />TYPED OR PRINTED -men <br />or <br />nu <br />n <br />ns. <br />including t <br />e Poss <br />ne an <br />m r <br />b <br />ty o <br />P g <br />COMMENTS AND EXPLANATION OF ANY VIULAIIONS (Ffererence an arracnmenrs nere/ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. -0001S `T7ft - !F4i'4=0ah-f17b1 n.