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PERWIrTTEE NAME)ADDRESS(7m*,driarOrfNmw?Lerar/awtfDlArvW) <br />NAME <br />ADDRESS - <br />BOX 483 <br />•41A CO <br />FACILITY i E NO. 2 MINE <br />LOCATION N I A C O <br />:_LIAM A. BEAR JR. r MINE <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY Y AR MO DAY <br />B 14 FROM TO <br />M G ?; <br />Form Approved <br />OMB rJo 2040-0004 <br />MINOR <br />(SUER MI <br />F - FINE <br />CHRONIC <br />NOTE: Reed k»tructlorw before completkig this lam. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />S Q PERMIT REPORT <br />,!MMEP.tTS i3ELf REQUIREMENT SINGSAMP <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT J <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/TTTLE PRINCIPAL EXECUTIVE OFFICER I -mly ..der penalty o law that this doevm[n1 and all attachmenb were TELEPHONE DATE <br />prepared under my dlrrcl$on or super"don In accordance with a system designed <br />to assume that qualified prrsonmi Properly gather and evaluate the Information <br />submitted. Bawd en my Inquiry of the person or person who manatr the system, <br />4 <br />or thaw Persons directly rspordble for tatherint the Information, the Information <br />the beat of m <br />keowled <br />s <br />b <br />itt <br />d Is <br />t <br />e <br />d b <br />Ir <br />d <br />l <br />W <br />l <br />t <br />' - <br />y <br />m <br />e <br />o <br />t <br />an <br />e <br />, <br />we, aecors <br />e, an <br />comp <br />u <br />, <br />e <br />e. <br />th <br />t th <br />l <br />ifl <br />itl <br />f <br />itti <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />I <br />t <br />b <br />f <br />i <br />f <br /> am aware <br />a <br />ere are s <br />tn <br />nn <br />Pens <br />es <br />or su <br />m <br />ng <br />ain <br />ormation. <br />n RE <br />OR PRINTED Inchrdint the Feasibility of Mm and Imprisonment for knowfnt rbistiorn OFFICER OR AUTHORIZED AGENT CODE NUNWR YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference *# attachments here) <br />PPT TS !'77 I FT 4AI_ ITY DFPlVF3 Ac, "%F4 F FCT ^PiIWTI ?,fdr <br />. I • ;?i-t.:.d ' y t 4 i --r?l -.. +?3i?.]• ii•tk??•!^+--?--* <br />EPA Form 3320-1 (Rev- 3/99) Previous edrbons may be used TtLS 1S a 4- fir Wrm. PAGE -OF