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PERMrTTEE NAMEIADDRESS (Include Far&.v Name/Larotion iJDifferent) <br />NAME <br />ADDRESS <br />f,-7C) <br />0. BOy <br />CD 61539 <br />FACILITY MINE COMPLEX <br />LOCATION CIE) B 163q <br />`.ARO. PECLAP1A-TION 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 Ap oved <br />OMB No-2040.0 <br />MINOR <br />(SUBA <br />F -- FI <br />DSCFl6 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE i <br />I / <br /> MEASUREMENT <br /> PERMIT - r vF _ i 1. r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT : <br /> - ? <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 b crrtifs under penalty of law that this document and all atlarhnens wen <br />i <br />e with a system d <br />r <br />a <br />ed <br />der <br />s di <br />n-tio <br />o <br />. <br />r <br />.isio <br />c <br />o <br />d <br />si <br />n <br />d TELEPHONE DATE <br /> p <br />ep <br />r <br />un <br />m <br />r <br />n <br />r <br />up <br />r <br />n <br />n a <br />c <br />r <br />anc <br />e <br />e <br />g <br /> la assure that qualified pe"innel properly gather and eyaloatr the information <br /> suhmittad. Rased on my inquiry of the person or persons who, manage the %>stem, <br /> or Thar percan. dirmlly responsible for gathering the information, the infortrtathon ` f f <br /> submitted is. to the hat of m. knowledge and belief, true, accurate. and complete. <br />w <br />e si <br />ke inform <br />tion <br />I am <br />that then <br />ifi <br />nt <br />enalti <br />ra <br />submitti <br />r SIGNAT E OF PRINCIPAL EXECUTIVE " <br /> <br />TYPED OR PRINTED . <br />a <br />are <br />ar <br />ca <br />p <br />es <br />r <br />a <br />a <br />gn <br />ng <br />including the Im"hility of fine and imprisonment for knowing tiodati(ms. <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />)IF <br />EPA Form 3320-1 (Rev 199) Previous editions may be used. 00414 / 0Thj5l tGl S $-pin `f6rm.