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PERMITTEE NAMEIADDRESS i1ndude F'aci&7,VameRotarinn if DiJfenrul NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (D MR) <br />ADDRESS ;i <br />aX PERMIT NUMBER DISCHARGE NUMBER <br />?EN MONITORING PERIOD <br />FACILITY ?A MINE C1_ii YEAR MO DAY YEAR MO DAY <br />LOCATION 'j EN FROM TO <br />unoI'll ricer ,i <br />Form APrjroved <br />OMB tao 9( 40-0004 <br />MINC <br />(SUP <br />F - <br />GNRC <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMEN T <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ` <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT = r (-! .' _ ; r,? <br /> REQUIREMENT <br /> SAMPLE <br />' <br /> MEASUREMENT ; - <br /> PERMIT I . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT U <br /> <br />PERMIT <br />- <br />! <br />„ <br />% <br /> REQUIREMENT AMA <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT I <br /> REQUIREMENT <br /> SAMPLE ?- I j /1 S v <br /> MEASUREMENT V V <br /> PERMIT s .. F, LIT p <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certih under penah% of taw that this doeun,erd and all attachments were <br />i <br />d <br />i <br />h <br />d <br />i <br />d TELEPHONE DATE <br /> prepared under m% dirtstion or wpenis <br />on In :wcur <br />ancr w <br />l <br />es <br />gne <br />is system <br /> to assure that qualified penonnel properh gather and evaluate the information <br />h <br /> submitted. Rased on m) imluin of the perwm or persons who manage t <br />e -I m. <br />or thme persons directh re-sponsiblr for gathering the Infmmation• the infarnurtlon ?. _ <br /> e and belief <br />aecunte <br />and compkte. <br />submitted is <br />to the lx t .d ms knowled <br />in. - •, <br /> , <br />. <br />, <br />g <br />. <br />l <br />f <br />b <br />i <br />i <br />f <br />l <br />f <br />ti SIGNATU E OF PRINCIPAL EXECUTIVE 1 ?• <br /> <br />TYPED OR PRINTED on. <br />I am aware that there art signifkant pena <br />ties <br />or su <br />m <br />ng <br />se In <br />orma <br />tt <br />a <br />including the p.nsibilus of fine and imprisonment for km.wing shelatlone <br />OFFI R OR AUTHORIZED AGENT AREA <br />DE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND tArLRIVR 1 IUIY yr RV IT V IULR I IUI`IA (nrrertsrce 00 attnOrrrrrrrrts rrarttrl f <br />OWTH & REPRO] <br />EPA Form 3320-1 (Rev. 3,199) Previous editions may be used. _ - ' TI?iS W 4-part form.