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PERMITTEE NAME/ADDRESS (include F'acili(v.4'ame/Lucarion if iNffennt) <br />NAME F.'', ADDRESS <br />?Ll 61424 <br />FACILITY to I NL <br />LOCATION _a CO e 1 424 <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 />OMB No. 2040-0004 <br />M I.AJOR <br />(SUBR <br />F - I NAL I NTi <br />5RVve111 NF D R N G TD TUB <br />NOTE: Read Instructions before completilTg•this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> >< ANALYSIS <br /> AVERAGE MAXIMUM <br />i UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT' <br /> PERMIT <br />' <br /> REQUIREMENT '• AV?? DAILI' ";A rl <br />i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -, .r Jf. I r , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT rFr '7I _ U . <br /> REQUIREMENT 'ODA AVIa „1Lr FI;. Jfri <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT }.u r q t _ .. ;r•:. .- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT at x3t? 1 <br />1-T 7 <br /> <br />r i <br /> <br />- <br /> REQUIREMENT SODA Y ?1:: DA I L <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ar <br /> REQUIREMENT rJrt "i 7A:LY M" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif., under Penults of law that this document and all attachments were TELEPHONE DATE <br /> prep.md under m? direction or cuwr%ision in accordance with a yMem designed <br />' - - <br />- <br />- - to assure that qualified Personnel properly gather and evaluate the information " <br />' <br /> ubmilled. Rand on mi inyuirv of the per on or person who manage the system. <br /> or thosr pr-ns directh responsible for gathering the information. the information - <br />- -•- <br /> wl <br />d Belief <br />le <br />and com <br />lor <br />ilt <br />t <br />th <br />I" <br />d <br />e <br />t <br />e <br />ccur <br />h <br />d i <br />f <br />k 1 v <br />? w1 <br />- p <br />. <br />o <br />m> <br />no <br />e <br />g <br />an <br />, <br />ru <br />. a <br />u <br />. <br />su <br />m <br />e <br />s. <br />e <br />o SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED 1 am aware that then arc significant pemdtira ror submitting false information. <br />including the ibditq of rinc and im rev rurm for knowin • viotations. <br />k p .; P k OFFICER OR AUTHORIZED AGENT AREDA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used 00229/CffnA1i:y4--0at Jbrn-I.