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PERMITTEE NAMEIADDRESS i1netude Facility Aamell"ation if Piffrrmti <br />NAME _ -C <br />ADDRESS i ! ! 1 1 I'd i <br />?O 81. 4 <br />FACILITY ., .IZON P7INE <br />LOCATION A CO 5-14 <br />?.ANC> WADE, r'11NE MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />MI NOR <br />( S UBR MH ) <br />F <br />,R - FINAL. <br />&MINE ORNG TRIB TO <br />Form Approved. <br />OMB No. 2040-4004 <br />I'RS <br />L <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT I 3UL: f?`JG DA I r` Mx 1°,i3NT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ! s:; -.r-:.; -- t.E F L, F1 t L' <br /> REQUIREMENT DA I L_'Y rl X <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .: I .<:. 't,.Y <br /> REQUIREMENT = 15A 1 L .: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t _ r i r <br /> REQUIREMENT )C:; T-?Ail_'Y' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />DAILY M'.; <br /> SAMPLE <br /> MEASUREMENTI <br /> PERMIT -i.. ._ t t <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I eertif) under prnalty of luw that this document and all attachments were TELEPHONE DATE <br /> Prepared under my dirmlion or wlK•ni,iou in Accordance with a system designd _ <br /> In assure that qualified persrutnel properly gather and essuluale the information <br /> submitted. Bwacd on my inquin of the pe-n or perms who manage the system. <br />or those persons dircc-ti responsible for gathering the information, the informaton . <br /> to the IKwt or m <br />, knowledge and belief <br />true <br />aec-l and complete <br />submit <br />d is - - <br /> . <br />. <br />. <br />, <br />: <br />. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I ant .ware that there arc significant penalties for submitting ralse information. <br />including the possibility of fine and imprisonment for knowing siol bons. OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. '`'' 1r{ T7w;-ii?i'4-paerTciVni.