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PERMIT-TEE NAME/ADDRESS (Include Facd0y Namr//oeation if iNfferenl) <br />NAME - i, , <br />ADDRESS r <br />Ci. BOX <br />LA <br />FACILITY HOF? T L <br />LOCATION LA <br />LAW E <br />C0 01424 <br />MINE MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (D MR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />MINOR <br />(SUBR t11 <br />F - F`7N( <br />Form Approved. <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REPO .'' <br /> REQUIREMENT JODA k`•iC> Dl: M• <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t T 9LF P. I <br /> REQUIREMENT >t Y is DA i i_ Y r'-x i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT yam:; _ r? E F'rtR l <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I -ruh under Penult of law that this document and all attachment. were <br />t <br />di <br />i <br />i <br />i <br />d <br />ith <br />d <br />i <br />d TELEPHONE DATE <br /> on or supen <br />n acvor <br />a se s <br />prepared under mi <br />rect <br />ston <br />ence w <br />em <br />es <br />gne <br /> o, assurr That qualined l-nnel properfN gather and r%alualr the information -- - <br />- -' - - submin.d. llawd on m% inquin of the w-n or prr.un% who manage the spsttm. <br /> or (host persons direclh r-i-miidc for gathering the information. the inro mation <br /> best of <br />s knowl <br />e and belief <br />true <br />accurtte <br />and com <br />lete <br />itt <br />t <br />th <br />d <br />b <br />d i <br /> . <br />, <br />p <br />. <br />m <br />o <br />e <br />m <br />e <br />g <br />. <br />su <br />e <br />s. <br />i <br />r <br />l <br />f <br />b <br />i <br />W <br />i <br />f SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED ormation. <br />gni <br />tcunt penu <br />tie, <br />or su <br />m <br />tting <br />,e <br />n <br />1 am aware that there are s <br />including the possibility of rune and itapriummmu (or ktpnwing , Iolati,mw <br />OFFICER OR AUTHORIZED AGENT AREA <br /> <br /> <br />NUMBER <br />CODE <br /> <br /> <br />EAR <br /> <br /> <br />O <br /> <br /> <br />AY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ? i [? + _T, 1ft& 1"*0aft -form