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PEAWME NAME/ADDRESS t7,.AA l wojyN..wLaeasbw (/D(QF.w) NATIONAL POLLUTANT OISCMARGE ELIMINATION SYSTEM //NPDESI <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />130 X PERMIT NUMBER DISCHARGENUMDER <br />`R SET MONITORING PERIOD <br />FACILITY ::BORN CRK ELK R}? MINE'_` YEAR MO DAY YEAR MO DAY <br />LOCATION =RSE1 CC: ci FROM TO <br />MES T. COOPER. EXEC V. <br />Form Approved <br />OMB No. 2040-0004 <br />MINOR <br />tSUDR NH; <br />F - FINAL : z <br />SEDIMENT POND TO SANBORN CREI=f^. <br />y <br />NOTE: Read Instructlom before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ; <br /> MEASUREMENT <br /> PERMIT jt##at ## =# It##it b. ####" ' O - c 1 I N T' I <br /> REQUIREMENT M I N I Ill U:' MAX I MUM <br /> , <br />T N T AL SAMPLE s: • ;... <br />;_. D MEASUREMENT <br />0 1 C PERMIT ####ii# #?E lrst !f ###?? SS t 1 7'AD <br />U%N'T REQUIREMENT SJUf? f,'Ji; ILY" ? :II <br />D 'S E SAMPLE <br /> MEASUREMENT <br />Q PERMIT # ### tt ;:: : ###4r is # ft## I! REPORT REPORT <br />;ROc ,.; REQUIREMENT ?{ODA AVG DAILY MX NDNT?- <br />i AL SAMPLE <br />CE MEASUREMENT <br /> PERMIT ;:###it ####1F# ###### S ?C!C) ','OU ! I C GR,-,L? <br /> REQUIREMENT RODS - DA I L `f MX <br /> SAMPLE 4: > <br /> MEASUREMENT <br />`?' 1 O 0 PERMIT =###_k ####IE# it##### #####tt :t0 t?!`!i Ir f;Ai3 <br />O?2GS REQUIREMENT # INST MAX iT <br />'I CONDUIT SAMPLE <br />TMENT PI MEASUREMENT <br />n PERMIT REPORT REPORT N <br /> <br />:. <br />T - <br /> <br />_ <br />t , REQUIREMENT SODA AV' DAILY MX rtpr.: <br />s ' SAMPLE <br /> MEASUREMENT <br />PERMIT is k ;t t? xf; . s?i1 i:. sr i ;? . ?•.: <br />REQUIREMENT NST MAX MG," <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t t'°^t(y u ` pens ty n 1.. that thh document and all atlachmenU .1'" <br />TELEPHONE <br />GATE <br />prepared under my dlrectton or super.hion In accerd-.Ilh a system dnl[ned <br />. to atfun that qualified personnN PrOWY Lather and evaluate the Infornullon <br />submilled. aced " my Inquiry of the penow a perwea, who manage the system. ? <br />di <br />tl <br />ybl <br />th <br />f <br />rec <br />y mpere <br />or <br />ose prrsorw <br />e <br />or gatAering the Inrormallow, the lnforwrtton <br />b <br />d 1% to the best of m <br />knowled <br />s <br />lft <br />d b <br />t <br />( <br />li <br />f <br />? <br />f <br />y <br />I <br />u <br />m <br />e <br />ge an <br />e <br />e <br />. <br />rue, a-un <br />e, and mmpkle. <br />?_. <br />I ¦m ¦w.re that then ¦ e dgdficnt pen¦t1les I_ suhmitun <br />6he info matlon <br />SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> g <br />. <br />TYPED OR PRINTED Including the Prniblllt, of fine and Imp lx nment for k-ing .Id.Uo i OFFICER OR AUTHORIZED AGENT CAE NUM[IER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference off •ttachmonts here] <br />4HR ^1-?, , n -' )FK T, <br />f LEABLE SC)I__ IDS LMT APF'!.. T rr, T q nYF? <br />7F` T <br />r R: 24HR EVEN <br />OF ' T <br />is a 4-part. form. PAGE <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This