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PERMITTEE NAME/ADDRESS ilnrlude Facility .Fame//oration if thgernW <br />NAME <br />ADDRESS <br />l B? n ?scs <br />FACILITY HOR D N MINE: <br />o <br />LOCATION _a G <br />MINCE WADF-, MINE MANAt: E <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT (D R) <br />I <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />MINOR <br />(SUOR MH ) <br />F - FINAL. <br />cJR&M I NE DRNG rR T R TC <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• FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT FZ )=?= : -: 1.4 C: E. r? <br /> REQUIREMENT DA I L'Y 111 X" MC114 T F <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT A 5 <br /> REQUIREMENT I ;'LiA AV(.; : LY" MI •::/l_ <br /> SAMPLE - - <br /> MEASUREMENT <br /> PERMIT r t T R EP OR i ir? 3 <br /> REQUIREMENT ViT ue' 1 t <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 ceruf% under fienalls of In% that this thwument and all attachments Mere <br />red u <br />ection or s <br />ero-m i <br />ord <br />r with <br />re <br />de <br />m <br />di <br />a <br />s <br />ste <br />dei <br />ed <br />TELEPHONE <br />DATE <br /> p <br />pa <br />n <br />r <br />y <br />r <br />op <br />n <br />cc <br />anc <br />a <br />l <br />m <br />gn <br /> u, -ure that'l-lifird peraonnea proprrh gather and rsaluate the inkamation <br />- mhmitt •d. Rayed on m? inyuin of the fw•ram or perwns who manage the -trm• - <br /> or theesr persons direcdy respottsihte for gathering the information. the information <br /> %ubmitt d i., to the hest of my Am)%Irdgr and belied. Irur. accurate, and compirte. , <br />_ <br />w <br />ifi <br />en <br />lties fo <br />false i <br />I a <br />th <br />t Th <br />r <br />si <br />t <br />s <br />b <br />itti <br />fo <br />atio SIGNATURE OF PRINCIPAL EXECUTIVE --" <br /> m a <br />are <br />a <br />em a <br />c <br />gn <br />can <br />P <br />a <br />r <br />u <br />m <br />ng <br />n <br />rm <br />n. OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED including the r-ibifity of rant and imprisonment for knowing sioladort. CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. !-M, tbrm.