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PERMITTEE NAMEIADDRESS (Include Facilily :Yame/Locutinn if UifJereml <br />NAME <br />ADDRESS <br />E,2fi <br />G0 B <br />FACILITY i iL)it I ZON M I P•iF <br />LOCATION I -A co El <br />LANCE WADE, MINE MANAGE <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <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 <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ==11DA AVG DAILY MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _. i r?'EPCtF•'. ; - . <br /> REQUIREMENT VH ' :.- "I r <br /> SAMPLE ' ' <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT Y, EP U R i <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 ee,iir, under penall) it lac that this document and WI ulmchments wore <br />ti <br />with <br />t <br />d <br />di <br />i <br />i <br />i <br />d <br />d <br />i <br />ed <br />d TELEPHONE DATE <br /> er m. <br />rec <br />on or wpen <br />n accor <br />ance <br />a s)Y <br />em <br />gn <br />prepare <br />un <br />s <br />on <br />es <br /> 1. .'lure that quulifid perwnnel proper]) wathlT and es 1-te the inrormation <br /> submit] d. Rased on nn inquire of the perv n or pers,ms who manage the system- <br /> or Ihox person direct]) resptmsiW for gulhering the information, the Information <br /> suhmittd is, to the [ t of m) Anowledge and holier, true. accurate, and cornplete. <br />t <br />if <br />t <br />lti <br />itti <br />l <br />ti <br />I <br />h <br />h <br />i <br />f <br />b <br />f <br />i <br />f SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED ere are s <br />ican <br />pena <br />orma <br />um aN are t <br />a <br />t <br />gn <br />es <br />or su <br />m <br />ng <br />a <br />se <br />n <br />on, <br />including the p-ibiltt) of fine and impris,atment fix knowing sirdatums, <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />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. E3 / Offtis18? 4-paFt fiOTltl.