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PERMITTEE NAMEIADDRESS (Include F"ifity.%amrflocation if Different) <br />NAME <br />ADDRESS <br />_A ?;L7 51 <br />FACILITY HORIZON MINE <br />LOCATION A <br />L.ANCF I+ADE • MINE 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 />MINOR <br />(5UBR MH, <br />F - F I NAi <br />5R!-MINE I <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 j <br /> MEASUREMENT <br /> PERMIT F"EPORT ?EFUR <br /> REQUIREMENT ;tiA AVG' DAIS ` (h <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ?fP0r?T <br /> REQUIREMENT •`1T`(i = ?"-AILY rIX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ?I , j r 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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I eer(ie) under penalq ,if law that this document and all attachments were <br />d <br />i <br />d <br />- TELEPHONE DATE <br /> prepared under m% direction or supenisioo in accordance with a %-Irm <br />es <br />gne -- <br /> to assure that qualified prnnnnel properi> gather and evaluate the infurntatioo <br />"- - submitted. Rased nn m> imluin or the pervm or persons who manage the spftem. - <br /> or thorn pennn, direct(, responsible for gathering the information, the Information <br /> <br />submitted is, to the hest of ms km,wirdgc and lalirf, true, accurate. and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />- L <br />` <br /> <br />TYPED OR PRINTED I ant aware that there arc signifh-Ant penalties for submitting false infurmatiua. <br />including the pn.ihilit? of fine and imprisonment for knowing .iodation,. 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. C -.'1F-h131S-3`4=pa#t farm.