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PERMMM E NA MEIADDRES S (7-A- a F.,Oy N..,?L° .,- (t Dae.,wr) <br />NAME <br />ADDRESS <br />dIA CD 8142 3 <br />FACILITY I E NO. I ! Y NH <br />LOCATION 41A 00 814213 <br />.LIAM ii. HEAR JR. , MINE MGR <br />NATIONAL POLLUTANT OISCHAAGE ELIMINATION SYSTEM INPOESf <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER OfSCHAAOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />?;_, Form Approved. <br />?- G--?'OMB No. 2040-0004 <br />R <br />R MI-Ill <br />FINAL JD i <br />NOTE: Read irictrucdor,» before eompletino this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FRIOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ .. - r <br /> REQUIREMENT <br />• it <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : r •:-•x :. :: : . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br />I•tU,•.i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT CE' R: 3 <br /> REQUIREMENT IL .: } IfT , rLi <br /> SAMPLE - <br /> MEASUREMENT <br />0 PERMIT ?. # ? r, ;> s ; ??i': <br />:_ E? REQUIREMENT <br />GEi: " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT F,Ok 11 REPORT •? =_e <br />i REQUIREMENT <br /> SAMPLE :. . <br /> MEASUREMENT <br />PERMIT 4 - -. <br />REQUIREMENT <br />fl, <br />NAMEmnE PRINCIPAL EXECUTIVE OFFICER 1 m r' pt"•'y ° •w that Ihls documtnl and all .Itacfimrnte were TELEPHONE <br />DATE <br />prepared under my direcllon or fuper+l>fon In •crordanre wllh a yelem designed <br />to ensure That qualified personnel properly galher and tyaluale the Information <br />.wbmllled. eased on my Inquiry of the person or persons who manage the ty.tem <br />or those persons directly responsible for gathering the Information. the information <br />submllled t.. to the bell (-y knowledge and belief, true, arrvnte• and complete. <br />I am swam That them am signifl a l pmaltla for submittin <br />rate lnformatt <br />SIGNATURE OF PRINCNAL EXECUTIVE <br />TYPED OR PRINTED g <br />on. <br />Inchsding the possibility of not and Imprtsonment for knowing violations. OFFICER OR AUTNORIZED AGENT AREA NuM[iER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference dJ attachment: here] <br />EPA Form 3320-1 (Rev 3199) Previous ed lions may be used This is a 4-part form. PAGE OF