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PERMrrTEE NAME/ADDRESS (lnehe& FmOfyNe.?Laearon I/DlOWwn) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPOE.SJ <br />NAME DISCHARGE MONITORING REPORT (OMRI <br />ADDRESS L <br />BOX :I PERMIT NUMBER DISCHARGE NLWOER <br />I A C MONITORING PERIOD <br />FACILITY 'E N11. MINE YEAR MO DAY YEAR MO DAY <br />LOCATION NIA C; 0 Q 14 FROM TO <br />-LIAM A. BEAR JR. MINE MG' <br />Form Approved <br />OMB No 2040.0004 <br />NOTE: Read Ir»trucdtxw before completing We form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> <br />E OF <br /> X ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />ll> REQUIREMENT .•, * ; ;f;k. I PIUt't <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT w tor. r?•? r id :/ !.... <br />)F- REQUIREMENT rlf j^,; ; 1 s <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###•: 4# <br />-i. REQUIREMENT r11J1; -; fiCfll"N <br />( SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT MA X GEI-; <br /> SAMPLE t .. <br /> MEASUREMENT <br /> PERMIT PI-1• <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I -ttty a r Pena ly o lew that this dorument and all stterhmenq were TELEPHONE DATE <br /> Prepared ander my direction or Cup-hilon In amordanre nIlh a system deallined <br /> I* e-re Chet gaallned pereonnel properly gather and e•duate the Information <br /> .1imlued. ,seed m my Ingalr) of the person or persom who manete the rysum, <br /> or thou persons directly repornlbk for jethering the Information, the Information - <br /> mbmttted is, to the bet of me tnenkdge and beef, Tree, a ntte. and complete. <br />I am snare Chat there are sltntnrant Penalties for.abmlttin <br />rape Inrermatlon <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED i <br />. <br />Inrladinf the possibility or nnr sM Imprhonment For knowing etolatl r OFFICER OR AUTHORIZED AGENT CAREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference eft attschmtrntb here) <br />EPA Form 3320-1 (Rev 3'99) Previous editions may be used r This 15 3 4-Pare Corm PAGE OF