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PERMITTEE NAME/ADDRESS hurled a Famifr.vans /l.mafion if lAfffranft NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />X PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />-Il_t< I ZI_ii i YEAR MO DAY YEAR MO DAY i <br />LOCATION L_A FROM TO <br />i ANC FF WAri <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL_ !"INTRS <br />SR&MINE DRNG TRIO TO TU I•TLE DR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT vDF A`JG DA I L'r f•I <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT t r, .. :r •F r. > ., FE r. ! <br /> REQUIREMENT -U-DA AVG DAIL_'Y <br /> SAMPLE <br /> MEASUREMENT i - % <br /> <br />PERMIT <br />- .: <br />Rrr <br />r_s-`jr: ! <br />17 <br /> REQUIREMENT <br /> SAMPLE - <br /> MEASUREMENT - <br /> PERMIT * tt r< 1 <br /> REQUIREMENT Dt% I I t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT {OTtfl <` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT n , <br /> REQUIREMENT DA I i- Y ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMErnTLE PRINCIPAL EXECUTIVE OFFICER I t,crtifs under penalt% of lu% that this document and all altuchments were <br />re <br />ared undrr m <br />dirmti(m nr sti <br />• i,ion in mvc,rdame with a s <br />slem desi <br />ned TELEPHONE DATE <br /> p <br />p <br />? <br />w <br />% <br />g <br /> It, ussurr that qualified personnel prymrh gather and rsaluatr the information ` <br /> submitted. Buxd un m% inyuin of the person or prrwm wfio manage the s+ztem. <br /> or lh- W-n, dined} reslum.ihle for "llienng the information, the information <br /> uhmill d I,. to the brut or m, knowledge and trclirf. true, accurate, and complete. <br />I <br />in <br />t there, <br />t <br />ttn <br />f <br />b <br />itti <br />th <br />i <br />if <br />f <br />l <br />I <br />f <br />ti SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> <br />TYPED OR PRINTED ur,u <br />d <br />.-am <br />a <br />are s <br />gn <br />ican <br />pcna <br />ng <br />a <br />n <br />orma <br />on. <br />t <br />m <br />x <br />it, lading the 1-ibilits of fine and impris,mment for Lmreing %iolutions. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIULA I IUNb (Hererence all anacnments here) <br />EPA Form 3320-1 (Rev. 3.199) Previous editions may be used. ' Tffil ? 1S`-a' 4=?tiFi' f01 iii. PAGE OF