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PERMITTEE NAME/ADDRESS ditclude F'"Wi.ii.tame1loriftion tjDiffereN) <br />NAME <br />ADDRESS 1 -;OR I Z ON MINE <br />BOX 62%?a <br />'L in, '_:D 314r` <br />FACILITY i-1D( 1 Z0 M I NF <br />LOCATION LA f-0 3142 <br />LANCE Wf?D =, MINE MAPIAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <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 />NAL <br />E DRNG TR <br />MNTRS <br />NOTE: Read Instructions before completing this form. <br />PARAMETER <br />I QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />SAMPLE <br /> <br />>< OF <br /> EX ANALYSIS TYPE <br /> AVERAGE <br />I MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE i r <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT '3QDA , :`G DA 111-'y' MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 19 Ef <br /> REQUIREMENT -; r1?r`v i1+=1 i i i'i: <br /> SAMPLE <br /> <br />MEASUREMENT _ <br />_ <br /> PERMIT se a• :-+.?, <br />.,RT <br /> REQUIREMENT <br /> SAMPLE <br /> <br />MEASUREMENT x <br /> PERMIT REPORT R 171- UK <br /> REQUIREMENT 30DA L) =-• LY MX '_ .. _ <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 certify under penult of law that this d(witment and all attachment were <br />d <br />d <br />di TELEPHONE DATE <br /> prrpa" <br />un <br />er my <br />rection or suwnksion in arcurdance with a sestem designed <br /> o? assure that qualified personnel properh {father and esaluate the Information ? - <br /> ahbmitted. Rased on me inquire of Ihr per on or per.nn+ whu manage the %% stem. - r <br /> or th- person directly r-pomibfe for gathering the information, the information ' <br /> submitted is, to the best or m) kri-ledge and belief, true, arcuate, and tromplete. I <br /> <br />I am aware that there ar <br />ificant <br />for wb <br />si <br />en <br />ltie <br />itti <br />f <br />l <br />i <br />f <br />i <br />SIGNATURE OF PRINCIPAL EXECUTIVE _ <br />' <br />TYPED OR PRINTED e <br />gn <br />p <br />a <br />s <br />m <br />ng <br />a <br />se <br />n <br />ormat <br />on, <br />including the li-sihilih 4 rim, and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />ANIJ r-ArPLANA HUN Ul- AN T <br />here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may tie used 0016? : Thia=is a 4-point form.