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PERMITTEE NAMEIADDRESS finrlude Farifirr Samell a'arinn if Piffereap <br />NAME <br />ADDRESS <br />IOX <br />FACILITY ;GR 17.1: <br />LOCATION I_A _ D E ; 4 c. y <br />LANCE MINE MANIAGER <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 />hiNC;R OMB No. 2040.0004 <br />- 'Ui3R MH i <br />FINAL I' NTR5t <br />3R&MINE DRNG TRIO TO TITTLE DV. <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT AV 1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />t <br />r _ ,. <br />.. _ . <br /> <br />`J <br /> REQUIREMENT i:iJl4 AVG la r. i9t!'` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT W, -5r - <br /> REQUIREMENT - <br />r NT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT DA <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ,trtif% under pcnalt) of law that thi, doovumena and nil alt.,hmem, were <br />prepared under m* dinrtion or uperthion in arrordanre with a s <br />ntem desi <br />ned TELEPHONE DATE <br /> ) <br />g <br /> to a curt that qualified pormonnel proprrl) gaalhr and r,aiume flit information <br /> ,ubmittd. Rased on my inquin of the per,rm or per,ons who ntanagr the .).tem. <br /> 'or threw penon, dirtrtl) rt,ponsibir for gathrring the information. tht information <br />.? suhmitird is, to the hrst of m) Mnoaltdyc and Itt•lia. ante, atrurair, and complete. <br /> 1 am awarr that ahe" art signifkvm penalties for ,ubmittin <br />false information SIGNATURE OF PRINCIPAL EXECUTIVE .- <br />TYPEDORPRINTS g <br />, <br />including [helm,ihilit)or fair and imprisonment for knowing ,iolufions. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />GUMMCIV 10 ANU r- A VLANAI IUN yr ANT VIOLA IIUNZo Iriererence an affacnmenfs nerel <br />EPA Form 3320-1 (Rev. 3,%) Previous editions may be used. l This is a 4-part' fOn-n.