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PERMITTEE NAME/ADDRESS (include Facility A'amellncarion if Diffrretw <br />NAME <br />ADDRESS <br />FACILITY HLiP I ZON' M I r:E <br />LOCATION A Q B1424 <br />LANC F WADS M I NL PiA.'NA- ,ER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR M DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />1-11 NOR <br />(SVBR MH) <br />F - FINAL r1NTR5 <br />SFi&MI We DRNG T R IB TO TUT T L.E DR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT lik AVC MX :?lOIUT F <br /> SAMPLE <br /> MEASUREMENTI <br /> PERMIT R EP OF <br /> REQUIREMENT VG DA I L <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ?Dr? - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i 1 -._ - rt mot` ?- <br /> REQUIREMENT 3C', A -A ; 1) 0 1 L Y Ni <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT it , <br /> REQUIREMENT l? AVi= D.A [t_ !' x <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i -(7- t ,t <br /> REQUIREMENT ?VG DAILY ~I> <br /> SAMPLE <br />1 <br /> MEASUREMENT <br /> PERMIT t i <br /> REQUIREMENT r . AVG <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif . under penult) of law that this document and ail attachments Nero TELEPHONE DATE <br /> prepared under m) dinethm or supenision in accordance Nith a system designed <br />_ to n.surc that qualified personnel pruperi% gather and esahwte the information <br />- - submitted. Based on m? inquir} of the Person or prrs.ms swho manage the -tem. <br /> or those persons dirrctl? responsible for gathering the information, the information <br /> ute <br />to the b-t of ms k <br />is, W <br />true <br />accu lr <br />and com <br />s <br />hmill <br />d h <br />and belief - - • <br />_ . <br />, <br />• <br />. <br />u <br />y <br />, <br />ro <br />ge <br />p <br />SIGNATURE OF PRINCIPAL EXECUTIVE -. <br /> I am aoare that there are significant penalties fur uhmittinit raise information. <br />k <br />i <br />i <br />ti <br />ih <br />l <br />f <br />d i <br />i <br />f <br />t OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />TYPED OR PRINTED m.N <br />ng s <br />ons. <br />imluding the puss <br />ih or <br />ine an <br />mpr <br />sonment <br />or <br />(i <br />a <br />i D <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS <br />here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 001