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PERMITTEE NAME/ADDRESS iinclude faith A'mne/Lxatiom ifDii fornU <br />NAME ! ,:CADUa <br />ADDRESS i_ <br />Bul • v-,8 <br />Bull 6218 <br />_A CO 814 <br />FACILITY 1-jt r j i' '?'1 ? r 1 NE <br />LOCATION <br />L- +i V 0 E3 14 <br />LANCE WADE, MINE MANAC-ER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <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 />r. C <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO- FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE r ,t <br /> MEASUREMENT <br /> PERMIT i- i_='ORT <br /> REQUIREMENT I -0f) a AVG DA.L L-'I, MX I'EC;;. TF <br /> SAMPLE <br /> MEASUREMENTI <br /> PERMIT _ ?.pa?. Pf'QftT fTT_F LR i <br /> REQUIREMENT 3UDA AV G Lila I LY h 4 <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under petmlty of law that this document and all attachments were <br />prepared under nn dieretion or town ision in accordance with a system designed TELEPHONE DATE <br />_ _ _-. to insure flat yualifiad perwnnrl prolerlt gather and ea aluatr the Information <br />smhmnled. Rased on my imlitin of the person or persons who mana>;a• the -%tem. <br />- <br />' <br /> or thosa prrsum diretlh "'pon <br />sible for Katlerinp the information, file information - <br /> wbmitt d is, to the best of my knowledge and tallef. ti-av. accurate, and complete. <br />I am aware that there arr si <br />nirwant <br />enalties for athtmttin <br />information <br />rak <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />- <br />- - <br />TYPED OR PRINTED g <br />p <br />g <br />e <br />. <br />including the posibility of fine and imprisonment for knowing siulaion,, OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. 00121 "f.Ttt%S t'4-pitft"1f??tlll.