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PERMITTEE NAME/ADDRESS tlnclude F'aciliry.\'ame/locafion if Differenn <br />NAME <br />ADDRESS <br />FACILITY MINE COf IreI _ ;: <br />LOCATION 3 9 <br />k.ARfl. F2F ; ! A! AT l :N MANAGER <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 MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />F - Ftt <br />CHRONIC TEST FUR .?:Ai 1:3F;/i4, <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 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT J <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT " <br /> PERMIT ` <br /> REQUIREMENT i <br /> SAMPLE <br /> MEASUREMENT f, <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -: s n--r <br /> REQUIREMENT i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE \1 <br /> MEASUREMENT t" y <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under pena6i or taw that this d-unicm and all attachments were <br />r <br />di <br />ti <br />si <br />with <br />t <br />d <br />d <br />i <br />d <br />d <br />i <br />d TELEPHONE DATE <br /> prepa <br />un <br />er my <br />rec <br />on or super <br />sion <br />ance <br />a sys <br />em <br />e <br />n accor <br />es <br />gne <br /> m assure that qualified personnel properly gather and evaluate the information I <br /> submitted. Based on mi inquin of the Person or persons who manage the spsirm. t <br /> or those persons directis rmpmsible for gathering the information. the information - <br /> subntitted K to the best of m> knowledge and belief. true, accurate, and mmpiete. <br />I am aware that there are significant Penalties for submitting false information <br />SIGNAT RE OF PRINCIPAL EXECUTIVE <br />- <br />I <br />TYPED OR PRINTED . <br />including the possibility of fine wild imprisonment for knowing siolatiams. OFF[ ER OR AUTHORIZED AGENT C R pE NUMBER YEAR MO DAY <br />L,UMMCPI I J ANU tXP'LAN Fk I IVN Vr AP IT VIOLA I WI i , (r7ererence arr a(lacnmenr5 neref <br />EPA Form 3320.1 (Rev, 3199) Previous editorts may be used. This iS a 4-Part fOf111.