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PERMITTEE NAME/ADDRESS (Include Facility Namell ncation if Different) <br />NAME <br />ADDRESS <br />O BA63 <br />FACILITY MINE COMPLEX <br />LOCATION i? i_ IV GO 8163 <br />r' P C:NfI. RF?i APiAT T flit! h1AIVAt,?R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />MINOR <br />( :SUBR JC <br />F - FINAL <br />GHPONIC 4 <br />Form Approved. <br />OMB No. 2040-0004 <br />Wk s <br />NOTE: Read Instructions before cornnletino this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE _ <br /> MEASUREMENT _ y <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />j <br /> REQUIREMENT I t I <br /> SAMPLE <br /> MEASUREMENT - <br /> PERMIT <br /> REQUIREMENT } <br />i <br /> SAMPLE <br /> MEASUREMENT v; <br /> PERMIT r' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT % <br /> PERMIT <br /> REQUIREMENT i <br /> SAMPLE <br /> <br />MEASUREMENT _ <br />- <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br />NAMEfTITLE PRINCIPAL EXECUTIVE OFFICER 1 certif - vender pemth> of law that this doe'ument and all altachmeun were / . <br />TELEPHONE <br />DATE <br /> prepared under m? direction or supershion in -ordame with a ' t- desigmd _ <br /> to assure that qualified Personnel properh gather and eealuale the inrormarlm <br /> submitted. Rased on m% inquire of the person or persons who manage the -tein. <br /> oe thou persons direeth resp,,n.m a for gathering the information, the inform.Uon - <br /> submitted is, to the hest of ms knowledge and Wief, true. aeiurate, and comph•le. <br />1 unt aware that them are significant <br />enalties ror submitting false information <br />SIGNATYRE OF PRINCIPAL EXECUTIVE ; <br /> <br />TYPED OR PRINTED p <br />. <br />including the lwnsihihts of rinv and imprisnnmem for knowing siedugons. <br />OFFICER OR AUTHORIZED AGENT <br />AOREA <br />NUMBER <br /> <br />YEAR <br /> <br />MO _ <br /> <br />DAY <br />..,,......?...., .-..... ".. __.---.._.. _. ?... ....__ ....... .................... r,..o,......?,..? „?,?? '1tti}TF "- RF P ROD LiL R 1';A7 7r)N'7 4 =, "Tf_'1X I r'! Tv" Rfi T t_ rt;.lr.-7 <br />EPA Form 3320-1 (Rev. 3,99) Previous editions may be used. Tlus Iii' a 4-part fOFltt. PAGE OF