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i FormAp <br /> <br />PERMITTEE NAME/ADDRESS (7_&* F«WryNw?Lx.rr.m I/D, CEIVED <br />r?,? <br />NAME <br />NATIONAL POLLUTANT DISCHARGE EUMINAnON SYSTEM fNPDESI <br />DISCHARGE MONITORING REPORT W <br />Rl .2040- <br />1\ l?/J1 OMB NO. 2040 0004 <br />C. <br />;•1 Nl; 7 <br />ADDRESS <br /> <br />-? . <br />OCT 31 2008 _• <br /> <br />PERMIT NUMBER ascNAROE NuMeE>t tiU I <br />-- <br /> <br /> Division of Reciamation, <br />MONITORING PERIOD <br />FACILITY Mining and Safety YEAR MO I DAY I AR I Y O DAY <br />LOCATION FROM TO - -- <br /> NOTE: Read inatnuc corn before completing this fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br /> <br /> <br />X FREQUENCY <br /> <br />OF <br />SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ## c#iF# ####'? ": 9. ' t- <br /> REQUIREMENT M I N I MIIWt i MAXIMUM <br /> SAMPLE <br /> <br /> MEASUREMENT / <br /> PERMIT ##iE##tF ### ?t?? i :, ##### 1 mac:., <br />VAL tJ ?- REQUIREMENT 30DA <br />AVG <br />DAILY MX (tONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ## REPUR i t±;:_. <br /> REQUIREMENT 30DA AVG DAILY MX r10NTH <br /> SAMPLE <br /> MEASUREMENT <br />* S PERMIT „ •.:, t, _ <br /> REQUIREMENT 3lDDA AVG DAILY MX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ :; r.• I _ t <br />GROf_ REQUIREMENT LOT f1lAx GENT <br />_r O_ SAMPLE : I <br />^'>=ATMEi'• MEASUREMENT <br />n PERMIT <br />`.- REQUIREMENT A AVG i LILY MX <br /> SAMPLE <br />7 MEASUREMENT <br />PERMIT - " <br />REQUIREMENT Q R T R A-s _ sRTR MAX <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I cerUfq a pen. y o law that this document and all attachments were <br />TELEPHONE <br />DATE <br />prepared order my direction or suprnhlon In sccordann with ¦ system designed <br />to mum that quaNOed pen mnnel Property gather and evaluate the Information <br />submllled. Based mn my Inquiry, of the person or persom who nanarr the system, <br />th <br />di <br />tl <br />nsibl <br />th <br />i <br />I <br />e <br />f <br />th <br />f <br />l <br />h <br />I <br />f <br />or <br />rec <br />y r <br />spo <br />or ga <br />er <br />ng <br />oe, t <br />ose persons <br />e <br />e <br />n <br />ormat <br />e <br />n <br />ormation - <br />submitted 4, to the bell or me knowledge and bAW. true. accurate, and complete, <br />dfl <br />t <br />SIGNATURE OF PRINCWAL EXECUTIVE <br />- I <br />h <br />l <br /> ram <br />.m aware that t <br />ere are s <br />gr <br />pemaltles for submitting fake Information. AREA <br />TYPED OR PRINTED Inchsding the Possibility of fine and ImpAso iment for knowing vtolatlolts OFFICER OR AUTHORIZED AGENT ODE NUMEIER <br />C YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference &N attachments hotel <br />"IR PRFCTP EVENT IS CLAIMED. IF CLAIM APPROVED PY WQCD, <br />cMENTS-SEE i 3y, - c`._'RDE <br />FG V 'LING Ili-TFrt?, TiltaS-I.: 1.; <br />TItyS;1S' <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. S 4-pan form. PAGE OF