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PERMIME NAME/ADDRESS(7-o&&Faok(yNw?L stfart/Dtalw'wse <br />NAME <br />ADDRESS <br />BOX 4@3 <br />.; I A C' <br />FACILITY F NO. 2 MINE <br />LOCATION. !IA C <br />I TANS n P=flp Iq MT <br />J NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPDESI <br />DISCHARGE MONITORING REPORT (OMRI <br />PERMIT NUMBER DISCHARGE Hta.IeEx <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />0 @ 1 r FROM TO <br />r%lvz <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUBR MH ) <br />F - F I NA'_ DEi <br />C !CH--' OF SP T!? "JNNI501•4 R I'•/FP <br />NOTE: Read Ir»tructlorra beftxa ct mplatlr?9 this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREDUEHCr <br />Of SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###### #? ##ix 5 ?1x##Irst %. O 'GEKLY 1NSrTI.. <br /> REQUIREMENT M I N IMUM hAX I. UM <br /> SAMPLE - , ... <br /> MEASUREMENT <br /> <br /> PERMIT ###?! #st ## 1<#If# 3F#'A #iF =s ?=.; <br /> REQUIREMENT 30DA r' V G JAIL';' <br /> SAMPLE - <br /> MEASUREMENT <br />t? PERMIT +# : --. 3E#ik9E## REPORT REPORT" iV+"`/ i'•?u <br /> REQUIREMENT 30DA AVG DAILY KX hIGNTH <br /> SAMPLE <br /> MEASUREMENT <br />_ <br /> PERMIT _f.l t?C' bVVU NCE/ <br /> REQUIREMENT ;;;)JA [°VG DAILY MX biCzdlYf <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , . . <br />IN <br /> REQUIREMENT -'ST MAX r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REFOR REPORT °r? Sri <br /> REQUIREMENT -.C}pA rr i<,' DAILY MX <br /> SAMPLE <br /> <br /> MEASUREMENT <br />PERMIT # si yt t 3t?t :, . r _ , .. <br />REQUIREMENT _ R AVc? QRTR MAX ` <br />NAMEMnE PRINCIPAL EXECUTIVE OFFICER I fertr y under Pena'y ° I.w that Ihh document and all attochmeou were TELEPHONE <br />prepared under my dirxlbn or sup",11slon In accordance with • system ddgned DATE <br />to awn that qualified personnel properly gather and evaluate the Information <br />submitted. aaed on my Inquiry of the person or persons who manage the:retem, <br />or those penis directly responsible nor gathering the Information, the tnrormallon <br />t <br />d <br />l <br />wbmilttd * to the beat of my knowledge and belles. true, accura <br />e. an <br />comp <br />ete. <br />F PRINCWAL EXECUTIVE <br />I <br />N <br /> I am aware that then are stgnlflcant penalties for wbmltting feW Inforwsthm, S <br />G <br />ATURE O AREA <br />TYPED OR PRINTED Including the pmelblBty of fine and Imprisonment for knowing lolation s. OFFICER OR AUTHORIZED AGENT COOS NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aM attachments here/ <br />'R ?IRF.CIP EVEN'- I^ CLAIMFD. IT CLAIM APPROVFD PY WGCD. <br />:REMENT?T. f ,, <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. Ths >ESy :s-p?f tj EptTil. PAGE .OF