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PERMITTEE NAME/ADDRESSQ.drLyorfktyN..?Lorett.r(/D(#6t) NATIONAL POLLUTANT DiSCHAAOF ELIMINATION SYSTEM //NPDESI <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE <br />,4IA <br />FACILITY E NO. 2 MINE MONITORING PERIOD <br />..a I A CO 81 4 YEAR MO DA YEAR MO _ DAY <br />LOCATION FROM - TO <br />_LIAM A. DEAR JR. MINE M6F, <br />C, ?' Form Approved <br />OMB No. 2040-0004 <br />- 1 c ?, - Ce) <br />MI OR <br />(SUBR MH ) <br />F - FINAL uti <br />Sft:MINE WTR TO DEER TRAIL DTCH <br />NOTE: Reed kwtructlone before completlno 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 /> <br /> PERMIT <br /> <br />R <br />r r <br /> REQUIREMENT I NST MAX -? <br />F <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT f <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER I f "llr under Fe"' ty o Ix- 1R11 this document and JI 1ttlchmenla were TELEPHONE DATE <br /> prepared under my direction or sups-Halon In accordance with • system deigned <br /> to assure that gumhntd personnel property gather and evaluate the Inthnnition <br /> submitted. Beard on my Inquiry of tht person or persona who manage the system, <br />i ? <br />? <br /> or them pencee directly responsible for gathering the Information, the Information _->7'[ • <br />_ <br /> submitted i>, to the best of my knowledge and beW, true, a race, end complete. <br />1 11 111" that then am sig"Inrant penalties for submiRin <br />false Inrormation <br />SIGNATURE OF PRINCNAL EXECUTIVE <br />TYPED OR PRINTED g <br />, <br />nclyding the poedblBty or nne and Impntsonrntnt for knowing vholltiona OFFICER OR AUTHORIZED AGENT CAE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReforenc* 0 strechments here/ <br />if2 PRtC IP EVFPIT IS CLAIMED. IF CLAIM APPROk)FP RY Wr 1 <br />T r I-] IM C,; <br />T1ti <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used s is a S-part form. PAGE OF