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Form Approved. <br />PERMITTEE NAMEIADDRESS (7-"JrwWry)Vm.WLaewrew (/Dtob-t) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INODES! <br />RT <br />MR OMB No. 2040-0004 <br />NAME DISCHARGE MONITORING REPO <br />(D <br />I <br /> -'US 'fH ) <br />ADDRESS <br />U J n <br />r c. <br />PERMIT NUMBER DISCHARGE Nt1MSER <br />F 1'" v t I <br />nNIA ,. _:. ITCH <br /> <br />i;-J I E NO. <br />FACILITY <br />2 MINE <br />MONITORING PERIOD <br />LOCATION ; N I A co E31 F <br />O Y fI Y <br />Y R O DA T <br />' _ LL I rAM A. BEAR JR . r MINE MGR O <br />R <br />M NOTE: Read Irmtruetlone before completing tfile form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FAEOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -j I <br />(ISS VA:_ REQUIREMENT LY MX UOUS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :. .. <br /> REQUIREMENT r?AR <br /> SAMPLE <br /> MEASUREMENT <br />i <br /> PERMIT t <br />is REQUIREMENT t Fl I'R AVG GRTR MAX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - L. 7 ti 0 <br />- REQUIREMENT SODA Ate a MX Dc_ EOA <br /> SAMPLE <br />MEASUREMENT <br /> <br />b 1 d PERMIT - T, , . IN <br />. <br />L REQUIREMENT I P!8 i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' nnsty u der Penalty . low that mh doru .red all attachments were <br />TELEPHONE <br />t <br />DATE <br />prepared under my dlrerl$on or roper W" In a <br />ccm snrr with a systems ddgned <br />to amore that quattMd personnel Prop. y gather and tealusle the Information <br />submitted. Based en my Inquiry or the person w persons who manage the sy lem. <br />w those persom d1mvily responsible for gathering the Information, the Information <br />wIrmllled K to the best or my knowledge and better. True, wtvrale, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />th <br />t th <br />n ar <br />l <br />lfk <br />t <br />n <br />lti <br />F <br />b <br />ltd <br />f <br />t <br />t <br />f <br />I <br />l <br /> am aware <br />a <br />e <br />e s <br />gn <br />an <br />Pe <br />a <br />es <br />or w <br />m <br />ty <br />n <br />ormal <br />on, <br />ng <br />a q A <br /> <br />TYPED OR PRINTED <br />Inc%WIng the Possibility of one and Impr»unmenl rw knowing rlot.u? <br />OFFICER OR AUTHORIZED AGENT NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND ExPL.ANx I Ivry yr mrv T vrvtrn 1 lvna Vfererence Nr errecnmernro neref <br />NSTRUCTIONS - I. C. 10. PG. 10. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used This as 11.4-part forin- PAGE OF