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PERMITTEE NAME)ADDRESS (7.ebflfuaryN..?Le ,.#.I(D(i.wv) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM j(WDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />f7. BOX ? . PERMIT NUMBER DISCHARGE NIAAEER <br />MONITORING PERIOD <br />FACILfTY i E NO. _ MINE YEAR MO DAY YEAR MO DAY <br />LOCATION <br />t! I A C O B 14 FROM TO <br />.;-LIAM r? BEAR JR.: M.1 NE MG--;1 <br />Form Approved <br />OMB No 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL DE <br />5R,DEER TRL OTC OR UNMD TRIB <br />NOTE: Road Irntructiorn before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FRIE ENCr SAMPLE <br /> oF <br /> EX µ?Ypg TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT WEEKLY raSIT? <br />r;c JG ii V:` i REQUIREMENT <br />r;T ;L. SAMPLE <br /> MEASUREMENT <br /> PERMIT L # K-.-# i; <br />,. REQUIREMENT 1fo :? i, r MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ##sE#tt# ## #i # # ###t= REPORT REPORT O NCE/ A i <br /> REQUIREMENT 300A AVU DAILY MX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 6000 . NCF/ <br />`.' <br />RA <br />l <br />)c. V REQUIREMENT ' A A', DAILY NX i•-'TH <br />_ SAMPLE - <br /> MEASUREMENT <br />% PERMIT Qibtt; .. sftFgih#st I• tt##?? 1:1 _,)„ <br />_.!JEN-F ,,ORS W, REQUIREMENT _ IrlST MAX <br />.,`I i!OUIT SAMPLE <br />1.. TREATMENT PLAN ; MEASUREMENT <br />t z n ID PERMIT REPORT RFPnRT ref § ~< __. ...'y v-?? <br /> REQUIREMENT <br />T,41 SAMPLE <br /> MEASUREMENT <br /> PERMIT ... i?r :. x c=:Pr. . 14f AB <br /> REQUIREMENT <br />y! 3RTR MAX <br />NAME(TITLE PRINCIPAL EXECUTIVE OFFICER I Krtrl) , r pen. l) , I,. that this tlavmrm and .n.u,cnmenb were <br />TELEPHONE <br />DATE <br /> prepared ,Oder m) dlrerllon or wper"IHtm In wc_d,nre with a a)elern designed <br /> Io ", that qu,hlkd personnri properi) gather and eedu,te the Intorsnallon <br /> wbmined. Sated on m) Imiulr) of the person or persona who manage the erelem, <br />i <br /> or thole personor dlre lt) tvpons <br />bk Im gathering the Informallon, the Inform,tlem - - <br /> wbmltted Is. to the bnt of m) knowledge and belle(, Imc , nle. ¦nd enmpkie. l <br /> <br />I ¦m aware that there are stgnlnrant penaltln for mbmllnng raiw Inf-tIon <br />SIGNATURE OF PRINCWAL EXECUTWE .. U <br />TYPED OR PRINTED . <br />inrsr,dlng the poedbiltle a nm and Imprisonment for k-Ing "lolatto OFFICER OR AUTHORIZED AGENT CODE NVMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) <br />71 AI's P12 ,_: <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This is a 4-part form- PAGE OF