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PERMITTEE NAME/ADDRESS (?.. r FardtyNwvLa mi- (/D(OWwo) <br />NAME <br />ADDRESS <br />FjQx 18 <br />I_G co 6: <br />FACILITY '..PER MINE <br />LOCATION T V' CID g <br />i?OND G. DU BOIS, PRES/GP <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT (D R! <br />PERMIT NUMBER DISCHARGE NtIMeER <br />MONITORING PERIOD <br />YEAR MO DAY Y MO DAY <br />FROM TO <br />Form Approved <br />JMB No 2040-0004 <br />M I NOF <br />(SURF <br />NOTE: Read Inotruc-tlof>s befoca cornolatino this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREO <br />UENCY SAMPLE <br /> O <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br />r SAMPLE <br />MEASUREMENT <br /> "J _7 <br />- PERMIT It <br /> <br />REQUIREMENT <br />MINIMUM <br />MAXIMUM - <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />J REQUIREMENT :30DA AVG DAILY MX ±'i-;PJTN <br /> SAMPLE <br /> <br />MEASUREMENT <br />r <br /> <br /> PERMIT It lr -?r -9 -w -A <br />r, <br /> REQUIREMENT 30DA P.`JIs DAILY MX PONTI <br /> <br />`. SAMPLE <br />MEASUREMENT - , <br /> <br /> PERMIT Wou F <br />13 <br /> REQUIREMENT 30DA AVG DAILY I'lX i <br /> SAMPLE <br />MEASUREMENT <br /> <br />,32 1 <br /> PERMIT : , <br />:irT N!3 <br />_UENT i_ i- 'YES <br />'l REQUIREMENT INST MAX i ; ?T <br />L: - <br />_' I <br />U TREATMEN I <br />SAMPLE <br />MEASUREMENT <br />- <br />- <br /> <br />O 1 0 PERM <br />T . <br /> I <br />REQUIREMENT %ODA AVG DAILY MX ; . <br /> <br /> SAMPLE <br />MEASUREMENT - <br /> PERMIT <br /> <br /> REQUIREMENT i11DA AVG i AILY f": <br /> <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER 1 nnuy "Mi" Penalty 'T""" thh do- l and all ¦tl¦chmrntf wrrt <br />P"Pared aver my dlrectlon w superl`l o In occordan with ¦ system designee <br />t <br />th <br />t <br />1 <br />TELEPHONE <br />DATE <br /> <br />•; r% <br />.; <br />! <br />• o aware <br />a <br />que"1 <br />M personnel Properly gather and -0-le the Inror>natlon <br />tabmllted. Based -any Inquiry or the person m <br />erawea ?hn m <br />n <br />l <br />/ <br />-- <br />- <br />- <br />• p <br />a <br />age <br />hr,,y,,,,, <br />or those <br />erms directl <br />res <br />oMble f <br />th <br />i <br />th <br />•t <br />?? - <br />- <br /> p <br />y <br />p <br />or ga <br />- <br />ng <br />e Inkumalioa, the Inrormatlon <br />submllled K t <br />th <br />b <br />t or <br />k <br />i <br />4 ?- <br />_ i % j <br />-- <br />? - <br />J . - <br />• <br />- <br />- o <br />e <br />es <br />my <br />wm <br />e <br />gt and beaef. Irw. accurate, and compkte. <br />I ¦m awe" that there are slgnlfkael ieenalfles for submittin <br />fabe inror <br />tl SIGNATURE OF PRIN <br />I 1 / ; <br />", .., .. i <br /> <br />` g <br />ma <br />on• <br />I <br />s C <br />PAL EXECUTIVE <br />- <br />TYPED OR PRINTED nc <br />uding the posdblllty or line and Imprisomnent roe knowing elotaftrm OFFICER OR AUTHORIZED AGENT NUNWR <br />A A CO YEAR MO DAY <br />.,rn . a,n evf?I •NATIAhI AF ?NV Vlrll •TIAIJe ,v_._._...._ .w ?n DE <br />TSS & TOTAL IRON LIMITS WILL BE WAIVED, & SETTLEABLE SOLIDS LIMI <br />SEE BURDEN OF PROOF REQUIREMENTS UNDER I. A. 2. TDS r10NITORING - <br />OR <=10YR, 24HR PREC IP EVENT <br />EPA Form 3320-1 (Rev. 3/") Previous editions may be used 0,1) 0 3 5 / :,T A.3b1 _ y_ Q PAGE OF <br />g ?'s4 ?.