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KAL4[ME NAME/ADDRESSpnabbFoefhryNmw/Loe.rrwr{(Dt sewj <br />NAME <br />ADDRESS <br />U 815 <br />FACILITY i H & MINES <br />LOCATION CO $ a 1, <br />I DDE <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY I Y A MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040.0004 <br /> <br />NOTE: Read kwtrucdonB before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FRfOUENCY <br />SAMPLE <br /> <br />EX J <br />OF <br />Y <br /> ANALYSIS T <br />PE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> - <br /> PERMIT ^d. MUM <br /> REQUIREMENT <br /> SAMPLE <br />17 <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />H <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />t cerlily vnckr Pen. ty o law that this dor amemt and all attachments ..ere <br />TELEPHONE <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />Prepared under my dlrectlon or wper.hlon In neordsncr with ¦ system designed <br />- t. resrre that qualified personnel Properly gather and evaluate the Information <br />wbmMed. Bred on me IngWry of the person or persons who manage the system, <br />' <br />- or those penom dlrectly responsible for gathering the Information, the information <br />- - - -?-? <br />- - <br />C wbmllled le. to the best of my knowledge and beMef, true, amsnte. and tompkle. - <br />.m .ware that (here .re dgnlnr. I Penalties f- vubmdttin <br />hbe Inrr,rm.tlon <br />SIGNATURE OF PRINCIPAL EXECUTNf <br /> g <br />, <br />: <br />TYPED OR PRINTED rluding the pa,albuny r nne.na impn.onmwnt row anowinr nd.onrn <br />n OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION Ur AMT YIVLA I IVNS (rfeforence an Irracnmenrl nort•/ . rc, <br />pop c ? -. o•,,s e <br />I <br />SUSPENDED SOLIDS . TSS } . To,rAL IRON AND /Cif <br />Conn.