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PERMITTEE NAME)ADDRESS(i a.At For0ty NaaWLarwi-tfDO6,,w) <br />NAME <br />ADDRESS <br />LOX. 483 <br />IN I A CID 814', <br />FACILITY T E NO. 2 MINE <br />LOCATION "41 A Co E314, <br />I TAM A 13=Ar, .IM MTKIF7 Mf]G <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM rrNPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />C SUBR MN <br />F - FINA <br />DEPtR <br />NOTE: Read instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i .. <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # 9 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###;t : : # u I C / <br /> REQUIREMENT MCINTf t <br /> SAMPLE <br />(r MEASUREMENT <br />- PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , <br /> REQUIREMENT <br /> SAMPLE <br />i ;- MEASUREMENT <br /> PERMIT R''EPOR I? EP+7R "e x , ; r r ! '3' 11 <br /> REQUIREMENT sit DA A'. I A I L Y !•1 <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT '+ <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 mnoy sock, pe"' ty Iaw that thfs dorument and a0 attachments were <br />TELEPHONE <br />DATE <br />Prepared ender my dlrcctlon or supervision in accordant` with • system dalgrwd <br />10 aisun that qualified personnA properly gather and evaluate the information <br />mismitted. Band on my Inquiry of the peratm oe persons who manage the system, <br />or those persons directly mponsible for galherint the Information, the Information - -- <br />submitted Is, to the best of my knowledge and belief. true, accurate. and meoplele. - <br />SIGNATURE OF PRINCNAL EXECUTWT <br />lrk <br />f <br />b <br />itti <br />i <br />tn <br />i <br /> s <br />or su <br />m <br />I am awam that then an s <br />g" <br />canr pena <br />ng War Informat <br />on, <br />TYPED OR PRINTED InchtEing the passibility of for and Imprfaonrtwnt r« knowing folistlooe. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference dl attachments here) <br />PAGE OF <br />EPA Form 3320-1 (Rev 3199) Previous edrbons may be used T111S iS 8 4-part for-M.