Laserfiche WebLink
PERMITTEE NAME/ADDRESS(InrbfeFacdyNanaa/L ,wia (1D(Q6rwm) <br />NAME <br />ADDRESS <br />:IA CC) 814 <br />FACILITY I ` NCI. 2 MINE <br />LOCATION ,IA CO 614 <br />__LIAM A. DEAR JR., MINE MG <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPDESI <br />DISCHARGE MONITORING REPORT fDMRI <br />PERMIT NUMBER DISCHAROE NUMBER <br />MONITORING PERIOD <br />YgA? MO D Y R MO D Y <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINO R <br />(SUD R MH) <br />F - FI NAL DELTA <br />WWTF T O DEER T RAIL DIT CH <br />NOTE: Reed inetruictions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br /> <br />EX EOUENCY <br />OF <br />r SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />EASUR <br />M <br />T _ / . <br />(:? M <br />E <br />EN <br /> PERMIT ##### r REPORT OPTIONAL F'OE <br />W I i :,I r=N i REQUIREMENT <br />30DA AVG <br />MX ?D AV <br />MONTH <br />_ <br />_Dr SAMPLE <br />20 DF MEASUREMENT <br /> PERMIT #### # i1#!:### #3 ###? 4 <br /> REQUIREMENT 341) A AtJr? MX %i? AI../ MON71{ <br /> <br /> SAMPLE - <br /> MEASUREMENT <br /> <br /> PERMIT .? t <br /> REQUIREMENT , <br />FMININUI MAX I MUM <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT NC-/ <br /> REQUIREMENT 30DA AVG MX 71) AV MONTH <br /> SAMPLE <br />_ MEASUREMENT <br />C1 PERMIT , . if... .: •?i :7 ; t t? . s? ?! # t <br /> REQUIREMENT ;?ODA AV(-, MX ?D AV C ;•:"r H <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />-•1ST MAX <br />' <br />r" SAMPLE <br />F? i, T MEN i r, MEASUREMENT <br /> <br />PERMIT r ... . <br />REQUIREMENT 30DA AVG DAILY MX <br />1 mrMy under pens ly o law IhN IhH document and atl altwhmenls were <br />NAME/'ME PRINCIPAL EXECUTIVE OFFICER prepamd under my direction w>r TELEPHONE <br />perv on In accordance with a system designed <br />DATE <br />to assum that qualified personnel property gather and evaluate the Information <br />i, <br />b <br />it <br />d <br />B <br />d <br />i <br />i <br />f t <br />su <br />m <br />te <br />. <br />aw <br />on my <br />nqu <br />ry o <br />he person w persona who manage the system l <br />1 <br />or those <br />ersons dlrecty m <br />oMbie f <br />theri <br />th <br />th <br />i <br />f <br />ti <br />I <br />f <br />/' t <br />p <br />p <br />w ga <br />ng <br />e <br />n <br />orma <br />on. <br />e <br />n <br />ormation, <br />submitted b, to the bet of my knawteege and better, true. arcurate, and compkte. <br />I am aware that there are significant penalties for submittin <br />false Information <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> g <br />. <br />t <br />i APEA <br />TYPED OR PRINTED nc <br />udlng the possibility of fine and Imprisonment fix knowing elolauem OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EAYLANX I IVni Vr nn y v1VLn 11Vrra INgrerence on effacnmenfs nere) <br />INSTRUCTIONS - I. C. 10, PG. 10. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 0341 / 0T"&_jW & 4-Oar form.