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PERMFTTEE NAMEJADDRESS (-.&V ForehyN--WLorarfew I/D(Aw-w) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOESI <br />NAME - DISCHARGE MONITORING REPORT (D Rl <br />ADDRESS <br />BOX: PERMIT NUMBER DISCHARGE NUMBER <br />:_TER WH I TLEDGE, MINE tForm Approved <br />MONITORING PERIOD <br />FACILITY ,.ANE CI,I '? i,''J t 1.'+c YEAR MO DAY YEAR MO DAY <br />LOCATION ;A C:.: FROM TO <br />OMB No 2040.0004 <br />,•I . <br />( <br />F - 11NAL pit <br />UNDERGROUND MINE TO E SALT CR. <br />NOTE: Read Ir»trucdone before cornphtlnp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,, r?r # ;- - ..r l r, <br /> REQUIREMENT M I r.4., MAXIMUM <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # ?: a1# k ".: r ;` <br />i REQUIREMENT 1Glr'A i f'tX ' -; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT it?? rr A### xr:: 3500 i v+,? -r =i; <br />_UEP4 REQUIREMENT 30DA DAILY X ftC)i'd Fr <br />(s SAMPLE <br /> MEASUREMENT <br />1 PERMIT iF x=, #####.? ### :< : #af .}.c 10 _i': Ci;;-'l a.• <br />_NT '- REQUIREMENT INS., r°fAX <br />I SAMPLE <br />rRE_A :Ili=i; l f MEASUREMENT <br />r-G ? 0 n PERMIT 7i_ GP, T PEP`RT : ##qL#:. Ita1#1Fe1# <br /> REQUIREMENT ;A DAILY MX <br /> SAMPLE <br />SOLVE 1i MEASUREMENT <br />' PERMIT 1, # dF# # <br /> REQUIREMENT ,)RTR .1, AILY MX <br /> SAMPLE i <br /> MEASUREMENT <br /> PERMIT .;.: t_? •? _ ,t.,F, <br /> REQUIREMENT i r.-i51 MAX <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ;"nay antler penalty ° I- (het th <br /> <br />prtpared under my dlnrtlon or sup is dorumem end all anachmrnU were <br /> <br />ervision in accordance with . systern designed <br />TELEPHONE <br />DATE <br /> <br />_ ? . - i ?--- to asstrrt that outltMd personnel properly [other and evNuatt the Informatlon <br />fobmitled- Board not my Inquiry of Iht persun or person who notate the system, -yf,, //LL <br /> or throe ptrsom directly spotbk fa plhering the Inrormailon, the Inforwrtlon <br /> <br />--' <br />--- submitted K to the best of my knawkdEt end better, Irw, a relr, and complete- <br />he <br />f <br />b <br />i <br />ifi <br />t <br />lti <br />ll <br />f <br />f <br />E QNATVRE OF PRINCIPAL EXECUTIVE ? ?/ j) (i ! C`i J <br />- re art s <br />I am await that t <br />gn <br />can <br />Pena <br />es <br />or su <br />m <br />tlnt <br />ain In <br />orvrrtlow, AREA <br />TYPED OR PRINTED Im*udint the potdbilly of flee and Imp am anent for knowing rlotallotn OFFICER OR AUTHORIZED AOEFET CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (RitIorenc• DIN •ftachmenta hor*/ <br />= IQD REPDRTED OIL & c:t•'.FASE - SFF I. 13 1 C TDS MDNITCRI <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used ?t1J¢ ??i? p -fplyyl. PAGE QF <br />Sc_ +I'