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PERMITTEE NAME/ADDRESS Plnchak• Facility Nume-lxt arinn if Dif awn NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS NA;ah i'I.? vE <br />P t BOY PERMIT NUMBER DISCHARGE NUMBER <br />?RENC MONITORING PERIOD <br />FACILITY , R M i , YEAR MO DAY YEAR MO DAY <br />LOCATION DEN FROM TO <br />MINO <br />(SLIB R <br />R •JC <br />F - FINIAL <br />POND E.! T R I P <br />Form Approved. <br />OMB No. 2040-0004 <br />)GK5N <br />x <br />NOTE: Read Instructions before COmDletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE r ; <br /> MEASUREMENT <br /> PERMIT # * # rF # # a 5. 5 = td l c <br />- 1- .r q i.• REQUIREMENT M 11`14 T_ f1L'I'1 f' ti is I MUM r4Oi4 <br /> SAMPLE # iFa 3t ; a 'r <br /> MEASUREMENT <br /> PERMIT # f#a :? r ###•# REPORT i Q WJCE/ :FiA <br />CR -•55 V .ij;. REQUIREMENT } 30DA AV J _ Y M i r•Ir nl, ' } <br /> SAMPLE r=# i ?. <br /> MEASUREMENT <br />.•E?'. } PERMIT x, ... E tta r'? t f## i.r i ?RAL <br />F ( DENT GROSS VAL.I:i REQUIREMENT <br />IN CONDUIT OR SAMPLE 0:3 <br />TREATMENT PL.Af>f MEASUREMENT <br />1 C' PERMIT _ .:T {ksi i f ##3r## t#'f#?t (rd CORD <br />'r.NT GROSS Vet; : ;- REQUIREMENT <br />LI _r. SAMPLE <br />it MEASUREMENT <br />_ PERMIT t F,: A*#### zs?### ti?!### <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />I <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this d-umcnt and all attachment,, ere <br />_ TELEPHONE <br />DATE <br /> prepared under m) dirmtiun or supervision in accordance with a system dcsi€ned <br />Richard A. gitln son to assure that qualified personnel Properly gather and evaluate the 1111-u nation <br />Hasid on my myutrv of the person or pcrv+ms who manage the system. <br />submitted / <br />i <br />l <br />j <br />t <br />Vi . <br />t e s <br />f <br />ce <br />en or thou persons directly rcspomstb!e fiat eathcnng the mternauom the information <br />i <br />b <br />' <br />f <br />d <br />h <br />f <br />l <br />d <br />d b <br />l r, <br />r O 7^ l ?r <br />(? /! <br />r1 <br />n 5 <br /> ccmp <br />my know <br />ge an <br />. tnte. 3ecuraw. an <br />et. <br />submitted is, to t <br />e <br />est <br />o <br />e <br />e <br />ie <br />l <br />i <br />f SIGNATURE OF PRINCIPAL EXECUTIVE <br /> orr!X ,r, <br />I am aware that there arc significant perwhies for submitting fa <br />w <br />n <br />f <br />d i <br />l <br />i <br />i <br />o <br />k OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED mPnwnment f <br />nowing vio <br />at <br />ons <br />including the pc sibil <br />n o <br />fine an <br />r CODE <br />COMMENTS AND EXPLANATION OF ANY VIULAI IUN, (He?erence an anacnments nerej <br />"RECIP EVENT <br />?S TO THE D I <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. Thh is a 4-parl- Kr1111. PAGE OF