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PERMITTEE NAME/ADDRESSpwe6&fwthryN.+?Lx.ti-(fp(f,..,u) <br />NAME <br />ADDRESS <br />U. C.ux Sus <br />'!1FRSET C G <br />FACILRY i ORN CRK & ELI Rvi, MINE <br />LOCATION ERSET CO <br />11ES T. COOPER, EXEC V. P <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEMJNPDES) <br />DISCHARGE MONITORING REPORT /O - R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />1 q. FROM TO <br />Form Approved. <br />OMB No. 2040.00OA <br />MINOR <br />(SUBR MFI ) <br />F - FINAL <br />ACUTE WET TESTING FOR 015A <br />NOTE: Reed Instructions before completing this tam. <br />UN I't <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 />-- <br /> PERMIT I vu. 000 1 --7 p >. , 4 7--77y <br /> REQUIREMENT MN VALUE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />- <br />PERMIT <br />AE QU IREMENT <br />F <br />NAMEfn LE PRINCIPAL EXECUTIVE OFFICER a "n"y under pen. ty n I.. thu lhh dorvment and .p .U¦chment. were <br />TELEPHONE <br />i <br />i <br />rr.H <br />I <br />d <br />ith <br />d <br />d <br />d <br />r <br />t <br />DATE <br />un <br />wp <br />on <br />n accor <br />¦ fye <br />em <br />prepare <br />er my d <br />rect <br />on o <br />- w <br />esft,wd <br />to care that qualified personnel properly L¦IMr and evaluate the Infnem¦lion _ <br />rbmittrd. Bred on my Inquiry of the person or persona who man.te the system, <br />r or [how perry directly respoedblr for E.therint the Information, the Inform.tlon (. ` <br />i :: f <br />- <br />- <br />.. ; <br />submitted K to the best of my bnowkdge and btetf, teroe, aceunle, and complete. <br />- <br />.. <br />ware th <br />si <br />nificant <br />enalties roe mbmittln <br />rWe inf <br />i <br />IGNATURE OF ?RINCNAL EXECUTIVE <br />I <br />l th <br />¦ <br />tl - <br />TYPED OR PRINTED g <br />p <br />j <br />¦m a <br />e <br />ere <br />m <br />ornr <br />en, <br />InckWirq the polelbiNty of fine and hnprbmmwnt rot mowing yiolaUgat F <br />OFFICER OR AUTHORIZED AGENT CAREA ODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OP ANY VIVLA I IUN5 Itfayarance on arracnmenrs nerai <br />REPORT LCSO - STATISTICAL PINT WSTIMATE WHICH IS <br />• TOXICITY TEST REPORT FORM TO DMR. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.