Laserfiche WebLink
PERMITTEE NAME/ADORESS(/n . . Formey N..WLxaeronl/D(Qerww) <br />NAME <br />ADDRESS <br />I3OX 483 <br />1IA CO 8142E <br />FACILITY J E NO 2 MINE <br />LOCATION '1 I A CO 8142E <br />1 L .I AM A. R FAR JR r M T NF MGR <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE EUMINATION SYSTEM (INPOESI OMB No. 2040.0004 <br />DISCHARGE MONITORING REPORT (DMR) <br />I j PJuf? <br />SUPR MH) <br />PERMIT NUMBER DtscHAAGE Num""t r - FINAL DEI <br />MONITORING PERIOD HRON I C WET TESTING FOR OObA <br />YEAR MO DAY YEAR MO DAY - <br />FROM TO <br />NOTE: Read hutrucdorte before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOVENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ## REPG)< ## . . ', ##b ;O; ?f . <br /> REQUIREMENT S I NGSAMP <br /> SAMPLE <br />A MEASUREMENT <br /> PERMIT #as##rtlt ?:# .11 <br />fG0 <br />#####R <br />i"?fi'>:: <br /> REQUIREMENT Mt <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT iE##### #### REPORT ;f##### ###### L_Y 0MF <br /> REQUIREMENT S 1NGSAMP <br /> SAMPLE <br />_ MEASUREMENT <br /> PERMIT #' #t: 1F# 1Q0 # * # ##.iP i :! '! DMP-.. <br /> REQUIREMENT MN VALUE <br /> SAMPLE <br />t1Jii, C.tiFi -P, MEASUREMENT <br /> PERMIT REPORT <br />I <br /> REQUIREMENT SINQSAMP s <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;.. .. ,. REPDRT _ <br /> REQUIREMENT STNGSAMP <br /> SAMPLE - <br /> MEASUREMENT <br />PERMIT REPORT <br />F ,- <br />REQUIREMENT <br />SINGSAMP <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER I cert(ty . e. pen. ty e low that into document and n attachment, war. <br />TELEPHONE <br />hl <br />' <br />I <br />i <br />h <br />t <br />d <br />i <br />d <br />DATE <br />r <br />prepared under my direction or suprr <br />tmr <br />n accordance w <br />t <br />a sys <br />em <br />e <br />gne <br />to asurr (hat quailned to* scmrel prom y gather and rraW ¦Ir the Informelim <br />submitted. Based ore my Inquiry c (the person er perswr who manage the system, <br />or those perwas directly respordble for gathering the Information, the Information <br />submitted !4 to the best of my know4dgo and better, true, occurstr• and compkte. - <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />fk <br />l <br />I <br />- - <br /> I am aware eat there art dgrel <br />sofl pensIdas rw mbmitnng fa <br />sr <br />nformation. A A <br />TYPED OR PRINTED InNWing the possibility or nne and Imprisonment for knowing violations OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rofarence ad attachments halal <br />T F?1=SULTS ?i?" (FTIit=?f.ITY DERIV-1 AS "%EfFE-T"• r-,POJTH AND <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. ; jT; $_I+S a 4.-party fgrm. PAGE iOF