Laserfiche WebLink
PERMITTEE NAME:'ADDRESS iincinde Fiacifilv.Yrrmc Lrxvrion it Di--irerrni? <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION:: <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) l v r <br />DISCHARGE MONITORING REPORT (DMR) RECCOVED <br />PERMIT NUMBER DISCHARGE NUMBER JAN 2112009 <br />MONITORING PERIOD Division of Reclamation, <br />YEAR MO DAY YEAR MO DAY Mining and Safety <br />FROM TO X <br />t1. Nf1TF• Ro?rl Incfr..nfinno i.nf...n ....... <br />Form ApproveC <br />DMB No. 20au-WO-3 <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />? OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT * iF N G <br /> REQUIREMENT <br /> SAMPLE <br />- MEASUREMENT <br /> PERMIT t `'r i =SCi <br />_ _ _t c r REQUIREMENT ?i?A <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT z: .; . . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r - 11V A f? <br /> REQUIREMENT <br />r <br /> <br />F r , <br /> <br /> <br />T <br /> SAMPLE s :.-. <br /> MEASUREMENT <br /> PERMIT r y.; sf tr#### ?li:)= ' :rPa <br /> REQUIREMENT MONTI- <br /> SAMPLE <br />t>i MEASUREMENT <br /> PERMIT qr ._..-I r Inc T <br /> REQUIREMENT c_::. z Fr •`? _ : ; t^ ; <br />NAME/nTLE PRINCIPAL EXECUTIVE OFFICER I certify under pcmlty of law that this dleamcot and all attrchments were TELEPHONE DATE <br /> prepared under my- direction or supenasum in accordance with a svsiem designed <br />t <br />i - <br />• _U ?- J <br />d?.. " co assure <br />hat yuaht <br />d Personnel properly gather and evaluate the information <br /> submitted. Based on my inquiry of the person or person, who manage the ,}stem. <br />_ or those persons directly reslamsiblc fur gathering the mfomhathun, the information <br /> uhnwtcd is, to the best of my knowledge and belief, we, accurate, and complete <br />I <br />h <br />h <br />ifi <br />i <br />d <br />f <br />' SIGNATURE OF PRINCIPAL EXECUTIVE c <br />' <br /> r, -,, are t <br />at t <br />ere are s <br />gn <br />cant pen: <br />ti?•s <br />rK submitting false ml <br />ortnation• <br />TYPED Off PRINTED nr the pusshbhlity of tine and imprisonment for knowing riolathons OFFICER OR AUTHORIZED AGENT COD NUMBER YEAR MO DAY <br />u ruin .. .. . <br />aRr Rct; IP F'!Ft?l- - "zF'F. I . A. I. F ! FOR RFgI. T RF"!Pws. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. PAGE OF <br />. , ?,3g ; '• T11iS its a 4»part form.