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PERMITTEE NAME/ADDRESS tin,hnieFadfin ,Y,rmr7ftearionr/Diff ti emn <br />NAME <br />ADDRESS rtL I'i : `'1F <br />EL.Y O 6164 <br />FACILITY <br />LOCATION I_ F, IC=ELY <br />-tf .1 1-=;1?!i: MINE MATI;;,.:?F? <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> <br />/45i <br />c/ <br /> <br />G <br /> <br />I <br />?J <br /> <br />G <br />C :k MEASUREMENT / <br />; ?r'? <br />/ r p <br />- <br /> PERMIT REPORT O NCE/ rK ^+T' <br />- <br />=-, 1•i REQUIREMENT r". MONTH <br />`I SAMPLE of :f i #-a ? V <br /> MEASUREMENT CJ Nu,r?" ?,':'?? I <br />_ PERMIT F 1.F'i IF. i i ;t'.. ;t 7 i #it tz}# 3i #if3i# # C N'? i\Ci-AN <br />_ F -L.1ji_f t ' REQUIREMENT MOnl?N <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />I <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of lain that thi, doeuntent and all anachments were TELEPHONE DATE <br /> prepared under my direction or suNmiston in accordance with a wmcm designed - , <br /> <br />- t„ assure that quahtied personnel pfopcrly gather and evaluate the Information <br />- submitted- Based on my inquiry of the person or persons who manage the system, <br /> or those persons directly responsible for gathLnne the information, the mformation <br />t •.> <br />- --- uhmiu d is, to the hest of my knowledge and hcltef, true, accurate .Ind complete <br />d rt :h <br />lu <br />r r <br />b <br />{ <br />ti SIGNATURE OF PRINCIPAL EXECUTIVE , <br />r <br />TYPES OR PRINTED n u prne <br />m, <br />mg : <br />. rni. r,•n. <br />e <br />n <br />rnpn .i.n. rt u; knowtn OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />GUMMILNTS ANU tXFLANAIIUN Uh ANY VIULAIIUNS (Heterence all attacnments here) <br />EPA Form 33201 ,R•?,, 951 r -': ous ed,l ors r ,,id, OR -I=-[ <br /> <br />:SS OF WHETHER AN EFFL <br />00,6' This is _a 3 part form.