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PEA WME NA ME)ADDRE S S t7,wirdr Faeabry N.?.rLorrrow t/D(QIwwn) <br />NAME <br />ADDRESS <br />Lick i8-/ <br />IG CO 816.2 <br />FACILITY '? P P ER MINE <br />LOCATION + I G CO 816.' <br />sYMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOESI <br />DISCHARGE MONITORING REPORT fD R) <br />PERMIT NUMBER DISCHARGE NUhIBER <br />MONITORING PERIOD <br />YEAR I MO DAY YEAR O DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />MINOR <br />(SUBR JC ) <br />F - FINAL MOFAT <br />ACUTE WET TESTING FOR OIIA <br />NOTE: Read Inatrucdons befwe completing this form. <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 - : t -. -? <br /> PERMIT -.. _ <br /> REQUIREMENT MN VALUE <br /> SAMPLE _ <br /> MEASUREMENT <br />Nr. ` PERMIT it 1 _, 077) . r <br /> REQUIREMENT MN VALUE <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 /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEf TILE PRINCIPAL EXECUTIVE OFFICER t fen,q u err pen. ,. o ?..: ,net thh document and all attachments wen <br />TELEPHONE <br />prepared under my d,r.ctlon a mpervtslon In ascot .-with .systemdesigned <br />1 <br />l <br />l <br />l <br />lb <br />- <br />DATE <br />. , to insure that guafif <br />ed personne <br />proper <br />y ga <br />er and ...N.I. the Inrornutlon <br />` <br />?- i mbmllted. Bawd on my Inquiry of EM person oc persona who mamas the system, , <br />tl <br />res <br />ontlbkt f <br />di <br />r <br />th <br />A <br />the I <br />f <br />ti <br />th <br />I <br />f <br />ti <br />-?/ 'r -" -- -- <br />I - <br />th <br />p <br />ose prrsom <br />rec <br />y <br />o <br />ga <br />e <br />ng <br />n <br />orma <br />on, <br />e <br />n <br />ornta <br />n <br />or <br />the bnl or m <br />k wnkd <br />t <br />o and bdW <br />1 <br />t <br />b <br />lli <br />d 1 <br />d <br />l <br />t <br />y <br />o <br />g <br />, <br />r ..c<vm <br />e, an <br />comp <br />e <br />e. <br />su <br />m <br />r <br />f, <br />SIGNATURE Of PRINCIPAL EXECUTIVE <br />th <br />t th <br />e a <br />i <br />ifi <br />t <br />ilf <br />llti <br />f <br />t <br />I <br />r <br />f <br />b <br />tb <br /> er <br />n s <br />gn <br />can <br />pe,u <br />es <br />or m <br />m <br />ng <br />a <br />n <br />1 am *.am <br />a <br />e <br />orma <br />n. <br />TYPED OR PRINTED Induding the posalbiNly of fine and Imprlsonn,rnt for knowing violations. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OI- ANY VIULA I IUN5 IHarorenco as arracnmenrs nerel <br />,E REPORT LCSO - STATISTICAL PIONT ESTIMATE WHICH IS <br />r t i•b - isldni <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used Ti is; R 4-e81j yErOriTl. PAGE OF <br />z