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PERMITTEE NAME/ADDRESS(?-A- rF coyA(..?L-eii"((DioW.at) <br />NAME <br />ADORESS <br />?Ux lE?% <br />IG CO 8 <br />FACILITY 'PER MINE <br />LOCATION I G CO 8 <br />YMOND G. DU BOI S, PRES/G1 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM IINPDESI <br />DISCHARGE MONITORING REPORT (DMR/ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DA YEA MO DAY <br />FROM TO ` <br />Form Approved. <br />OMB No. 2040.0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />POND #5 TO NO NAME GUL <br />NOTE: Read Inotructlorw before completing " 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 />R <br />N ,. <br />/ <br /> MEASU <br />EME <br />T - <br /> PERMIT _ <br />Ii;` IN REQUIREMENT M I N I Ih ' MAXIMUM <br />, <br />:'ENDE:T SAMPLE <br />T <br />. MEASUREMEN <br /> <br />PERMIT 77 <br />UENI v r , REQUIREMENT 30DA AVG DAILY' MX MONTH <br /> <br />lit) 'j- <br />1 <br /> <br />SAMPLE <br />EASUREMENT <br /> <br /> <br />4 : <br /> <br />l , <br /> M . - <br />?i <br />U PERMIT x y r. <br />RG`-•` REQUIREMENT 30DA AVG DAILY MX MONTH <br /> SAMPLE <br />T - <br />_ MEASUREMEN <br />1J)4 PERMIT <br />Ut N flCr REQUIREMENT 30DA AVG DAILY MX MONTH <br />- •- fANU ., SAMPLE <br />MEASUREMENT <br /> <br /> <br />X582 1 0 <br />PERMIT i IN Li t4 0-11 11 <br />LUiENT C REQUIREMENT # 114S? MAX IT <br />_ <br />i TREA SAMPLE <br />MEASUREMENT <br /> <br />J 1 PERMIT i? - _. •L_ , <br />7"UENT GROSS REQUIREMENT 30DA -1ILY MX <br /> <br />COL VED SAMPLE <br />M <br />S <br />R <br />M <br />T <br /> EA <br />U <br />E <br />EN <br />n PERMIT _ <br />REQUIREMENT :30DA AVG DAILY MX <br />I "ri y and" penally o law tha-thh d-mewl and all atl.chmants were <br />. TELEPHONE <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />m <br />. <br />d a <br />fer <br />dlr <br />cilon <br />r <br />u <br />rr+lfon in <br />d <br />ith <br />t <br />M <br />dd <br />DATE <br />, <br />p <br />p <br />re <br />n <br />my <br />e <br />o <br />s <br />p <br />accor <br />ance w <br />• sys <br />em <br />gn <br />?^1 to assure that qu.Mfied personnel properly gather and evaluate the InfornnUon <br />in <br />ulr <br />ub <br />itted <br />B <br />d o <br />f th <br />r <br />or <br />r <br />th <br />h <br />s <br />m <br />. <br />re <br />n my <br />q <br />y o <br />e pe <br />son <br />Pe <br />sona w <br />o manage <br />e system, <br />or those prraom dlrecny respoeslble for gathering the Information, the Information <br /> <br />, <br />- snbmined h <br />to the best *(m <br />knowled <br />e and b <br />Ir <br />t <br />s <br />t <br />d <br />`. •" <br />ot <br />- / <br />/ <br />, <br />g <br />y <br />e <br />e <br />. <br />we, a ra <br />e. an <br />comp <br />e. <br />,- <br />i <br />ifi <br />SIONATURE OF P"INCWAL EXECUTIVE <br />I <br />t r - ,, <br />- <br /> am aware that there are S <br />gn <br />can <br />Penalties for submitting Woe Informatlon• <br />TYPED OR PRINTED Inciodint the paaelbilite or nne and Imprbonment for knowing vlolatlom OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IONS !Reference ar errecnmenrs here] <br />I3LE S0L?D5 LIMIT APPLIED FOR r'=10YR, 24HR PRECTP EVENT- <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 0t JC, l ;t 17 ? h 4-4 tj Be4-Qa-r 4 4) nn. PAGE .OF ?_ <br />---------------------