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Form <br />MICE NAME/ADDRESS pweYi i?e?dryN.' - ' "': ?• ?NATIONAL POLLUTANT 04SCHMOE ELIMINATION SYSTEM /INPOE.?J OMB Nop204e0c-, <br />DISCHARGE MONITORING REPORT IDMAJ OMB No 2040004 <br />= <br />ORE55 -z-- <br />PERMIT NUMBER GE 'NUMBER r; <br />• <br />R J 1= T - L.1 (D t :) f <br />MONITORING PERIOD <br />FACILITY Q' ,f ?. p ELK CRK M I NFI: <br />YEAR DAY YEAR NO DA <br />LOCATION FROM TO <br />f? . ?. X EC - NOTE: Read Instructforte befo.e complotlnp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT MINIM' ' ;" ? I ?i •` MON <br /> <br /> SAMPLE '.=. r,-•a = - <br /> <br />.. MEASUREMENT <br /> PERMIT '.v <br />. r <br />)r _ REQUIREMENT 3ULA P.': i r::=. . ' <br />MON? <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT x <br />- .. <br /> <br />lTI <br />!?ILr <br />i. REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -s <br />11 <br /> REQUIREMENT 'ODr: D ?L_` MX i.'•i <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />-.4 <br />_- r 91 14 <br />_.. <br />?.. _ V,",-- REQUIREMENT <br /> <br />t }. <br />SAMPLE 44 <br />i3EA1 MEN ,: MEASUREMENT <br />i G PERMIT <br />`_NT GRO:-. '.L_1.! REQUIREMENT 'ODA DAILY' r?'r TI- I <br />..: SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT 1 t`P ^' i MON T !- <br />thN <br />I <br />v <br />nl and ae a1lKh were TELEPHONE <br />e " er Penalty o4 low that <br />nE PRINCIPAL EXECUTIVE OFFICER I fe a <br />N DATE <br />p <br />oe <br />de <br />r <br />on In <br />AMErn <br />Prepared under my direction or fuynl>tn accerdanne with - • system destined <br />-'? to awns that quaHned personnel property ether and evaluate the Information <br />i <br />I <br />?• submitted. Bred oo my <br />nqu <br />ry of the Peron or penors who manate the system, <br />df- <br />ordbk F <br />r tho <br />er <br />on <br />it <br />re <br />therin <br />the I <br />fo <br />m <br />tlnn <br />th <br />I <br />f <br />r <br />i <br />-' "t I --' - <br />I <br />- - <br />y <br />_ o <br />se p <br />s <br />s <br />c <br />p <br />or ga <br />g <br />n <br />r <br />a <br />, <br />e <br />n <br />mat <br />on <br />o <br />f <br />L <br />? <br />' ' <br />fubmltlnd ia, le the bnt o <br />my <br />naw4dte and beMef, troe, atevnte, and rompHle. <br />-, <br />_ <br />6IONATURE OF PRINCI? L EXECUTIVE - <br />- <br />- e I vm -- that then are slgnincanl penatnes for rbmlttlng bHe Information, <br />TYPED OR PRMITED InrhWing the Passibility of Am and ImpAtonment for bnowing viol."" OFFICER OR AUTHORIZEO AOEIfT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference 0 attachments herel <br />7 -E 501 rr17 `rwT APPL T1-)1 F[]F? -,=In. ^f!-tR opct. To yr RIT: <br />f , <br />EPA Form 3320-1 (Rev 3!99) Previous editions may be used . 'rhis is a 4-part form. PAGE OF