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PERMITTEE NAME/ADDRESS (include FacilifY :Yame/t,1u•adon i11)ifferem ) <br />NAME <br />ADDRESS <br />E ?: CID I}. <br />FACILITY 1 MINE <br />LOCATION C. F E _F K <br />_ ; Eil14 <br />D 1 INFER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form A <br />OMB r: , . <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT ?. ? ?. 14 95 (? Imo! `ITU <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT --- <br /> PERMIT 4 <br /> REQUIREMENT D P, V <br /> SAMPLE <br /> <br />MEASUREMENT <br />L C ?X <br />Y <br />?? <br />tl A? <br /> PERMIT r. -. t_ : ?.... <br /> REQUIREMENT <br /> SAMPLE <br />R <br />M <br />- <br />_ <br />/? <br />1 = t <br />' <br />` k.- '? <br /> MEASU <br />E <br />ENT - om <br /> PERMIT 7 >: ,. r -. r r_ - <br /> REQUIREMENT fl'.'I' <br /> SAMPLE <br />I I -1?' <br />1v, <br />(~R-A <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE NIA r <br /> MEASUREMENT ? <br /> PERMIT _.. ,.. <br /> REQUIREMENT <br /> SAMPLE <br />I <br /> MEASUREMENT <br />O •a? <br />.UL <br />+ <br />-1 <br />I J 5 <br /> PERMIT t <br /> REQUIREMENT 1, = • s <br />NAME1rITLE PRINCIPAL EXECUTIVE OFFICER I reruy ondee penalty of law that this document and all attachment were <br />r <br />tler i <br />n'it <br />f <br />l a <br />s di <br />r too <br />o <br />s <br />l <br />n <br />kith <br />I <br />i <br />i <br />d <br />d <br />d TELEPHONE DATE <br />_ <br />4P -C <br />I y <br />? p <br />epa <br />K <br />n <br />n <br />re <br />l <br />r <br />t <br />pe <br />n <br />n accor <br />ance <br />a "- <br />l <br />r it <br />es <br />gne <br />to ¢.sure that qualified permnnei proped% gather and etnlunte the Inrrmmatum ' L -- ; --. <br />Y <br />. •. _ <br />V <br />t ?'' `t <br />- ` • -`-- <br />? whmili,d. Ruled nn my mquin of Utr person or prnont who manage the .}stem. <br /> or Ihotc persons dirmd% nvponeilde for galhrring the information, the information <br /> suhmitted is. In the heat of not Is-ledge and hetief. true. atcurali, and complete. <br />I <br />t th <br />il <br />[f <br />- <br />- <br />l SIGNATURE OF °RtNCIPAI .ECUTIVE <br /> <br />TYPED OR PRINTED am aoare <br />la <br />;m <br />itant pena <br />em <br />wr <br />tie, for athmitting false infurnutiua <br />including the I-ibilh! or rin..owd ingtrisonment for knowing tiolalians OFFICEP? AUTHvn1ZED AGENT AREA NUMBER <br />DE <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />FUR REGUIR-EM=N] <br />- - Flak I, a -t-hart fount. PAGE Ur