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PERMIT-TEE NAME/ADDRESS littJude Fmwiti NumdL.katu.n r(Ur(fi• rnq <br />NAME <br />17 <br />ADDRESS I , i'r i EL l; MINE <br />BOX 45"? <br />'RENCE _ <br />FACILITY THE IEL.0 MINE <br />LOCATION RENCE L) Ell `til <br />. Ip v Q PATTPRr-nw. MENt= Mr-lP <br />DISCHARGE MONITORING REPORT (OMR) <br />.v <br />PERMIT NUMBER DISCHARGE NUMBER F - F- I ?`4AL FRPINT <br />MONITORING PERIOD NEW =n! REEK <br />YEAR MO DAY YEAR MO DAY <br />FROM 101 .-1 1 1 <br />`\. <br />NOTE: Read Instructions before completing 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 />r ! - SAMPLE - - -- <br />MEASUREMENT <br />11 C: .: PERMIT , a h. 5 . <+ k!i 4 f WIGE! 'r.A? <br />F F F L ?' REQUIREMENT • P1U11 .'}Ft x I i 3'-;I + f'•', T` <br />C)t_' . SAMPLE <br />MEASUREMENT <br />Qt,'":, PERMIT ?it?t-r:r a a:: r 7 ( p. 5 ;•jiU..' 3RAE <br />REQUIREMENT .,`%(y Td7i <br /> SAMPLE ,.., r .r <br /> MEASUREMENT <br />x'3582 ; PERMIT i # : 'r xd the I : NT IN R _ <br />F ! i_UEN7 fski,_) ai_!_i REQUIREMENT <br />i)IN, II'd (Ci:4:-) 1j ; SAMPLE r : <br />TRr=ATMENT F`AN i MEASUREMENT <br />C. PERMIT _ii 41 <br />4 it <br />S?#7f# <br />####st# <br />{•d <br />Ci:: ?i <br />- ;;=RC75'-i REQUIREMENT , <br />r <br />_ SAMPLE <br />I <br /> MEASUREMENT <br /> PERMIT e;: 4• P.r:.PORT E ' 1. #It?)(:t# 4i+??i?# ax?i't+i# ? ?i' ' ?IS: A <br />AFFLUENT r 355 VF:_ '' REQUIREMENT T MAX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE <br /> <br />MEASUREMENT O <br />? I I <br /> PERMIT 1 \VI <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE QFFICER under penalty of law that this document and all attachments were TELEPHONE DATE <br /> <br />Pic f4 M L) A/ V pecpared under my direction or supervision in accordance with a system desigrted <br />tion <br />t <br />s <br />th <br />t <br />lified <br />er <br />n <br />el <br />r <br />erty <br />ath <br />r <br />nd <br />y <br />l <br />i <br />th <br />nf <br />rm 7. <br />"- " <br />' f <br /> o a <br />a <br />qua <br />p <br />n <br />p <br />op <br />g <br />e <br />a <br />e <br />a <br />ua <br />e i <br />o <br />a <br />sure <br />so <br />c ? <br />, i C ?1'i T•` - <br /> <br />submitted Based on my inquiry of the permit or persons who manage the system. , <br /> or those perwna directly responsible for gathering the information, the information <br />t` K I - suhmat <br />to the NI of m <br />kno•slcd <br />c and beli <br />f. tru <br />aceumtc <br />and com <br />lete <br />d n - - ! (' <br /> • <br />g <br />p <br />e <br />y <br />e <br />e. <br />. <br />a <br />, <br />uMnm <br />f <br />m <br />u Ih <br />rr <br />if <br />t <br />r <br />th <br />G <br />l <br />i <br />t;•nr <br />nn SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED t ., <br />_n <br />,a <br />am ., <br />.,rc <br />: <br />e <br />acn <br />ican <br />f <br />i- <br />a , <br />mc <br />a <br />se <br />n <br />. <br />md.,d r; ;hc ,;vh:!its of tine and imini-pm-1 for i.m„%me cud n,:n' OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />GUMMtNIJ ANU tAVLANAIIVN Vr- ANT VIVLAIFVNa (rrererence an arracnmenrs nereJ <br />IP EVENT SUR,JFCT TC' BLIRPEPi ?J PROOF REGLITREMENTS IN P4,-..1T <br />HE PIVISI( <br />EPA Form 3920-1 (Rev. 3199) Previous editions may be used. -t, r This-i5 a 4-pan lbrm. PAGE OF