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PEAM17TEE NAMEIADDRESS(7 rA Fet4hryN...rL«,wim(/Dlpbwl <br />NAME <br />ADDRESS <br />i'4' I A C U <br />FACILITY 17 NO. 3 MINE <br />LOCATION E-RSET CID <br />,'iIEL E BEAR, PRESIDENT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /rNPDESI <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />TOMB No 2040-0004 <br />F7 4 <br />NOTE: Read Irretructlorra before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FaEavENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT f-, <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT Y 1 " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT u °tyF' ?l t .:; r <br /> REQUIREMENT d- ' NA x. <br /> <br /> SAMPLE <br />T_r1 11'. ,_1? E MEASUREMENT <br />!3 ^ PERMIT .' <br /> REQUIREMENT I <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 />NAMEmnE PRINCIPAL EXECUTIVE OFFICER I n hly under prna ty o (I.. that this document and alt at,achments were <br />TELEPHONE <br />DATE <br />prepared under my directon or mpervMon In accordance with s system designed <br />to assure that auaBned personnel property gather and evaluate the Informatlon . <br />.,emitted. Based on my inquiry of the person or person. who manaie the system, <br />- - <br />or those peraem directly responsible for gathering the Inform otlon, the Information <br />submitted Is, to the bet of my tnowlydge and belief, true, accurate. and complete. - <br />SIGNATURE OF ?RINCIIAL EXECt1TiNE <br />t th <br />l <br />Vfl <br />anl <br />lti <br />f <br />b <br />itti <br />f <br />1 <br />t <br />l <br />I <br />f - <br />J' <br /> g <br />c <br />pena <br />am aware <br />ha <br />ere are s <br />es <br />or su <br />m <br />ng <br />a <br />se <br />n <br />ormation, AREA <br />TYPED OR PRINTED Including the poadDlllty of ram and imprisonment for snneing .Idatlorht OFFICER OR AUTHORIZEO AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aM attachments here/ <br />a ?.tr1 r)r _. ^r?•r t l.n! r cfit Tr«; ! ?}??T ',mil Tt? i r.rtR 1f?YFI <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is 3 4-Pert form. PAGE OF