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PERMITTEE NAME/ADDRESS (/wdi6fr+hry N?.?Leralow(/D0er.n0 <br />NAME <br />ADDRESS <br />IA C <br />FACILITY E NO. 2 MINE <br />LOCATION : I A C <br />I TAM A RFAR .)R . MI <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPDESI <br />DISCHARGE MONITORING REPORT /OMR) <br />PERMIT NUMBER DISCHARGE Ml1MBER <br />G 1 MONITORING PERIOD <br />YEAR O DAY I YEAR MO DAY <br />d 81 :r _ FROM TO <br />NF Mi_, <br />Form Approved <br />OMB No. 2040-0004 <br />MINOR <br />(SUER MH ) <br />F - FINAL DELTA <br />CHRO,N t t_: b3ET TESTING FOR 006A <br />NOTE: Road kwtMVcdone before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE <br /> MEASUREMENT <br /> ' l"i - <br /> PERMIT } #:: PORT <br />##### <br />#st#### <br />ii <br /> REQUIREMENT > I NGSAMP I <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER i eertaly ° of Pen' ly o I.w that thh 6x rnem and .11 ¦Ilachments were TELEPHONE <br />prepared under my direction or supervision In accord.nm with • system designed DATE <br />to assure that qualified personnei Property gather and evaluate the Information <br />submitted. Bred on my Irpulry of the Person or Persons who manage the system <br />or those prrsom directly responsible for gathering the Inlormatlort. Me Information <br />submitted I& to the best *(my knowledge and betlef. Ime. atevrate. and complete. <br />IGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 am aware that they: are signlfkant Penalties for submitting false Information. S <br />T AREA <br />NUMKR <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED Including the Poadbltity of fine and Imprisonment for knowing 001900M HORIZED AGENT <br />OFFICER OR AU COOS <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference off •rracnmenrs nere) <br />T! OF LETHALITY DERIVS AS ""EFFECT", POWTH AND <br />ICALL`t <br />This is a 4-part form. PAGE OF <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used