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FERMiTTEE NAMEIADDRESS t7.dr4 FwOiyMa.?Lrre.rtew I/D(feranr) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTDA (INPDfS/ Form Approved. <br />NAME DISCHARGE MONITORING REPORT IDMR/ OMB No 2040.0004 <br />ADDRESS <br />DQX 1 PERMIT NUMBER DIscHMGENUMaEn 1NAL DEI <br />NIA MONITORING PERIOD ER TRL DTC OR UPJMD TRIM <br />FACILITY E ND. <br />YEAR MO DAY YEAR MO DAY <br />LOCATION L O fl i. 4... FROM TO <br />LL I AM A. BEAR JR, , MINE MG r NOTE: Read hwtructione before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />EX Of <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT Ih(UP1 <br /> SAMPLE <br />f FrJI`i* MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />I f PERMIT <br />##:: <br />r ri4 <br />;s ?cr <br />nt.l i]I.? <br />:P?Cj:.: <br /> REQUIREMENT ;, i ; ,r IiOt••ITi 1 <br />TO TP.,_ SAMPLE <br />A MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />? PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT kEF`O' ` PC)R? <br /> REQUIREMENT ' <br /> r; 4 I ! Y i <br />. <br />T- SAMPLE <br /> MEASUREMENT <br /> PERMIT r z#xi?Y r.. I. _ <br /> REQUIREMENT <br /> <br />NAMEMnE PRINCIPAL EXECUTIVE OFFICER I "May under penally 0 Law Chet Ihle dr.vmenl and .u .Ilechmente were TELEPHONE DATE <br /> prepared under my direction or supenaslon In sue-rd.nce with • system designee <br /> to aaure that goatfled personnel properly gather and eetioate the Information <br /> submitted. seated oe my Inquiry of the parallel or person who manor, the sysl,m, <br /> or those persons directly rvportdble for ratlterinr the Information, the Information <br /> <br />L submitted ir. to the best of my knowledgt and bete{, Ime• accurate, end complete. <br />1 ¦m aware that there ¦m dgniflunt peneltles for mbmiuing fain Inronmtlon <br />SIGNATURE OF P%INCWAL EXECUTWE <br />- <br /> <br />TYPED OR PRINTED • <br />Incfisding the poodblilly of flee and Imprisonment for knowing Aelellm <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# attachments here/ <br /> <br /> <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This is a 4-Part forin. PAGE OF <br />