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PERMRTEE NAME/ADDRESS (7.c6* F.rO#yN..?L ati- l/D(06rny <br />NAME <br />ADDRESS <br />li U A 1 _., <br />IG C.0 GI <br />FACILITY 7 P ER MINE <br />LOCATION I G C© 81 <br />MOND G. DU LSDIS, PRES/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM WIDES) <br />DISCHARGE MONITORING REPORT /DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DA YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. 2040-0004 <br />MIti L <br />(SUBF <br />1= - F I IINAL MUF"A I <br />POND TO FAR EAST BUZZARD GULCH <br />NOTE: Read ktetructione before comoletkta this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREOUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT b. t3 V, L Y -. Z <br /> REQUIREMENT MINIMUM— . MAXIMUM <br /> SAMPLE -- <br />))' -%. MEASUREMENT <br /> <br /> PERMIT "I 5z R* "'R P- T. 3F -P 7mr= <br />_ <br />A <br /> REQUIREMENT J30DA A'Ji;' DAILY MX MCINT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ' I t ' > <br />V: REQUIREMENT l C ' L'0 VG DAILY MX MONTH <br /> <br /> SAMPLE 1 ' <br /> MEASUREMENT <br /> <br /> PERMIT _ , ;. t:. i i rc rs r <br /> REQUIREMENT ;SODA AVG DAILY I`1:i <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT NST MAX <br /> SAMPLE <br /> MEASUREMENT <br /> <br />5O 1 0 0 <br />PERMIT <br /> <br />UK I <br /> <br />> -A-WW <br />;,)ENT GROF.t- REQUIREMENT A ILY <br /> SAMPLE <br />?'LVED MEASUREMENT <br />' 1 <br />- <br />, <br />PERMIT M r= 1 <br />r% I <br />Y L <br />REQUIREMENT - 30DA AV' DAILY MX <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I mrin, on&f pens ly o (low that thh document and ell attachments were TELEPHONE DATE <br />prepared order my direction or mp-colon In accordance with • s)etem designed y' <br /> <br />, to aaum that gwsHtlyd personnel properly gather and eralusle the Information <br />mbmltted. Based on my In <br />uiry of the person or <br />ersons who mena <br />th <br />t <br />. q <br />p <br />ge <br />e sys <br />em, <br />th <br />l <br />d <br />bl <br />f <br />- c <br />'L <br /> or <br />ose persons <br />irect <br />y reporta <br />e <br />or gathering the Information. the Information --- - <br /> <br />' submitted K to the bet or my knowledge and belief. true. accurate. and complete. .. ./ .. ' <br /> I am aware that there are dgn irlrant penaltla for abmltting rate Inforntatlo" SIGNATURE OF PRINCWAL EXECUTIVE ' <br />TYPED OR PRINTED Including the poalbllity of fine and Imprisonment roc knowing ytolstlorm OFFHAR OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />LVMMCr4 1 5 ANU CAr'LAMPt I IVf1 yr fire T e rvLn r tvria irterorlrtca M ettlGAr"arni7 marl/ <br />:3LE SOLIDS LIMN APPLIED FOR <"=10YR, 24HR PP,ECIP EVENT- <br />!`! <br />/ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. ?,Jr,- :-}_)B,y,-QafORp PAGE OF