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PERmn-ME NAME/ADDRESS (7m.6 FairibrrN?.?LoraNew ((D(Qri.w ) <br />NAME <br />ADDRESS <br />BOX 18 <br />G CO E <br />FACILITY 'PER MINE <br />LOCATION ? G 00 E <br />v.nnnln r_ nii RnT4. PRFq/L <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOESI <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE 14UMBER <br />MONITORING PERIOD <br />YEAR MO DAY YE R MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MI NOR <br />(S UER J C) <br /> - FIN AL <br />AC UTE W ET TESTING FOR 017 A <br />NOTE: Read IrMtrucdoru before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FaEOUF <br />OF SAMPLE <br /> EX TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> r?' RAU <br /> ### ###### 0001 <br />100 ###### ###ir#? _ _ <br /> PERMIT . <br /> REQUIREMENT 11N VALU <br /> SAMPLE <br /> MEASUREMENT - <br /> ' :t! ', t:r <br />'' <br />1 O PERMIT <br />## '?> <br />##It#se <br />, . <br />? <br />---##### <br />Ir##?a# <br />. <br />. <br /> REQUIREMENT N VALUL <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />I <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT / <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUME OFFICER t -n"y Y r pens ly o (law that thh document and aN ¦ttachmenls were TELEPHONE <br />prepared under my direction or mperH/oet In accordance with • systems dedgned DATE <br />to aaR that tiuoi personnel property gather and evaluate the Information ' <br />submitted. Bred on my I"uiry, of the person or Persons who manage the system. <br />or thane persons directly respordble for gathering the Information, the Information <br />'? <br />f <br />d <br />l <br />t <br />.. :.: :..?. " . <br />submitted Is, to the best of me knowledge and belief, true. -ra <br />t, an <br />comp <br />e. . <br />e <br />EXECUTIVE <br />P <br />I <br />, - ; I am aware that there ass significant penaitles rat submitting M1he Intormufon, RINC <br />PAL <br />SIGNATURE OF <br />I <br />T AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED - Including the possibility of flee and imprisonment for knowing vivailores. OFFICER OR AUTHOR <br />ZED AGEN CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference off arrecnmonrs nerol <br />REPnF?T L_CSO - STATISTICAL- POINT ESTIMATE WHICH I8 <br />Th>sLs.a.4-p4rt form. PAGE OF I <br />EPA Forr 3320-1 rRev 3'99) Previous editions may be used ' ?'.'