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PERMITTEE NAME/ADDRESS (hnein4Fw*iyNa.s/L«arlawl/D(Ofnnu) <br />NAME <br />ADDRESS <br />O. BOX 167 <br />IG C1 <br />FACILITY l-, P ER MINE <br />LOCATION r G C <br />wwr-iwn n fit I nr'17c oo= - <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM /NPDES) <br />DISCHARGE MONITORING REPORT (O R) <br />PERMIT NUMBER DISCHARGE NL"SER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />E3 ; ,•'_ FROM TO <br />'r1 m <br />Form APProved <br />OMB No 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL. Mi <br />I)IBCHRG TO FLUME GULCH <br />NOTE: Read klstructiexw before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCr <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT f # #ii ?# it # 6 5 ##{: ` ..:r ,.I JEEKL I Iii` <br /> REQUIREMENT ( 1 f'r; k I ! 1'..: M <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ##iEiEiE is !i k tE ## ii fi###it ?? ?. i G <br />ll <br /> REQUIREMENT <br />lDA AV6 <br />!>r, r ?.y 111 <br />. ; <br /> SAMPLE i , <br /> MEASUREMENT <br /> PERMIT ####? # ### GF. it## OPTIONAL REPORT ;NCE/ GRAB <br /> REQUIREMENT 30DA AVG DAILY MX MONTh <br /> SAMPLE ?., <br /> MEASUREMENT <br /> <br /> PERMIT 6000 <br />F <br /> REQUIREMENT '30Q /AVG DA I L Y M X MONTF <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT x ti <br />10 r]r?T:ii :?1=AZ; <br /> REQUIREMENT I NST MAX v"NT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REPOT' REPORT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT f ## t< # tE 3, gnat REPORT REPORT <br />REQUIREMENT 30DA A.VG DAILY MX <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' fe`r"y a 'r pens ly a 1.w th.t this doevmenl and all .ttschmenb were TELEPHONE <br />prepared under my dlr Oon w wp"vislon in aecordan" with • system designed DATE <br />f to navre that qualified personnel properly gather and evaluate the Informatlon <br />submitted. based on my inquiry of the person w person who manage the system, <br />... ... <br />f <br />h <br />I <br />F <br />th <br />I <br />f <br />i <br />l <br />or g.theAng t <br />e <br />n <br />eematim <br />e <br />n <br />ormat <br />on <br />Of than perssse directly responsib <br />e <br />k <br />l <br />t <br />t <br />f <br />d <br />d <br />f <br />d <br />l <br />t <br />I <br />Z/ <br />H <br />now <br />e, an <br />my <br />e <br />ge an <br />belie <br />, <br />rue, a ra <br />comp <br />submitted Is. to the bet o <br />e <br />e. SIGNATURE OF PRINCIPAL EXEClJT1VE <br /> 1 am aware that there an significant penaNies for submitting fair Information. AREA <br />TYPED OR PRINTED Including the passibility of fine and Imprhonment fw knowing violstlom OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference e/1 ofrecnmenr3 nera) <br />Win! P ^nl- r;),. i. TMTT APPi IFD FOR "=10YR, 24HR PRECIP E'JFNT- <br />=••t <br />T ?;_?4- nn. ---, <br />EPA Forth 3320-1 (Rev. 3199) Previous editions may be used. c , :-. y{??f4 PAGE OF