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PERMITTEE NAME)ADDRESS pwe6&Fr+MyNw.eLerria t(DWrr W) <br />NAME <br />ADDRESS <br />ull,l 1 _i .' <br />iG ?0 SIb? <br />FACILITY ?=PER MINE <br />LOCATION ; G CO 816 <br />rMOND G. DU BOIS, PRES/GM <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOESI OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT W MR) PERMIT NUMBER DIscHAnatNwem - FINAL 1.10FA1 <br />:.-_T TESTING FOR 020A <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO - <br />NOTE: Reed Ir»truictlorw before comoletlnp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 3i### 100. 000 i ## I >' - r- _ <br /> REQUIREMENT MN VALUE. <br /> <br /> SAMPLE <br /> MEASUREMENT <br />'r <br /> PERMIT K x# a .lJ i ## 4# i i sE# L 177 <br />_UE-NT R O':: REQUIREMENT ALUF <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />t <br />I <br />th <br />° r <br />n <br />lt <br />t f ,i <br />y o <br />r <br />e <br />pe <br />a <br />.w <br />at this doroment and .u wechments were TELEPHONE <br />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER <br />prepared under my direction or supe. 0 on In accord- with a system designed DATE <br />l ! ?? to assure that qualified personnel property father and evaluate the InrmwnClon i !. <br />F • = i"" submitted. Seed on my inquiry d the <br />erson or <br />ersons who mana <br />e th <br />t <br />p <br />p <br />t <br />e sys <br />em X <br />or those persons directly responsible for fathering the Information, the Informato.n <br />to the best of m <br />knowled <br />submitted Is <br />e and Wi <br />r <br />tr <br />-te <br />nd <br />l <br />t <br />? <br />• <br />. <br />y <br />g <br />e <br />, <br />ue, smu <br />, a <br />comp <br />F <br />e <br />e. <br />I j' - • i <br />' f • I am were Choi there are slgnincant penalties for wnbmllllng ratty Information <br />SIGNATURE OF PRINCIPAL EXECUTIVE - <br />' i <br />i .' ! <br /> . <br />I <br />l <br />h <br />I <br />TYPED OR PRINTED nc <br />uding t <br />e possibility of tier and <br />mprisonment for it nowing violations. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />t-UMMtN 15 ANU ItArl-AnA I tarr/ yr ^m r wwl.n r rvrso frttrrsrance svi atucnmenre ntrrel <br />REPORT LCSO - STATISTICAL POINT ESTIMATE WHICH IS <br />TOXICITY TEST REPORT FORM TO DMR. WHEN WET TESTING NOT <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used <br />00600 % !ct;a a-pa Corm