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PERMITTEE NAME/ADDRESS pr.ardr i OIY Vmm?Lee.rf.a l/DO6,.,Q <br />NAME <br />ADDRESS <br />Lux 167 <br />1G CO 31E <br />FACILITY P P ER MINE <br />LOCATION !G co a l e <br />YMnr-in r_% nil RnTG. PRPCZ/t"`M <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOESI <br />DISCHARGE MONITORING REPORT (D R/ <br />PERMIT NUMBER DISCHARGE NUMBER <br />FROM For <br />MONITORING PERIOD <br />YEAR MO DAY T <br />TO R MO DAY <br />m Approved <br />OMB No. 2040.0004 <br />MINOR <br />(SUBR •JC ) <br />F - FINAL <br />D I SCHARGE TO WEST f :ORSF <br />NOTE: Road Instructions before rmmnlatlna 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 /> PERMIT ## : cr # ### 9 <br />G Iz E <br /> <br />REQUIREMENT <br />MINIMUM . <br />M X ,. SP•, _ <br />TOT At SAMPLE ; -•; r_ : -. <br />-P MEASUREMENT f <br /> PERMIT sr-` t rr .s ??c 70 NCE/ QRAt7' <br /> REQUIREMENT (\.• '_10DA VG DAILY Mr MONT; <br /> SAMPLE <br /> MEASUREMENT <br />C PERMIT i?3t###a / # 3t 3i #li#tt?t OPTIONAL REPORT 7i'dCE/ r?r-; :3 <br /> REQUIREMENT ' <br />:?rA 41QG <br />DAILY t IX <br />MONTi <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #3i ## # st it ?fi r gat * ls? :iii r?+jov <br />FOCI`=.c REQUIREMENT / _'•G!?/a AV_ DAii-_ FIX i•iTi <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT st3t#9t r. 0 AiTII ir..;. <br /> REQUIREMENT <br /> _'NST MAX i = dT <br /> <br />I SAMPLE <br />i ? i <br />*. MEASUREMENT <br /> PERMIT RIFPORT FORT <br />T RGt= > REQUIREMENT A = •' .Y MK <br />17", TAI_ SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT s##.. :##'f ;#1F#:. REPO' P , r;,_ , .r, <br />REQUIREMENT ODA e-- _Y MK <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER I nrtrly under prna y o Ise thn thti document and .n attachment were <br />prepared order my dlrtctlon or supervision In accord.nn with . system designed TELEPHONE <br />; <br />DATE <br />r t . `,??/• %.: Io assure that au.llned personnel properly g.lher and evaluate the Inrornutlon <br />sobmllted. Basal on my inquiry of the Person or persons who manage the system, / . _ / ??.. <br /> <br />or those Persons directly misondbk for gathering the Inforrrsdow• the Information . <br /> submitted Is, to the bet of my it makdIt and belief, true, accurate. and complNe. <br />~ <br /> 1 am aware that then an slpslrkant penNtles for submitting rain Informadon SIGNATURE Of PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED , <br />Inckding the Possibility of line and Imprbonment for knowing Holstions• OFFICER OR AUTHORIZEO AGENT CODE NUMBER YEAR MO DAY <br />GUMMCPI 1 ) ArV V CAI LAnn I run yr nee . . rv?n r rvn,? Inver wr wncw sore wnwcnnrwn,a nwrwy <br />ABLE SOLIDS <br />i :DS MONITOR <br />i <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br />T APPLIED FOR l0YR,24HR PRECIP EVENT- <br />799., .bN8i8 a4-pakn q nn. PAGE OF