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PERMITTEE NAME/ADDRESS ()adtbiersltryMen tL-tion (/D(Qlnent) <br />NAME <br />ADDRESS u- <br />BW =93 <br />NIA (_0 81421 <br />FACILITY E NO. .7 MINE <br />LOCATION 11A 1],'j 814211 <br />NATIONAL POLLUTANT OISCHMOE ELIMINATION SYSTEM /NPOES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER a7c=of NUMBER <br />MONITORING PERIOD <br />YEAR MO OAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-000- <br />(SUBR MFi <br />F - TINA <br />S1?; DEER <br />NOTE: Read kwtructlons before completing this form. <br /> NO FREOUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT xa c <br /> REQUIREMENT 1 Il ;1 <br /> SAMPLE <br /> MEASUREMENT <br /> <br />1 PERMIT -0 4-4#43r <br /> REQUIREMENT I`ltil' i ` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #3F r5 <br /> REQUIREMENT -DA <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT r:r'A <br />- <br /> REQUIREMENT A AUC ; !?N <br />?l <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT OPITIN <br /> REQUIREMENT MAX F ?! T <br /> <br /> SAMPLE ?t uiF u .- <br />R E MEASUREMENT <br />:. <br />T;77 <br /> <br />ic. <br />T( <br />i' <br />I <br /> PERMIT ;T EPCI?' "; - PCIR r • <br />. <br />) <br /> REQUIREMENT "ODA ; I_Y I'x <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT ?r#;l # ;; - _ ._#31 # !• _?, t <br />REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 f may und" prna ly ° aw that thh document end all ¦ilwhnaenU were TELEPHONE <br />prepared antler my dimclloe or mprr.FSlon In accordance with a System designed DATE <br />to amm that q-MW personnel Properly galher and esatuale the Infnrsnatbn <br />submitted. flawed on me Inquiry of the Prnon or persons who manage the system, <br />or those perm directly respardbk for gathering the Information. the Information , <br />submitted Is, to the bet o(my knuwkndge and bellef• Irw. accurate, and complete. <br />OF PRINCIPAL EXECUTIVE -.1 <br />' <br />- I am .ware that them are significant penaltlea for submitting fahe Inrorn adon. SIGNATURE AAEA <br />NUM'BE:R Y _ <br />TYPED OR PRINTED Including the paalbitlly of floe bad Imprisonment for knowing folations. OFFICER OR AUTHORIZED AGENT C <br />ODE EAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rere/ence off •r(Icnmwnts nare/ <br />-iR o?;r ,^?a LV SIT TSB CI_ATMFD. TF ATM APPPQL/LD PY W(? CD, <br />This is a 4-nar( form PAGE OF <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used