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P E R M ITTEE N A M E/A DDR ESS ,Include Farilin %airre/larrruiaa if 1 AJJornN <br />NAME L . J <br />ADDRESS 1- i M i <br />A I <br />FACILITY A C <br />i F7 H 1. I MiNE"5 <br />LOCATION <br />diF C <br />DISCHARGE MONITORING REPORT (DA ) <br />PERMIT NUMBER DISCHARGE NUMBER <br />- MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040.0004 <br />MINOR <br />( SuiR MH i <br />F - FINAL DELTA <br />l1rr; " Tr] E F' QATC/A'' <br />NOTE: Read Instructions before completing this form. <br /> NO FREQUENCY 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 <br /> REQUIREMENT } ; ' i'; r•ir r.i <br />?1 <br /> <br /> SAMPLE s: s <br />r I <br /> MEASUREMENT - 1 f' <br /> <br /> t1A k;li ". -,'AII <br /> PERMIT -#a##it 7-1+-#^ # #.:r <br /> REQUIREMENT -- ?• -- . I' ' <br /> <br /> <br /> SAMPLE F . - <br /> MEASUREMENT <br /> PERMIT c- ,r +.. o ,Y. .ec r :: r- t 1F # # 's fe _: n C7 r;_ r, <br /> REQUIREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r• c # 1 .,- a ; _ i r? -. <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT R. r" , ,-, .. n' ^Ji .' - 7;il <br />f l-. REQUIREMENT <br /> SAMPLE ;.. - <br /> MEASUREMENT <br /> PERMIT r (a ;? <- I c <br /> REQUIREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME[TITLE PRINCIPAL EXECUTIVE OFFICER I -W, under lw•nall .,rU than u,i. d.wumrm aml:dl:dtachnwnl. -ev TELEPHONE DATE <br /> prep,n'rd wWrr un dinv-l i,.n „r .ulwr. i,um in aaaurd.mcc x ith a y,trm daviynnl j ; <br />i <br />/ - -- - <br />. I„ .n-urr that ytwlifird Iw•n.mnel pn•prrlt 4ulhrr and eeahwlc the inG.rn,vliun ? <br />? <br />J <br />• <br />. , , - •? / .uhminrd. Havel ou m. iwpun ..f dw• prt?an ur pcr..m. wlw mm?a¢r the ..dcm. ? <br />_`?? ., •. <br /> nr Ih••.c fw•r.un, di-11% n•.Iwnn,hle f.rr c:rthrrine Ihr Inh,rmai i,m, the inlnrnvlLm i - <br />' <br />ur. aaam nte, and . umpkte. <br />vd.mnl,•f ,., 1.. IhM1 f m. kn-lodi;c and Iw40. a <br />r <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />." - ., : '7 / <br />r <br />.. <br />_ 1."n uu an 0w ti n a. 11!mrcant twnalti«, (,-r itune Lad- AREA <br />' <br />TYPED OR <br />PRINTED <br /> <br />nrh,d n¢ the Ir...,Lihl) .rl li n e :wJ ,mprnnnmun Ln An, ,unP eu latwnl`. <br />i <br />OFFICER OR AUTHORIZED AGENT <br />ODE NUMBER <br />YEAR <br />M <br />DA <br />Y <br />COMMENTS ANU tAF'LAINA I IVN Ur HIV T vIUL.A I <br />ADD' <br />- 9) Previous editions may be used <br />EPA Form 3320-1 IRev 3x•9 <br />frrererence tilt allawmrrnra nor c/ <br />IQ. -- t r- PREC IP EVENT SUBJE:CT ro DURDIrN OF PROOF REGUIRENEP. <br />'SHALL _ _ .-;_IFr-- TI] THE DIVISION WITHIN 4P HOURS. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ,NPDES) <br />R <br />f7?; This is 1'4-pa.n.jPrim PAGE OF