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PERMITTEE NAME. ADDRESS ,1,,auJc Faci(irv Vame lL x-ari(ie iMtfi-renr) <br />NAME <br />,<,'._ ,_.:fr;?o?-.•'t- , LLB <br />ADDRESS ANYON M I NF <br />WEST ? FJ STREET <br />s1 DAD i E <br />FACILITY -=N-:.( -' t:.! l`7'C :N 1-11 NF- <br />LOCATION rON = 0 E. <br />,t?.t r rt.ir?ntr, :^io.t n[^ch.tT <br />D15UI-IARut MONIIUHINU HLHUH: fUAdH/ <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 />I N (" <br />FINAL LAMPIS <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br />OF <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r •? : ?.s r: a z>s 6. - <br /> <br />REQUIREMENT ni r;+ <br />I' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />PERMIT <br />X -.' <br />?+ sr <br />:? ?i f a ?( <br />} <br />J T C <br /> REQUIREMENT 3C71) <br /> SAMPLE A <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE n ,:.. . <br /> <br /> MEASUREMENT <br />t PERMIT k= t r F7 E. ! 3 F' <br /> REQUIREMENT =" 3G? <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #-44`1- st tir r?# i- "NTIP.I ;F' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />;?.' <br />^6'0R i <br />R <br />iist r_ <br />a <br />- - <br />; •i- 1`!?i <br />C ., <br /> REQUIREMENT <br /> SAMPLE _ a <br /> MEASUREMENT <br /> PERMIT WIC F 'T.Fk1;A <br /> REQUIREMENT t <br />NAME;TITLE PRINCIPAL EXECUTIVE OFFICER 1 .crtf. under penalty of law that a+l, 1-urneni and all :machments were TELEPHONE DATE <br /> preparcJ under my direction or supervmon in accordance aith a system des+ined <br />' to assure that qualified personnel properly gather and eraluate the information <br />,uhmntcd fALSC•d on met uuy of die pvr,un or pe r,. ns wiu. m:utage the r: st, n, <br /> <br />frI C( G <br /> the intrnmencm <br />e per on, dinetly re:pon,ihle for gathenng the mtarmation <br />..r tho ?' <br />-- <br />- r -- r <br /> . <br />s <br />t <br />cc <br />t <br />nd c <br />m <br />l <br />te <br />F <br />t <br />f <br />• <br />I <br />? <br />l <br />d <br />d b <br />f <br />d <br />h <br />l /•, <br />? <br />. v/ <br /> r <br />ge an <br />e <br />ie <br />rue. a <br />ura <br />e, a <br />o <br />p <br />e <br />uhmntc <br />+, to t <br />is <br />„ <br />m <br />. <br />.no <br />e <br />. <br />e <br />al <br />f <br />b <br />o SIGNATURE OF PRINCIPAL XECUTIVE - V <br />PR mitting t <br />rmatmn' <br />I am aware that there arc ,ignificant penalties <br />or su <br />i mt <br />h <br />t f <br />a i <br />c <br />l <br />h <br />t <br />i <br />d <br />f <br />d <br />h <br />li OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER YEAR MO DAY <br />TYPED OR <br />INTED n n <br />ng <br />a <br />nns. <br />ing t <br />e {?o si <br />t <br />ne an <br />impns mmrn <br />or <br />nu <br />o, <br />m.hr <br />t CODE <br />COMMENTS AND EXPLANATION OF ANY VIULAIIUNS (Hererence all arracnmenrs nere) <br />t? TP EVENT SUBJE <br />TO P-l' _ DIVISION <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Prev,ous editions may be used. r.. This is 3 4-part form.