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PERMITTEE NAME/AODAF.SSRwh-dofwibyNamaLwrmlyf/nlp?e.ulr <br />NAME <br />ADDRESS <br />f_KFr? <br />FACILITY " -7LOWYO MIN <br />LOCATION 1•1r-EKER <br />,.L(_Y D. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM fNf OFSf <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER ascHARGE NLIMeER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM TO <br />Form Approved <br />M I NOR OMB No 2040-0004 <br />r ?1 lr;- 1- <br /> <br />NOTE: Read instructions befw• completing this fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. U <br />NCY <br />MtO SAMPLE <br /> X G <br />f <br /> E ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> <br />l? PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />u <br /> SAMPLE I <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE I <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 /> <br /> PER MIT <br /> <br /> REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE Of F ICER I eerttly u er penalty o flaw th.t t"1 1-71 and all .tl-h-L, wart' <br />TELEPHONE <br />DATE <br /> p"peeed under my di-iloo Or ruper.Man In eecordsn with a %yatem "grad <br />_ i to Gaon that qualified pem-I Properly [ether and ..duele the I"16matbn <br />submitted <br />bred on m <br />In <br />uir <br />of the <br />erson a <br />ersona who -ne <br />* the s <br />stem <br />. <br />' q <br />. <br />y <br />y <br />p <br />p <br />t <br />y <br />, <br />1? _ 1 <br />jib 1 r ! or Ihoee prrsom directly mponslbte for tethering the Information, IM Info 11- <br /> wbmitted y, to the bet or my k-ledge end bebrr true. acrurele. and -pkle. <br /> .rte atnln,.,,' <br />r„ <br />nts r- '.t.e Information <br />1 ...... that the SIGNATURE OF PRINCNAL EXECUTIVE <br /> p <br />• <br />- <br />. AREA <br />TYPED OR PRINTED <br />14 tSO/et <br />OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />Coor <br />-D <br />YEAR M_ F <br />AY <br />COMMENTS AND LXPLANAIwn Vr ANT VIVI./nIIWNa (Nerorenc•.oai.cnmonranors/ R i'REi IF' EVL-Pi CLAIMED. I-, GL3? i I'1 APF'h'nVgT? L'R D 1: <br />EPA Form 3320-1 (Rev- 3199) Previous editions may be used This is a 4-pan form. PAGE OF