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PERM[TTEE NAME/ADDRESS (1, tilwkF OryNaaWLerarlsm I/D(oli wt) NATIONAL POLLUTANT DISCHAAOE ELIMINATION SYSTUA /NPDESI <br />NAME DISCHARGE MONITORING REPORT (OMR) <br />ADDRESS ., _ <br />BOX 483 PERMIT NUMBER DISCHAIR111 NUMBER <br />I A MONITORING PERIOD <br />FACILITY ; E NO. 2 MINE <br />YEAR MO DAY YEAR MO DAY <br />LOCATION ! I A r'0 1 4: FROM TO <br />I TAM A REAP IR MTh11= M <br />Form Approved <br />OMB No 2040-0004 <br />MIN <br />E - F• I NAL L)r_L <br />CHRONIC WET TESTING FftR <br />NOTE: Reed Instructions before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT st s?: . rr"+ ## REPORT ><###: ??#? 1' C"Ir- <br /> REQUIREMENT S I NGSAMP <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #ii iE### ?: + 100 sr## s i## k# k# l' Omp <br /> REQUIREMENT MN VALUE <br /> SAMPLE <br />.1 MEASUREMENT <br /> PERMIT #####ii REPORT #it Ir ### "r PLY '(.7MP- <br /> REQUIREMENT S I NGSAMP <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT ####1baE 100 #ifriFiEaE' _ T PL '! '(JMI°- <br /> REQUIREMENT MN VALUE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT PF.POR <br />L. .. REQUIREMENT SINGSHC4f' <br />r SAMPLE <br /> MEASUREMENT <br /> PERMIT REPORT <br />.:3r?LC?ti REQUIREMENT <br />" SAMPLE <br />ION' MEASUREMENT <br /> PERMIT <br />RE-PORT <br /> REQUIREMENT >3I NGSAMP + <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ren'ly under pens ty ° ow that thh d°e°ment and all attachments were <br />prepared under my direction or superehlon In accordance with a system designed TELEPHONE DATE <br /> to asure that qualified personnel property gather and evaluate the information <br /> submitted. Based on my Inquiry of the prrson or perstmr who manage the system. <br /> or those persons dirsctly mpo1etble roe gathering the Information, the Inrornatlon - <br /> to the best of my knowleAge and belkf <br />true, ammie, and complete. <br />stbmitted Is <br /> , <br />, SIGNATURE OF PRINCWAL EXECUTIVE <br /> 1 am aware that there are slgNncant pendtle for submitting hies Information. AREA <br />TYPED OR PRINTED Including the Possibility or fine and Imprisonment for knowing riclatforn OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aM ettachmenta herel <br />T RESULTS OF ! ET1441 ITY rJFF It,c AS-3 .'7FFF!7CT", (;,RIDWTH ?a^?D <br />ur i „s T? '. ap t t- <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. TWs a5 a 4-pn fgnn. PAGE OF