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FERMITTEE NAME/ADDRESS pnti.&F.ewyN..?L«ai- (/D(or.-iI NATIONAL POLLUTANT DISCHAROE ELIMINATION SVSTUA NPDES) <br />NAME DISCHARGE MONITORING REPORT t0 R) <br />ADDRESS <br />13DX PERMIT NUMBER 04SCHARGENUMSM <br />_-N I A MONITORING PERIOD <br />FACILITY T }= NO M I NE: YEAR MO DAY YEAR MO DAY <br />LOCATION NIA CD 81. " FROM TO <br />L-LIAM A. BEAR jR. : MINE M\_: <br />Form Approved <br />OMB No 2040-0004 <br />AINUR <br />l SUBR I it <br />F - FINAL DELTA <br />SR; DEER I'RL DTC OR UNMU TRIB <br />NOTE: Read k»trucdons before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />of SAMPLE <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />W <br />EEKLY <br />. dS I i <br />J_--' - REQUIREMENT ilIN I1.10`1 <br />c SAMPLE <br /> MEASUREMENT <br /> PERMIT x zfitr t ;t's;? #?t#? ii s: _ ', t 1iwCEi a*A <br /> REQUIREMENT 30DA DriI; I`ix hiQN . H <br /> SAMPLE <br /> MEASUREMENT <br />'.. i PERMIT ###stlt #k sf> x x?< REPOR'T' REPORT Nt- A1.: <br />FFLUEf-l .? ,_ REQUIREMENT 0D-A AVG ILY NX MONTH <br />ION, i -' ( SAMPLE <br /> MEASUREMENT <br />5 PERMIT 1 ## it ##it a f_ x000 6000 NCE/ PAD <br /> REQUIREMENT :t iD? :'•, I i_Y MX Plf3NTH <br /> SAMPLE + <br /> MEASUREMENT <br /> PERMIT is iY# F.x.-wx: 3 Ems,"# si##i J..(1I. <br /> REQUIREMENT <br />-ii\ID 1: SAMPLE <br />WT MEASUREMENT <br /> PERMIT REPORT R r0,P , 7:ss%xi"?£ r 4 <br /> REQUIREMENT ' OL7A AVG ra .f <br />c . - ... SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT -i Mil k <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t cert'y a pent y o bw that this do, ment and all attarhmenh wen TELEPHONE DATE <br />pRparTd Ynd- mJ dIm lon or suprT <br />ehton In aecordtn[e wllh • eyslem dealgrted <br />to a>sun that quafined peraonnrl property g.lher and evaluate the information <br />submitted. Deed on ml Inquiry of the person or p rac m who manage the system, <br />or them penore dimity mpowble for gathering the Information. the Information <br />submitted b, to the bet of rtry knowirdge and beef. true, -mi.. and eomplete. - <br />SIONATVRE OF PRINCWAL EXECUTWE <br />nificant <br />enalties for <br />bmittin <br />fah <br />r <br />th <br />t th <br />e <br />i <br />Inf <br />rm <br />tio <br />1 "- <br />_. Y <br /> p <br />am - <br />are <br />en ar <br />s <br />g <br />su <br />g <br />e <br />o <br />n, <br />a <br />a ARE <br /> <br />TYPED OR PRINTED <br />Int4uding the possibility of fine and Imprisonment for knowing vtolatho <br />OFFICER OR AUTHORIZED AGENT <br />CODE NUMBER <br />YEAR <br />MO <br />I <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS tReforence aN attachments herel <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This is a 4-part Corm. PAGE OF