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PERIrtrME NAME/ADDRESS 0x.6fe Far&iyNw o/Lacaeran I/Dtf1wsn0 NATIONAL POLLUTANT OiSCHAAGE ELIMINATION SYSTEM /INPOESJ <br />NAME DISCHARGE MONITORING REPORT (OMR) <br />ADORESS - <br />BOX 4. PERMIT NUMBER DISCHAAGt NUMBER <br />;IA <br />FACILITY E NO. C,2 r- I Pd MONITORING PERIOD <br />YEAR O DAY 1 81 Y MO DAY <br />LOCATION I I A C O 8 1 FROM TO <br />_LIAM A. DEAR JR. , MINE MG <br />Form Approved <br />OMB No 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL DEI <br />SR /MINE WTR TO DEER TRAIL DTCH <br />r ; <br />NOTE: Road Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #3F##ft ##iFiF#3t . _, -lF## 9.0 <br />W <br />-EEK <br />_ <br /> <br />1 'a`-,- <br /> REQUIREMENT N i. N I i•iul ! MAX IMUM <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br /># <br />k r # <br />#' zsl i <br />, 70 <br />r• :, <br /> REQUIREMENT OGDA A`.j a r;?, 11__.'r MX ?f'YT -I <br /> SAMPLE <br /> MEASUREMENT <br />n PERMIT :r: I y f <br /> REQUIREMENT 30DA DAILY MX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r'`;i it itei3rk ;?tvV bV4itJ t er r r+ <br /> REQUIREMENT 3,00A A'.sr` DAILY U I X TIONTH <br />i ._ SAMPLE <br /> MEASUREMENT <br /> PERMIT •s 7777 <br />, <br /> REQUIREMENT ,.•IST MAX <br /> SAMPLE <br />:- ' MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ?Opa ,11-Y MX <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT ,-"-RTR AVG QRTR MAX <br />NAMEITTTLE PRINCIPAL EXECUTIVE OFFICER t candy under pena iy o law that thh document and all attachmenti wen <br />TELEPHONE <br />tl <br />e <br />+No <br />I <br />ith <br />te <br />d <br />d <br />dl <br />r <br />d <br />d <br />si <br />d <br />DATE <br />co <br />on o <br />sup <br />r <br />n <br />n accor <br />ance w <br />¦ sys <br />m <br />e <br />gne <br />prepare <br />er my <br />rec <br />le asun that quaMM1ed perwnnel Property gather and evaluate the Infewmatlon <br />eubmllted. Erred on my Inquiry of the pertnn ar pen who manage the tyorm, i <br />rm directl <br />res <br />onsible for <br />atherin <br />the Info <br />ti <br />1M Inf <br />o <br />th <br />n <br />r <br />ti <br />"'rte f <br />% ~_ <br />y <br />p <br />g <br />g <br />r <br />ane pe <br />rma <br />o <br />, <br />o <br />ma <br />on _ •- <br />• <br />itt <br />t <br />th <br />f <br />k <br />wled <br />t <br />t <br />b <br />d b <br />b <br />s <br />d b <br />W <br />d <br />le <br />l, <br />o <br />e <br />et <br />o <br />my <br />no <br />ge an <br />, <br />ree, accura <br />e, an <br />su <br />m <br />e <br />e <br />row+P <br />le_ <br />i <br />Nl <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />h <br />t <br />l <br />t <br /> can <br />I am aware that t <br />en an s <br />gn <br />pena <br />tim for oubmllting rain <br />nformadtm. AR A <br />TYPED OR PRINTED Including the possibility of fine and Imprisonment for knowing AolaUa OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReforence sN sttachmonta harel <br />PRECIP EVENT IS CLATMED IF CLAIM APPROVEP DV WOOD, <br />^d <br />.1 <br />T1tS <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used 5'KS' 8 4-pan ft)>Tn. PAGE OF