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PERMI7TEE NAMEIADDRESS;Include F'acilig Name) ocation if nifferett) <br />NAME MINING <br />ADDRESS <br />FACILITY <br />LOCATION <br />I r-W E-NIUINEER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No. 2040-0004 <br />M I iNOR <br />( USR JC <br />F - F I PdAL <br />.. (iRvasrF R <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE y <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT Ott P OR T <br /> REQUIREMENT i?t i L 3, Ifu Jh - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -; *. +-.7 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT Ag <br /> <br /> PERMIT - - ,. Ar• <br /> REQUIREMENT l?ivf -i,, _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certif. ,mdrr, pnalq .1 1.. that this document and all auachmem, were <br />e <br />ed under <br />su <br />m <br />di <br />lio <br />•ni <br />i <br />n i <br />c <br />ith <br />d <br />t <br />d <br />i <br />ed TELEPHONE DATE <br /> pr <br />p <br />r <br />m, <br />m <br />n ur <br />p <br />% <br />o <br />n ac <br />or <br />ance w <br />a s)s <br />ein <br />es <br />gn <br />1 to U-re that qualified p•nonnei proprrls gather and t-I-tc the information <br />h <br />i <br />d <br />H <br /> <br />I au <br />m <br />tla <br />. <br />osed nn my inyuin of the pervm ur persons who manage the s?strm, _"C <br />'--- _--_ -- <br /> or those persons dirnlh rrspnt<iblr !or gathering the information. the information - - _ <br /> submitted is. to the hest of my knowledge and tKIkL true, accurate, and complete. l,' I <br />l <br />L <br /> I am ..are that Ili- are sigrifk ant penalties for submitting raise information SIGNATURE OF PRINCIPAL EXECUTIVE '-Iz? <br />TYPED OR PRINTED . <br />including the po-ibilits or rim, and imprisonment for knowing ,iodations. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY <br />(Reference all attachments here) <br />EPA Form 3320.1 (Rev, 3199) Previous editions may be used. 0000t- This is A 4-part form.