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Form Approved <br />PERMITTEE NAME/ADDRESS(/neari rtfttyN?.WLacotta ((D(Qlrrrnt) NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM (NPDESI OMB No. 2040-0004 <br />NAME DISCHARGE MONITORING REPORT (DMRI _ <br />ADDRESS :iiJDR MH) <br />- BOA -763 PERMIT NUMBER Fl;C.AIOENUMBER - FINAL LEl <br />NIA ;??JTF TO DEER TRAIL DITCH <br />FACILITY "; I E NO. 2 MINE MONITORING PERIOD <br />YEAR O DAY I YEAR 0 D 6Y <br />- <br />LOCATION -1N I A CO 81, FROM TO = ---. <br />' [ LLI AM A. BEAR JR., MI NE M(:NOTE: Read InetrucNtxw 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 <br /> MEASUREMENT <br /> PERMIT K-. ., :. t• iex REPORT 0PTIONAC__ t 1?.. <br /> REQUIREMENT SODA AV" MX 70 AV MONTH <br /> - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # t:7 - 77 <br />_ 45 <br />it .. <br />_ REQUIREMENT 7GA ?`•';? MX 7D AV rf0}v (fti <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT > it z•> - _ .. <br /> REQUIREMENT MINIMUM MAX I MUN <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT * ' U 1 U! U vt,r: 1 <br /> REQUIREMENT 'JODA AVG MX 7D AV MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT _ r Wit: sr? s <br /> REQUIREMENT A .' :'D AV <br />- = SAMPLE <br /> MEASUREMENT <br /> <br />O PERMIT 1. fi <br />C f1G'c` REQUIREMENT I KIST MAX <br />- <br /> SAMPLE <br /> MEASUREMENT <br /> , E 1' <br />3 <br />' <br /> <br />UM I R <br />r% I <br />1 <br />ff <br />I <br />PERMIT <br />REQUIREMENT 30DA AVC -tA I LY MX - ;;jS <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I nruly under penalty o law that this rbmmenl and all ¦ttachments were <br />TELEPHONE <br />DATE <br />prtpared under my direction or supenhlow In accerdente with • system designed <br /> to assure that queNned pees tnel properly gather and evahrele the Information <br /> submitted. Based on my Inquiry of the person or preserve whet manage the systerm <br /> or (hose penora Mrectly resporMbie for gathering the Inrormation, the information <br /> submitted is, to the best of my knowledge and belief, true, accumle. end complete. <br />? <br /> I am away: that there are slgninnnt penalties for submitting fain Informetlun SIGNATURE OF PRINCIPAL EXECUTIVE - - <br />TYPED Oft PRINTED • <br />tnduding the possibility of line and Imprlsonrrwnl for knowing violations. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />6UMMtr4 1 b ANLJ [Armrest I Ion yr lire e . win r rvrea <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used <br />rwnc• off aliff -r,rnWnts norer/ <br />NSTRUCTIONS - I. C. 10, PG. 10. <br />13 IL, 7 /'" •T.#rbs:(sa 4-peril farm.