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PERMITTFE NAME/ADDRESS p-&& sae+trry N-WLoranon jfD(#a.wt) <br />NAME <br />ADDRESS <br />t ?zilAIL .ii?..WFtf 3, <br />ER cc) 3 <br />FACILITY jWYQ MINE <br />LOCATION <br />.LY O. SAN/.)ER-S, :)P OF OP! <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO. D Y YEAR MO. DAY <br />FROM TO <br />Form ADPfov'd <br />OMB No 2040-0004 <br />SUBP <br />FINAL <br />JASN SAY TO WQPK AREA Fj.-' :D <br />NOTE: R*ad k?iitructlorw before comphtk?p thlll form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />X OF <br /> E ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER ' `r""' " ` pe""y ° la""' `h" d°`""'r"' and all atacnmenu were TELEPHONE <br />re <br />d <br />l <br />l <br />I DATE <br />_ p <br />part <br />under my d <br />rectbn or svPmh <br />on <br />n . rdanre with • ayalem deigned <br />_ u to amre that <br />uatltied <br />ro <br />er <br />nnd <br />l <br />ther <br />nd <br />l <br />h <br />--- -" <br />q <br />p <br />w <br />P <br />per <br />y ga <br />a <br />eva <br />uate t <br />e Infor tali ei <br />.l.T r \' <br />b <br />d <br />B <br />I <br />i <br />--i <br />oard "my <br />.e <br />mllle <br />. <br />nqu <br />ry of the Fern or "riorat who manage the ry+am, <br />- or Ihoar persere directly re'lPornible for gatherin <br />the Inrormatlon <br />the lnforw <br />tle <br />? - 1 <br />g <br />, <br />r <br />n <br />wbmitled la. to the beat of my knowledge and b~ <br />I-, <br />acavnte <br />and c.m <br />hl <br />(! 6 <br />. <br />. <br />, <br />p <br />e. <br />!O <br />- I am aware that there are ygrdnuat Penaltl" r t wrbmllnng ralee inromistlon <br />SIGNATURE OF /RINCWAL EXECAfr?W v <br /> . <br />Inai <br />di <br />Ih <br />?bllll <br />f fi <br />d I <br />l AREA <br />TYPED OR PRINTED u <br />ng <br />r po <br />y o <br />ne an <br />mp <br />ace wnt for knowing rldatlo OFFICER OR AUTHORIZED AGENT ODE NUMBER <br />C YEAR MO DAY <br />COMMENTS ANU t:ArL.ANA I IVN yr nn r vtvLA I IvND PrporAnc• M •rrwcnmonrs nerol ,4HR FREC:7P EVENT IS C;-AIM,=D. 11' CLAIM APPROVED L-JGCD, <br />EPA Form 3320-1 (Rev. 3!99) Previous editions may be used 'This is a3-pa-A form. PAGE OF