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PERMITTEE NAMEIADDRESS (Include Facility Name/Location if Different)
<br />NAME a3C'!?IN`; i,-.S0IJRCE1-; 4...!_C
<br />ADDRESS 'Pt x ' 1ti0. I V X NFS
<br />P. C. PtU'A 1163
<br />FACILITY
<br />D OW IJrME,. 1 MINES
<br />LOCATION
<br />Form Approved.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004
<br />DISCHARGE MONITORING REPORT (DMR) rI
<br />/•^'tt,, /•y gg••?? / 't ?)) '' ee I' .. v`CyyR pp t,t yy
<br />PERMIT NUMBER A DISCHARGE NUMBER 7 ._. FINAL
<br />MONITORING PERIOD D'ISCI' TO FARMER WOM-K
<br />YEAR MO DAY YEAR MO DAY - -
<br />FROM 0 TO - 3 :i 9-•3, . I^ti1 t; - 5 HA1 "c"„ I 3? k 3i
<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE
<br />
<br />EX OF
<br />TYPE
<br /> ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />F.H SAMPLE ii !4}?afi xti i 'i?'^ i? F 5
<br /> MEASUREMENT t
<br />00&Ct0 i. 0 O PERMIT te. m n }.^ : R i .f:"r-# ei $4 t F;:tY; ,.y. n ro ii e ar .tfi'4 t: 1
<br />= ! r t" s fti' r^? ?4d 9 'ih REQUIREMENT 3# 3F>i. : (i3 . .. MUM
<br />; n ": E;-;
<br />E.U :-" +t+ r
<br />Tr i
<br /> SAMPLE :i 3S «?fr v t• .. _ ?r ? :?r # ii f: a
<br />SUSPENDED MEASUREMENT l
<br />00 S-00 ) ?. PERMIT $?w ;i.. 'bt ? i,tf i s3 tw s's ze.. ?`: ti; i-j-S 3E, XA?n
<br />> re t i6 5+"C ;REQUIREMENT yYr 3 3 r" A A i !')n P3f («t'e` No!!.
<br />}t!
<br />'30(...'F DS. r r.. .. ...i"">?4 i SAMPLE 25
<br /> MEASUREMENT - -
<br />5e.5 .I. o 0 PERMIT t-'s•;fi, •rr:v-?'s• .. .. .•, ..r? .: •'s:. err :s 3•^z:.2• ,`.-?':'• :`'A :??` i ti 9 '. ?? :-ia
<br />t-W ? ns _ V,,m,_l REQUIREMENT t 3;#t 1 w s ?se, . }::""t I 't' #")s C"ta .s : i ? „i ix
<br />""'J._ AND GRF..s"aF. E SAMPLE ??Fa?i3! Fsi zxt•st•5: 3 ?yFh {:. ;3s• S?'.` t 19)
<br /> MEASUREMENT
<br /> PERMIT fc_....,..r:. .:••:?:•.:.;,:?...... ?: a'ri}•:, ..:;•:'•.._F'' .. ,. .. ,.. .. .'` ,ai(.,i?`J".r. .,,?`.;i};f
<br /> ;REQUIREMENT 1.4 1 T MAX 1°i??P_
<br />FLOW,, '1.ri: ,.i14 0-J.`.T Ort SAMPLE ? o?ii +xy K ..:•? :° t }`'s n .:•:''ti6•sE:?S
<br />THRLJ F I.•.CfkKi
<br />" MEASUREMENT
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<br />OCM1 PERMIT
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<br />SAMPLE
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<br />t Y W AL MEASUREMENT
<br />f4{wysti } iF PERMIT M;:; " ?`, :'. 3: :r }it•Gl t t..'. ?. t' Ji'c
<br /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were
<br />d under my direction or su
<br />ervision in accordance with a s
<br />stem desi
<br />ned TELEPHONE DATE
<br />
<br />fY ! ? F?f f! p
<br />y
<br />g
<br />prepare
<br />to assure that qualified personnel properly gather and evaluate the information
<br />submitted. Based on my inquiry of the person or persons who manage the system,
<br />
<br />A
<br /> or those persons directly responsible for gathering the information, the information 4 -
<br />
<br />
<br />.
<br />42 4 Z7 5- /- - submitted is, to the best of my knowledge and belief, true, accurate, and complete.
<br />
<br />ar
<br />that th
<br />re si
<br />nificant
<br />enalties for submittin
<br />false information
<br />1 s.?•
<br />
<br />SIGNA URk
<br />OF PRINCIPAL
<br />EXECUTIVE
<br />
<br />1--
<br /> g
<br />p
<br />g
<br />,
<br />aw
<br />e
<br />ere a OFFICER OR
<br />AUTHORIZED AGENT AREA
<br />TYPED OR PRINTED including the possibility of one and imprisonment for knowing violations. I ODE
<br />C NUMBER YEAR MO DAY
<br />C.UMmtrv IJ ANIJ GArLArvA I IVIV Ur Wilt VIVLAI IVINJ (rrererence an arracnmenrs nereL
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<br />4 f v:'S . , lr J 4. z'f ?` _.1 r+I 4 ... -: -3 J, ?.
<br />< PAGE OF
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. y - r ?tr- & "?' (•")111S S =p a11t1.
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