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PERMITTEE NAMEIADDRESS (Include Facility Name/Location if Different) <br />NAME <br />ADDRESS 173 OW r N .1 MINES <br />FACILITY P A - J . A ' :! 1 rt <br />LOCATION <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) ,?I i aCF ` <br />1AX3 44 <br />PERMIT NUMBER DISCHARGE NUMBER = a <br />So. <br />MONITORING PERIOD ';':.:`"NI t <br />YEAR MO DAY YEAR MO DAY <br />FROM i=i ? TO L0 k_16 73 x: '• 1 ..r .. 1i 'V iz^ir <br />NOTE. Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX ALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS AN <br />d- SAMPLE .it rs •. s ?.. - :+ > ? i <br /> MEASUREMENT <br />'7-x'11) PERMIT 'f ?t slit•# tt 3i'? #k ;# ?{• ?i mat 6, a T ?1.Z Ie ?RALi <br />-r -i :F° VA; 1* REQUIREMENT :x ;M 1111 Nt?i I <br />' ' J ?> -t'=e? <br />f i <br />' SAMPLE si # sE #i ?? c r• sE s :? °c=? <br />V <br />_ i S. ? '+ <br />..• <br />v_ <br />, <br />? <br />= MEASUREMENT J <br />i. <br />i1 <br />p END ` <br />t`aL4 (ry t,.' PERMIT ir.ri§F# fE#a=ri A : ## '#'ii:?r ?J tI rd.fr ;F$fD <br />("Sfi t ,4 tlr REQUIREMENT t? :i1{ FtG 7D A `D ?ti!)_ rltii?S;t'1 <br />} r c, j r(w SAMPLE i• d',:'€• 4 `s . tS ?. z ; u._ t t <br /> MEASUREMENT <br />r . .. 5. <br /> <br />+ PERMIT a.s?_#: ?E it # # i. r E x'# R)FPf _r WT 0 5 <br />tt .? z l <br />_ t 3 <br />) <br />-:.. ., <br />. <br />. ,,, <br />. <br />REQUIREMENT <br /> <br />, z- ". <br />t <br />?: <br />.rG/ <br /> <br />t• m, <br />D 'Ff <br />. <br />4 5 <br />A <br /> <br />r1 <br /> <br />! i <br />t <br />, <br />t <br />'JA[ <br />1^ .. G-?' 3z ft ' ti <br />• ... <br />_ <br />. <br /> SAMPLE 4- „ t. A Ji• a * <br /> MEASUREMENT <br /> <br />y # <br />PERMIT <br />.; ;. •k o <br />f 4 ' :a ..:# w <br />., ;ti •i;. <br />3E u K <br />s ii <br />, :., <br />f , <br />'0 T. <br />i <br />3R, A <br /> REQUIREMENT <br /> SAMPLE 's l° ] ##' 4 ?:.:z .? r, # d r ` : ',;• <br />' <br />N; <br />J MEASUREMENT <br />a_A <br />TR ;-s s Nf i <br />T I r ' <br />? <br />t.r <br /> <br /># PERMIT .,..r r REPORT <br />aTd ?# ? <br />t•'t ? i1 <br />?F i .a': ? . <br />3 <br />i! i?? <br />_3 <br />PEC <br />s <br />v .i.i3 <br />_-?;) ..1 r 1t w t-'t? L! REQUIREMENT k'• r fF i` iii i r^s- ;< s l•°t'U: <br /> SAMPLE y y r? :; .:x } t :: 4 ., t t it <br /> <br /> MEASUREMENT <br />j : <br /> PERMIT >z,x?i r-.. Px1 :2'i i? ! Y ES=J. <br />-" •. 3i i <br />3d .. =. <br />: y. r sF >t r, <br />. g <br />t :r <br />ink T C <br />0 U A, L <br />=F F t i ?; t r"k'_7 r VP+L .' Jk- REQUIREMENT i r :'T3 1 'MAX <br />I fLa - <br />k n. <br />3NT! I <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHON E DATE <br /> Prepared under my direction or supervision in accordance with a system designed <br />/' pd? ?'f y} ?•• to assure that qualified personnel properly gather and evaluate the information <br />submitted. Base' on my inquiry of the person or persons who manage the system, <br />the information <br />or those persons directly responsible for gathering the information <br /> , <br />l <br />a- ete. <br />submitted is, to the best of my knowledge and belief, true, accurate, and comp <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />? <br /> 1 am aware that [here are significant penalties for submitting false information, R A <br />r <br /> i <br />i <br />l <br />ti <br />d i <br />t f <br />k <br />i <br />li <br />f f OFFICER OR AUTHORIZED AGENT ODE UMBER AR MO . DAY <br />TYPED OR PRINTED mpr <br />sonmen <br />ng v <br />o <br />a <br />ons. <br />ine an <br />or <br />now <br />ty o <br />including the possibi C <br />COMMENTS AND EXF'LAIVAIIUIN Ul- ANY VFULAIIUNV (reference rat auatunncnw nrrCy <br />'i .f '• t .??? .'J `,".'si'd {. 11;4? i ? .•t '. .:fir ?. t.. ,.;F r.-2 E'S' <br />-t'* edt S ? v;.'=tV Ee ! <br />ANY " =t`.?i•i4. -!? w'..>il'' ': '..'4"".,?,.? z C P-?t i .. t "°3f•.: W.. ???ia i ? '.1 f t•c , <br />ART <br />h?? PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. i r?ij [L ?ct]1Offfl.