<br />IPERMITTEE NAME/ADDRESS (Include Facility Nante/Location if Different) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM, NPDES) }
<br />NAME , DISCHARGE MONITORING REPORT (L R). ' !
<br />•n
<br />Form Approved
<br />OMB No. 2040 0004
<br />?I
<br />,iE WIL113P LIAL,
<br />I-4€.
<br />Cf.3t`4PNY rs J.11yOR
<br />,
<br />ADDRESS HAMILTON MINE `•. cbL;ss_ 00',4. 002 A
<br />(SUER MH)
<br />9 L•?H I TE-` BR x in - F1 f?fl??r EIICI ?? PERMIT NUMBER. DISCHARGE NUMBER .. ? - FINAL Y?'+€Ti? w
<br />' CR
<br />?
<br />'
<br />'
<br />'
<br />dA f ;1I i..LE 7 2O 4 ?
<br />?
<br />f
<br />? PIS I7 NCH TO I?d?a
<br />NE EiEt
<br />FACILITY
<br />
<br />ESANIL'T°di4t „kIN
<br />MONITORING PERIOD
<br />
<br />R
<br />LOCATION ' f, YEA MO . DAY YEAR MO DAY
<br />I+dATU; .I TA CO g 142. FROM ;1 / v.1 TO i1• 3NJ' 'Ee NC] D zv134GE • Iy #+` 1#
<br />`p ` qp r y+{ / ?? p? }?
<br />fRETi4.'; L sdGS•tlEki. NOTE: Read Instructions before com `
<br />`
<br />pleting this form
<br />`=PARAMETER QUANTITY OR LOADING \ QUALITY OR. CONCENTRATION NO. FREQUENCY
<br />OF SAMPLE
<br />7
<br /> 4 • . EX . ANALYSIS • TYPE
<br /> AVERAGE MAXIMUM ' UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />IN, ., , ;.. :. SAMPLE #3t 3f 3!## 3t '+# iE3i #3F#3S#.!F ( 12)
<br />.. MEASUREMENT
<br />
<br />{ ..
<br />C"a04E3Ci 1 PERMIT n3 :;?. 3i 31?Fd 3 ##3E Ea itlct:Tik#; 0 -WIC FE. ;R A
<br />.F f " `'t9R€7SS VALUE REQUIREMENT :.c 3 3F tt 3F - . Mj N I: MV C?I MA ro-i: Um Sl9 VyONTP y
<br />SOL.I'PS ,. TOTAL SAMPLE 3E38#4# F# sii## F.3t ##'##}k' 19)
<br />
<br />?USRE4?1??
<br />zL MEASUREMENT
<br />,
<br />
<br />:) 0. 0
<br />PERMIT
<br />4f4*4:A#
<br />?E31?F?31 ?
<br />##3t
<br />?:##i##ti. .
<br />.a?3
<br />??
<br />Wa.GF/
<br />
<br />f?1? .
<br />_'R
<br />EF C"i_:?f1L °i ?:FO£s':_.VLUE REQUIREMENT "0La'Jre "?1t ?+?' ('y£?f_ ftL;ivll
<br />SO L a Srt ."I,:..I»ABIL8. SAMPLE %#Ii3f3Y 3t i43F M k#3E •'.S #3i# `' ;•f f'`'I < 25)
<br />,
<br />• , '' ?
<br />MEASUREMENT ` 1,
<br />f
<br />e
<br />y?
<br />l
<br />?:.
<br />PERMIT '
<br />3f3t 1i3i'k7tkkl 3F##
<br />: 3f#t#3fF }may $''R?`'
<br />
<br />l
<br />IE O y'y {?? y
<br />
<br />'tV J-4.` ?•'t /?
<br />
<br />Sf?P°C ?.d .: 4
<br />EFf=Li9EIV;' GROS?s V+4i + REQUIREMENT #### '10DA laVt DAIL, ILK `ILfL €'iC)I?ITf°I
<br />aPIL. AND GREA SE :'' SAMPLE ###### #6sF?3F## ##3i##?E 3E 4k rii3f?6 i Y"r l
<br />J MEASUREMENT
<br />35f32.' # O+ PERMIT :# 1 1 3Y 3# sE ;? i # s6 ,.. #i##' ##:# 3f 3t i:# ?t ,:. ?s y° S :ONi ,IN 'R.AZ''
<br />E'F L:JENT GROSS .: VALUE REQUIREMENT
<br />.
<br />_ xl3F#3i bA1y.._Y 'M MO/ L (:TENT -
<br />r{;.;Iawo''; M. e'r-I IDUIT :'OR . SAMPLE', 03) ##31 ii'?#. ##3E #3E 3i , ###I 3E#
<br />Tp'•iR4,fTREA"I,HEf`d'f'.:'PL,.AIRl7 MEASUREMENT
<br />._
<br />4Df,., PERMIT IIREr biRT' ,_.. Ry-.Paver, - .:. '°.x:.35•.'.:#•ii•# .:: $#•'sE•#•Sf•ii`. ''.E•#•3t il^ *#•#• ' °[' NTIN iCUrt.DR
<br />EFFLtlE$+I°a CROSS ';VALU REQUIREMENT .30D A- #st 1w^ , : • ,A rLY MX MOD UaU`i
<br /> SAMPLE . ti 3f 3t # # 1f' 3f'A i4 3F sF #94 '! # 1, 9 }
<br /> MEASUREMENT ;
<br />0' PERMIT }1 ft ?tot F '...• iFSE :? ik 4 ##3E. ##31# # RFI:'I:: RT REPORT, .' °
<br />i TrF L.V aF{A L±
<br />T± FL?)EI?IT ' KISS -VA IJE REQUIREMENT - #F tE#3f 3 `Iii f# I (. x CICS /L
<br />Q I ,L AND OR EAt5E SAMPLE 94), ' #? 3i iF#?! 3f #3P s8# ft # ## si ?3 #
<br />V,I5UA MEASUREMENT ,
<br />84P66 1%-
<br />, 0 PERMIT :i` r ?•.?••?• :, •#•i',••3 ?•?•?• :?•<'r ?•?H ?1' ?'#'3l `'d ? : =r •sl•.?i••t?
<br />1
<br />EF FLUENT CRC1 s5;` -VALUE REQUIREMENT TN MAX., N13=0
<br />€ 3?
<br />MONTH
<br />
<br />,
<br />NAMEtITLE PRINCIPAL EXECUTIVE OFFICER,
<br />- I certify under penaltyfof law that this document and all attachments were
<br />re
<br />ared
<br />nd
<br />r
<br />di
<br />ti
<br />i
<br />d
<br />with a
<br />t
<br />d
<br />i
<br />d
<br />i TELEPHONE. DATE
<br /> p
<br />p
<br />u
<br />e
<br />my
<br />rec
<br />on or supervis
<br />on
<br />n accor
<br />ance
<br />sys
<br />em
<br />es
<br />gne
<br />to assure that qualified personnel properly gather and evaluate the information' ' - -
<br />-
<br />,
<br /> submitted. Based on my inquiry of the person or persons who manage the system,
<br />. ', .. •. .
<br />., ... .._ " . : or those persons directly responsible. for gathering the. informati,in,.the information
<br />, submitted is, to the best of my knowledge and belief, true accurate, and complete.
<br />I
<br />w
<br />r
<br />th
<br />t th
<br />i
<br />ifi
<br />t
<br />f
<br />l
<br />e
<br />lti
<br />f
<br />itti
<br />i
<br />f
<br />ti S NAT F PRINCIPAL EXECUTIVE /0
<br />-
<br />`-
<br />' am a
<br />a
<br />e
<br />a
<br />ere are s
<br />gn
<br />can
<br />p
<br />ng
<br />on,
<br />na
<br />es
<br />or subm
<br />a
<br />se
<br />n
<br />orma OFFICER OR AU
<br />HORIZED AGENT AREA
<br />•'
<br />TYPED OR PRINTED„' incluldingthe possibility of fine and imprisonment for knowing violations. T
<br />
<br />-
<br />.
<br />CODE NUMBER
<br />
<br />- 'YEAR MO
<br />
<br />COMMEN15 AND EXPLANAI•IUN UI- ANY VIULAIIUN, (HereYegce all attacnments-here)
<br />`
<br />rE€"II r' 131.E.:SbLIDS' I.,.Tt'TIT .WA>wl:VED 'FOR 10,-YR, 24-HR PRECIP EVENT "SUBJECT TO-BURDEN OF PROOF RECaUIREME?NTS 1r^,N
<br />'F'ART 1. D, 6.... ANY AD6I ..IONAL. DATA :SHALL BE S#.!t'C'L'ED TO THE DIVISION WXTHIN 45 HOUR S
<br />EPA Form 332071 (Rev. 3/99) Previous editions may 66 t-sed. 1 ? PAGE' IOF OF, ,.. O,QO'xy/c7 f? ITII
|