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<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. 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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