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I'LRMIT TEE NAME""'RESS(include - - NATIONAL POLLUT ISCHARGE ELIMINATION SYSTEM(NPDES) <br /> FM/ItyName/ nr1 DISCH IONITORING REPORT(DMR) <br /> NAME �_ T_C_OA_L_CO_ (NUCLA_MINE) _-- (1- (17-19) F — FINAL <br /> ADDRESS 13cA,, SOUTH YALE C00000,�3 001 W ACUTE WET TESTING FOR OUTFALL <br /> _FLAGSTAFF '-.fir .� ----AZ 86001 } PERMiTNUMBER ; DISCHARGE NUMBER <br /> — <br /> ---f-- —— -— -- 'MONITORING PERIOD <br /> FACILITY _———__ YEAR MO DAY I I YEAR MO I DAY <br /> LOCATION —! FROM TO MINOR (SUER WC) MNTRS <br /> ATTN: DENNIS STEVENSON, PRESIDENT` I20111 (12•23) 11415 (1617) /28-19J (3031) NOTE:Read Instructions before completing this form. <br /> 0 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER + (46-53) (54-61) (38-45) (46-53) (54-61) No. FREQUENCY SAMPLE <br /> EX <br /> a OF TYPE <br /> (3137) ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (6163) (64-68) /69.70/ <br /> • /F STATRE '48HR AM: SAMPLE <br /> I ERIODAPHNIA '-• MEASUREMENT ! ! O <br /> i GM3B 1 0 '0 PERMIT ,;� :##### . ### REPORT REPORT PASS=0 TRLY CRAB <br /> I FFLUENT GROSS VALU REQUIREMENT,• { ##' # ;SZNGSAMP SINGSAMP FAIL= <br /> F STATRE 96HR .ACU• SAMPLE <br /> EPHALES PROMELAS' MEASUREMENT <br /> i • n�• h — } O <br /> .�N6C 1 0 0 i PERMIT t ;REPORT #:P####: -REPORT JIASS=O <br /> TRLY ;RAB <br /> FFLUENT GROSS VALU REQUIREMENTr a ,.,_ B M SINGS AMP FAIL=4 <br /> 1 SAMPLE i, <br /> MEASUREMENT <br /> PERMIT l '• y. " 1 <br /> 4 REQUIREMENT. <br /> SAMPLE 00 <br /> MEASUREMENT tl <br /> PERMIT <br /> 9 REQWREMENTw., <br /> SAMPLE'' 4 <br /> MEASUREMENT' <br /> f PERMIT <br /> REQUIREMENTrya I t' <br /> �� �,+ ,f _ •�+� --r.. ;.t: <br /> I <br /> SAMPLE <br /> MEASUREMENT <br /> { 1 PERMIT '' t'.'y. 'i ! c, �? i .� �' _• <br /> REQUIREMENT' y�L <br /> s SAMPLE <br /> MEASUREMENT „ <br /> ws' PERMIT <br /> ( ,,REQUIFIEMENTk - <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE DATE <br /> ^�7 _ - AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN;AND BASED <br /> T�f/ FOR <br /> &► I i"Tun OBTAINING ON THE INFORMATIONRY OF THOSE . I IBELIEVEUALS IMMEDIATELY <br /> HE(SUBMITTED INFORMATION <br /> IS TRUE, ACCURATE AND COMPLETE, I AM AWARE THAT THERE ARE SIG- ALI-C, <br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING 6o TJ+/_�+�� <br /> E Jr v THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 AND SIGNATURE OF PRINCIPAL EX UTIVE r'f J Q� <br /> 33 U.S C. 1 1319. (Penalties under these statutes may Include fin ttp to $10,000 <br /> TYPED OR PRINTED and or maximum Imprisonmentofbetween6monthsand.lyears. 27 <br /> / A OFFICER OR AUTHORIZED AGENT DE NUMBER YEAR MO DAY <br /> COMM ENT AND EXPLANATION OF ANY VIOLATIONS(Reference all attachments here) <br /> SEE PART I.8. OF PERMIT FOR DETAILS OF TEST PROCEDURE. REPORT RESULTS OF IHC TEST AS "MINIMUM" AND 50% <br /> MORTALITY TEST AS "MAXIMUM" AND ATTACH ACUTE TOXICITY TEST REPORT FORM TO DMR. COPIES OF ALL INFORMATION <br /> RPXOf m eV. P(•eY oU edlNons maybe used. (REPLACES EPA FORM T•40 WHICH MAY NOT BE USED.) 0 0 0 0 3/9 0 0 514 I715 PAGE 1 OF ' <br />