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-- - Nn,IUN— rLILi-u TANT DIS(.HARi E LLIMINATION SYSTEM I\YULJ/ form Approved <br /> fucllilt hume/Lulullun U J'11,1-1l ., DISCHARGE MONITORING REPORT (041R) OMB No.2040-0004 <br /> NAMF__L;�f, C ) �L___________ 1'-l01 (17-191 /— Approve/sapoes 9-30-85 <br /> ADDRESS 1300 Sou h Ya)e __ +�_______ OO5 <br /> ____Flagstaff Arizona_�cIQD�_--+--- PERMIT N MBER DISCHARGE NUMBER <br /> FA ILITY—)Y— Mine -- MONITORING PERIOD <br /> OS-- --------------- YEAR MO DAY YEAR MO ! DAY <br /> LOCATION ......__— FROM 87 07 1 01 1 <br /> TO 87 09 1 <br /> 30 <br /> (20-21) 12?-23) r24-2s) 126 7) 12,t-29) (30-31) 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 /> OF <br /> (3137) EX ANLYSIS TYPE <br /> A <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62�3)I (6LT (69-10) <br /> F1 /)1 , SAMPLE <br /> LO1,0 MEASUREMENT No Discharge <br /> �,/ PERMIT <br /> � //) REQUIREMENT <br /> T� S SAMPLE <br /> MEASUREMENT <br /> _ PERM IT <br /> h 13 n J REQUIREMENT I 1 <br /> V SAMPLE <br /> �L/C-1✓/V MEASUREMENT <br /> ERMIT <br /> REQUIREMENT <br /> SE7T SGL SAMPLE N <br /> MEASUREMENT - I <br /> U <br /> PERMIT REQUIREMENT- G 4_ <br /> �J SAMPLE <br /> ME 9 <br /> MEASUREMENT �L7 7 <br /> PERMIT <br /> ,S l (0 REQUIREMENTSAMPLE <br /> T O// /► <br /> P7 ' MEASUREMENT T <br /> PERMIT t7 <br /> /Ci J REQUIREMENT <br /> SAMPLE <br /> ME <br /> ASUREMENT �- tp +PERMIT <br /> t A <br /> REOUIREM ENT ; C{ Fj QJ'"Il/1 1 /D 0/ <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED / /��j /(' TELEPHONE D A T EE <br /> N AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AD BASED / <br /> ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> OBTAINING THE OF <br /> I BELIEVE THE SUBMITTED INFORMATION <br /> James S. Lunar �-- <br /> IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG % <br /> Manager Permits NIFICANT PENALTIES FOR SUBMITTING FALSE IN <br /> INCLUDING , bO2 7/4-5253 87 1 U 21 <br /> 1 THE POSSIBILITY OF FOR AND IMPRISONMENT SEE IB USC S IOOI AND/ SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 33 US 11319 rYrnnhlr. .— rhe.r uoru/r. ma. —d— I— up ro tlu rXrl <br /> TYPED OR PRINTED ard,,..nAirr.Ium rnrprl..wlnlrnr„I hrtu..n h m„nrh.and+.ro.., OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> Or <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Re/rrence dl utlucomrnll here) <br /> PA Form 3320- 10-79)PREVIOUS EDITION TO BE USED (REPLACES EPA FOR WHICH MAY NOT BE USED.) OF <br /> UNTIL SUPPLY IS EXHAUSTED <br />