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PARAM ETER <br />I-i Card OXIY) QUANTITY OR LOADING <br />(441) 04-61) <br />Card Onbs) 0 toi A 1TY OR CONCENTRATioN <br />08-45) (46.53) 04-61) <br />No <br />EX <br />62 <br />FREOLIENCY <br />OF <br />,,,,,,„ <br />(0448) <br />s A pLE <br />TYPE <br />(B9-1o) <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />SAMPLE <br />MEASUREMENT <br />a, 12- <br />e As <br />4 A0 <br />PERMIT <br />Reim iftsmeNt <br />' <br />5.0 2.-- <br />1 , <br />1 44 <br />SAMPLE <br />MEASUREMENT <br />, <br />e" ' <br />. <br />7 i 6 '1 <br />'7.7 4 <br />rid <br />lar SA <br />PERMIT <br />strouittemeigt <br />—..1 <br />1 • (:0 <br />1. o <br />SA M PLE <br />M EAS UR ENIENT <br />. . <br />\ <br />4% 0 <br />Pc.ra <br />PERMIT <br />REQUIREMENT <br />■ <br />SAMPLE <br />MEASUREMENT <br />0. 00 C. <br />MI; § <br />‘7e.teLi <br />PERMIT <br />R EQUtREMtNt <br />0.0 4— <br />0 • 02-13 <br />i <br />• / , <br />5 AMPLE <br />MEASUREM <br />O. 54 <br />//e <br />/ a <br />nioutowameto. <br />. <br />D. 31 <br />o, 44 <br />SAM PLE <br />M EASU REM ENT <br />a oo / <br />14 <br />• <br />PERMIT <br />R EQUIREMENT <br />• <br />1),, 00 / 4— <br />a , 0 a 24 <br />SAMPLE <br />MEASUREMENT <br />,0 , 00 3 <br />pi,f/,e <br />p.R.,,,, <br />....,,......,..., <br />NAM E/TITLE PR MC. IPA L EXEC UT V E OFFICER <br />— — — ---- _ <br />I CERT FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED <br />AND AM FAMILIAR WITH THE NFORMATION SUBMITTED HEREIN AND BASED <br />ON MY INQUIRY OF THOSE INDIvIDUALS tMMELKATELY RESPONSIBLE FOR <br />OBTAINING THE INFORMATION t BELIEVE BE THE SUBMITTED INFORMATION <br />IS TRUE ACCURATE Art0 COMPLETE I AM AWARE THAT THERE ARE SIG.. <br />POPICANT PENALTIES FOR Su SMITING FALSE INFORMATION INCLUDING <br />THE POSC9lLITY OF FINE AND ImPRISONMENT. SEE IS U S C II 1001 AND <br />019 (Ponalrse$ und thew sitatureo may Include fines srp ro gtotloo <br />.,d o r ■aaJamum tavelsOnairta of hrtierfn 6 manilla and 5 yearn I <br />• ^ .. . . , <br />2 <br />TELEPHONE <br />— <br />DATE <br />te 6 / 4 1.0-0- 3- ,,„.........., <br />3 <br />. Z-S 4 <br />I <br />MO$j <br />- <br />SIGNATURE OF PRINCIPAL EXECuTIVE <br />OFFICER OR AUTHORIZED AGENT <br />rYPED OR PRINTED <br />... <br />AREA <br />CODE <br />NUMBER <br />YEAR <br />DAY <br />PERM iTT E/ADDRESS (Include <br />orlon rtfizk) <br />FoPoll4 Vas <br />/4".' <br />LOCATION,_ <br />Mine. -Ak-Ar <br />A <br />"Pace. 1U a at. ta re <br />NATIONAL roLLUTAN HARGE ELIMINATION SYSTEM INPDI.S) <br />DISCHARGE MONITORING REPORT (DMR) <br />(216) (17-14i <br />ea- 004-o rra <br />PERMIT NuMEIER <br />FROM <br />YEAR <br />011,1(1 IV 14 04.25) <br />MONITORING PERIOD <br />MO 1 DA V YEAR <br />TO <br />DISCHARGE NUMBER <br />MO <br />si 11 <br />DAY <br />0 <br />tl a"271 01-29) (AN <br />For pproved <br />OMB No. 2000-001t <br />NOTE: Read Instructions before comp eting this form. <br />