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PERMITTEE NAME /ADDRESS (Include Facility Nmne/Lacalion if Different) <br />NAME f R E5 <br />oL3Y`�.i .L_ li L"u]4.IUf':CLJ i...i.`,.- <br />ADDRESS BOWIE NiO. 1 MINES <br />P E r� i7 X 163 <br />RAONIA ! (i i A-? F <br />FACILITY <br />LOCATION ly AON I A <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040 -0004 <br />NOTE: Read Instructions before completing this form. <br />li <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NQ• <br />FREQUENCY <br />SAMPLE <br />>< <br />EX <br />OF <br />ANALYSIS <br />TYPE <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />e <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />i:iL.ILf6, 1,01 .,L <br />SAMPLE <br />;t15PENID%D <br />MEASUREMENT <br />t C- <br />PERMIT <br />4'. <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />4 <br />ir c, ; <br />REQUIREMENT <br />kIL AND GREASE <br />SAMPLE <br />MEASUREMENT <br />7 0 O <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />- HRU TREA T MENr PLAN <br />MEASUREMENT <br />PERMIT <br />.?0050 y. it 0 <br />REQUIREMENT <br />Qf.., ., A`v`. <br />SAMPLE <br />I SUAL <br />MEASUREMENT <br />PERMIT <br />141066 <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certik under penalty of law that this document and all attachments were <br />prepared under my direction or supervision in accordance with a system designed <br />to assure that qualified personnel properly gather and evaluate the information <br />TELEPHONE <br />DATE <br />ID/, <br />W �" J y % � t ^ t "" r <br />If _ <br />submitted. Based on my inquiry of the person or persons who manage the system, <br />_ <br />� <br />A4 <br />q <br />or [hose persons directly responsible for gathering the information, the information <br />- <br />- <br />_ <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />am aware that there are significant penalties for submitting false information, <br />including the of fine imprisonment for knowing violations. <br />_ <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />TYPED QR P INTED <br />AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />possibility and <br />CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />SETTLEATSLE SOLIDS LIN- T WAIVED FOR 10• -YR, 24HR PRECIP EVENT SUBJECT TO BURDEN! OF PROOF REQU.tR <br />PART 1. ti & ANY ADDITIONAL. OATH SHALL BE SUP'PL I ED TO THE DIVISION; WITHIN 46 HOURS. <br />EPA Form 3320 -1 (Rev. 3/99) Previous editions may be used. 000(30 fDTpls,lL) a 4 -part form. <br />PAGE OF <br />