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PERMITTEE NAMVADDRESS (7-" Fw *#yN-n?Lxr,en ((D(fw t) NATIONAL POLLUTANT ONSCHAIGE EUMINATION sYBTuA INPOE$) <br />NAME EC€iVED DISCHARGE MONITORING REPORT IDMR) <br />r1 I E NO 2 M I` v <br />. <br />ADDRESS <br />I BOX 483 elOOp <br />UU <br />2 PERMIT NUMBER otsCHAA01NUMBER <br />PADNIA [[ <br />All O <br />FACILITY P CW I E NO. '-1 t•I <br />f Reclaim' MONITORING PERIOD <br /> plvlslon o MO D Y O D <br />Y <br />LocATTON 1N I A MinMq and Sa'*FROM _ <br />TO <br />?:LLIAM 1, <br />.. Approved. <br />.;MB No 2040-0004 <br />MINOR <br />(SUER MH) <br />F - FINAL DI <br />SR/MINE WTR TO DEER TRAIL DTCH <br />NOTE: Read Irletructlone before completing thin form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREoUE7NCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE r t <br /> MEASUREMENT <br /> PERMIT <br />6. 5 <br />0 <br /> REQUIREMENT MINI NUM MAXIMUM <br /> SAMPLE <br />i MEASUREMENT <br />-- PERMIT # # # Y- _ -4 _- <br />LUc V i REQUIREMENT "JDA A :' t?,', !_ -7'f' MX MONITH <br /> SAMPLE <br /> MEASUREMENT <br />- <br /> PERMIT r r- 777 <br /> REQUIREMENT 30DA A',7? DAILY MX MONTH <br /> SAMPLE <br />r fit MEASUREMENT <br />5 ! ( PERMIT - - £ <br />y <br /> REQUIREMENT 30DA AVG DAILY MX MCINTH <br />r SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />?. REQUIREMENT i NST MAX ENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT r, c , I- ,. . <br />VENT G R 0 S SAL' REQUIREMENT 0L t> i L_Y MY, <br />?- - = SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT AST MA'< <br />NAMErnTLE PRINCIPAL EXECUTIVE OFFICER t crriey ° r pen¦ ty o Iaw that this document and an ¦ttachmeots veers TELEPHONE DATE <br />prepared under mss dlrectlon or wper+lslon in accord nee with a system designed <br />to ems- NAM quallned Personnel Properly gNMr and e,sh aot the Information <br />ssbndited. Bred on my Inquiry of the Person a persons who manage the system, - - <br />or those persons directly responsible for gathering the Inforwtauoa, the information <br />th <br />t <br />f <br />k <br />wf <br />nd b <br />t <br />b <br />it <br />d h <br />t <br />t <br />d <br />1w <br />t <br />d <br />le <br />o <br />e <br />o <br />my <br />ne <br />e <br />e <br />, <br />rw, serwra <br />e. an <br />comp <br />te. <br />su <br />m <br />te <br />es <br />ge a <br />, <br />SIGNATURE OF PRINCIPAL EXECUTM - <br />h <br />i <br />fi <br />t <br />lt <br />f <br />itt <br />hb <br />f <br />ti <br /> I am aware that t <br />ere am s <br />gni <br />can <br />pewa <br />les <br />or subm <br />ing <br />e In <br />orma <br />on, A W <br />TYPED OR PRINTED IndWing the possibility of not and Imprisonment for knowing .iolstlorea OFFICER OR AUTHORIZED AGENT CODSS NUM9ER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReforence aM offechments herel <br />THR PPFCTP EVENT IS CLAIMED. IF CLAIM APPROVED BY WQCD, <br />-OR F <br />ASF- i L z . ? - ?R T H. 1._ <br />TluEPA Form 3320-1 (Rev. 3/99) Previous editions maybe used. - - - - - s.li a 4-?W ' fdrm. PAGE :OF