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PERMITTEE NAME/ADDRESS i1n,1". ForQrq ,YrnrteJLrxwinn ijUi/jcrrnrl <br />NAME <br />ADDRESS <br />FACIUTY <br />LOCATION <br />???Q'6NATONAL POLL DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />IF- PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />RECEIVED OMB o.` <br />JUL 17 2008 -1 <br />Division of Reclamation, <br />Mining and Safety <br />XXX <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />? OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT `y <br /> REQUIREMENT <br /> SAMPLE <br />c?, ;• ,r: r „ MEASUREMENT <br /> PERMIT <br />t. :. REQUIREMENT <br /> SAMPLE .. ` <br /> MEASUREMENT <br /> PERMIT ;, _ . . -:p .. - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . r 115 '_ R r`-;;.? <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ^z# t! i [ :f:i. <br />I:. r REQUIREMENT <br /> SAMPLE u . <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br /> SAMPLE <br />l MEASUREMENT <br /> ? - <br /> <br />PERMIT <br />... <br />F•• _.?:.. <br />? - <br />.: ?= _ .r <br />?....... ?-x <br />- . <br />_1=. <br />::( <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under i nalt .•, las :hat this document and all attachments were <br />- <br />-- TELEPHONE DATE <br /> prepared under my dincuon or supervision in accordance with a system designed T <br />a <br />t <br /> to assure that qualified personnel property gather and evaluate die information <br />J A MF S T COOPER, PRESIDENT submitted. Based on my inquiry of the person or persons who menage the system. 1 <br /> or those persom directly responsible for gathenng the intonation. the information <br /> submitted is, to the best of my knowledge and belief. true, accurate. and complete <br />I am aware that there arc si <br />nificant <br />false information <br />enalties for submmin SIGNATURE OF INCIPAL EXECUTIVE .70 1929-5855 008 07 07 <br /> <br />TYPED OR PRINTED g <br />p <br />g <br />. <br />including the possibility of fine and rmpnsonrnent for knowing violations OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . CODE <br />GUMMtNI5 ANU tAVLANAIIUN Ur ANT viuL.AIIuNJ tHeierence an arracriments nere/ <br />PRE--C IF E',--;EN-i I`TLAIMEL-. EXEMPTIONS, FROM <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 0003 ; .,TWS is .a 4,par4 fon-n. <br />fi