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<br /> <br />PERMITTEE NAME.AODRESS rln<daJr ( ) <br />POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES <br />RECE <br />9' <br />? ?A-o I <br />V Form Approved. <br /> <br />NAME 1? <br />L <br />? <br />SCHARGE MONITORING REPORT (DMR) OMB No. 2040-ODOR <br />ADDRESS OC <br /> T 2 `t ERMIT NUMBER DISCHARGE NUMBER <br /> <br /> <br />F <br />- ' ? Division of Riacl aG <br />MONITORING PERIOD <br />' <br />ACILITY Mining and S R MO DAY YEAR MO DAY <br />LOCATION FROM TO <br /> NOTE: Read Instructions before comoletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :: i - - <br />Va__tl" REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r• <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />l PJ =- REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . r .., . <br />i : - <br />-ir REQUIREMENT ? ?: <br /> SAMPLE z r <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE 7 " <br /> MEASUREMENT <br /> PERMIT R) ", : • •.: <br /> REQUIREMENT ri <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />- DEPORT <br />- <br />- <br /> REQUIREMENT :. Y I:l y <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that Ihi, document and all attachment, it cr, <br />d <br />i TELEPHONE DATE <br />. <br />. prepared un <br />er my d <br />rcctton or supentsiun in accordance with a system designed <br />h <br />li <br />d <br />l <br />l <br />h <br />d <br />l <br />h <br />fo <br /> <br />r <br />• at qua <br />Nm nnc <br />proper <br />y gat <br />eva <br />to assure t <br />fie <br />er an <br />uate t <br />e in <br />rmation . !- <br /> submitted- Hawed on my inquiry of the parson or persons who manage the system. <br />- - - or those persons directly responsible for gathering the mformauon, the intixtnauon <wG <br /> -uhmnled ,s, to the best of my knowledge and belief; true, :ucuratc• and complete <br />I am aware that th <br />re arc si <br />nificant <br />enalties for <br />ubm <br />n <br />lal <br />fomr <br />tt <br />i <br />ti SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED p <br />e <br />g <br />sc <br />n <br />a <br />s <br />i <br />i <br />g <br />on. <br />including the p asihiiity of fine and imprisonment for kii-in <br />isolations OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO Y <br />DAY <br /> g CODE <br />I.VMMtN IJ ANU CAYLANAI IVN Ut ANT VIVIAI iurcJ (Keterence air anacnments here; <br />24HR RECI <br />EPA Form 33201 (Rev. 3/99) Previous edrtior s :nay cc This is a -f-part f'oi-m.