NCG020766 DMR WW (5)

PROCESS/MINE DEWATERING WASTEWATER DISCHARGE MONITORING REPORT (DMR)
Please Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCG020000
Part A:Facility Information
Samples Collected In Quarter: 1.4,3 i 4 e (all samples shall be reported within 30 days following monitoring period)
Circle one)
Certificate Of Coverage No. f}2 °i�(F£,•,_ County of Facility aur
Facility Name \fru la tt.goc•4l,. �0, ,,,,,_ Name of Laboratory
Facility Contact p&_L k .. `h.A• ll,C�,, a Lab Certification ii
Facility Contact Phone No. (j/p) a' 044 /7'
Part B:Process Wastewater and Mine Dewatering Wastewater Monitoring Requirements 1
,.. ' ;x,,''�'' ;Date':''' 6`:''.50050;!,` ;A040U. _ ,,; t;�.�g `,,•M;