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LRIR4Y SILVER MINES <br /> Discharge Notification Form <br /> Part A: Discharge Information <br /> General information when reporting a spill to outside authorities: <br /> Name: Ouray Silver Mines Inc. <br /> Address: 1900 Main St. Suite 1 <br /> Ouray, CO 81427 <br /> Telephone: (970) 325-9830 <br /> Owner/Operator: Ouray Silver Mines Inc. <br /> Primary Contact: Matt Juth General Manager <br /> Work: (970) 325-7241 Ext. 1025 <br /> Type of oil: Discharge Date and Time: <br /> Quantity released: Discovery Date and Time: <br /> Quantity released to a waterbody: Discharge Duration: <br /> Location/Source: <br /> Actions taken to stop, remove, and mitigate impacts of the discharge: <br /> Affected media: <br /> air storm water sewer/POTW <br /> water dike/berm/oil-water separator <br /> soil other: <br /> Notification person: Telephone contact: <br /> Business: <br /> 24-hr: <br /> Nature of discharges, environmental/health effects, and damages: <br /> Injuries, fatalities or evacuation required? <br /> Part B: Notification Checklist <br /> Date and time Name of person receiving call <br /> Discharge in any amount <br />