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PERMITTEE NAME/ADDRESS (Include Facility Nome/Gocarion ifDi$erenrl _
<br />NAME piTT58UAG b I1ICYIT. COAI NIflIYG
<br />ADDRESSEDNA MINE
<br />P.G. BOX 176
<br />FACILITY GAY CR6Efl CO 90467
<br />'LOCATION
<br />1TTYS A-V T^ 7_ if: Yf.. ^T~F SUDT_
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR~
<br />(Z-t6) '((~~ 9)
<br />Y
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM TO 3
<br />(PdPD !2133) (2a-251 (2&2l) (28-29) PO-3D
<br />Form Approved.
<br />C I MG A OMB No. 2040-0004
<br />Abprdyal expires OS-31-98
<br />(SUER !i)
<br />F - PIMA ,. iCU11
<br />SURFACE iDiCFF SC SPCL1'CFEER
<br />00a YC i1SCN1flGE (__1 a40
<br />NOTE: Read Instructions before completing this form.
<br /> (3 Cerd Ony) QUANTITY OR LOADING (<Certi Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (4653) (54-61) (38-45) (4653) (54-61) EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />(sz~G]l ANALYSIS
<br />(64-ti8)
<br />69-70
<br />NERCUAT, TOTAL
<br />IA$ HG) sAylPl,t:
<br />MEASUREMENT a0aaaa
<br />- a0a 0
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<br />LO'O~Z
<br />G, D•(~IOZ ( 1°.) ~
<br />71900 1 2 2 ~ t
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<br />EPFLUENI GROSS Yl`LO
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<br />FLUY ~ Mp,~C A { 03) 0044 0 a044 O~t0a00
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<br />DILUTIOY FACZOi SAIv1PLE'• •Fuo op 1 ld) OaOa a»4aas aa0as0
<br /> MEASUREMENT ~
<br />90093 1 1 2 •:.tY- -, *i~ ~ F~. ' IO' ~ •~ +! I~ ~?: ~1_~
<br />~ 404 ~ i75~ ! Y
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<br />EPFLUENT GRO55 VALUE '
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<br />IL AND GREASE SP7YIPLE Oaa000 9 ) OOOOaa 0a4#4a 000000
<br />Y I S U A L MEASUREMENT
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<br />EPFLUEYT GROSS VALUE -
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<br /> ME,45DR~ENT ,
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<br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER .' I C RTI
<br />AM F FY UNDER PENALTY OF
<br />MI
<br />AR WITH THE INFORM CAW THAT 1 HAVE ERS
<br />ATION SUBMITTEb HER ONALLY EXAMI
<br />EIN
<br />AND BASE NED AND
<br />D ON MY .~„
<br />, ', , • _, _ ~ 7fiCEPHONE DATE
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<br />U
<br />/~ ~ ~ ~ ~~ INOUIRY-OF,THOSE INDIVIDUAL
<br />1 BELIEV
<br />~Rt~N v' ~^~TR~4~ ~ THE INFORMATION ;
<br />S IMMEDIATELY RESPONSIBLE FOR OB
<br />E THE SUBMITTED INFORMATION I TAINING
<br />S TRUE:
<br />~
<br />' '
<br />,
<br />r'~ I ACCURATE 'AND COMPLETE.
<br />' I AM:AWfRE THAT'THERE ARE SIG
<br />Y NIFICANT
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<br />; PENALTES., FO SUBMITTIN
<br />•~ QOSSIBILrIY OF ~INE AND IMPR
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<br />• G FALS 1NFORMA
<br />IGN;. INCLUDIN
<br />ISONME~' SEE Ie U.SL.410QL AND H
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<br />33 U.S.C. SIGNATUR. OF PRINCIPAL'E%ECUTIVE t',tl '
<br />7318. (Penalties untler these
<br />' §
<br />TYPED OR PRINTED marimuif{+mprisonment olpeMea
<br />,1~. • stawtas mtry ixlutle linei up lu b10,00
<br />n6moM(u entl5yeers).. 0 entl or
<br />~ OFFICER OR AUTHORIZED AGENT A A
<br />CO E
<br />NUMBER
<br />YEAR
<br />"MO
<br />DAY
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<br />P
<br />i
<br />D EXPLANATION OF ANY VIOLATIONS (Re/erence all ettechments here)
<br />TGT-L IRGA LIflIiG YILL_EE MAIiHA• l1D.3617LLE8L
<br />SEE X~Af2. F. ~Ic'.!7)8 DESflIL47t.;,..(,~aIflI.I ~~fLIM6
<br />3CLICS.i3lI7 flBPIZEC F.Cf Sc 1GIF, i4YF'FEPC]F
<br />s pc1!z~rs - SLE f.C.9. F. %III. •
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<br />~'~. •00210/OOC111-16s'i
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