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PERMI7TEE NAME/ADDRESS (Include Facilin• Name/Lxarinn d Different/ <br />NAME CYPRUS EMPIRE CORPORATION <br />ADDRESSEAGL E' MINE COMPLEX <br />P.U. DOX 68 <br />CRAIG CO 81626 <br />FACILITY <br />LOCATION <br />ATTN. AGEORGE E 'JAJDA• '/ P <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT (DMA) <br />COU034142 022 A <br />PERMIT NUMBER ISCHAgGE NUMDER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM v vY vt TO vv v~ .w <br />Form Approved. <br />i ~ 1 NDR OMB No. zoao-oaoa <br />tSUDR NW) <br />F - FINAL MOFAT' <br />SP07L5 5P WTRJf<SEEP/WILLIAMS FI2 <br />#~~ NO llISCHARGE I_1 u~rv <br />NOTE: Read Instructions before completing this form. <br /> QUANTITY OR LOA pUANTITV OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER EX OF TYPE <br /> AVERAGE MAXIMUM ~ NITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br />U1L N c; St SAMPLE il'-n'thc'Ra I ~;t a'sr't tr tti+'tr**° ~'"a'It "r° ~-f <br />I 1, <br />l'ISIIAI_ MEASUREMENT O Q '1 trISUAE' <br /> <br />840E,6 7 U O PE131v11T 'ti ~~iF E5=1 ~ #~# <br />EFFLUENT GROSS 'JALUE AEOUIIiEM~NT " =?~ ~=~~"I` ~( N0=0 ~.: s - #### ~ " <br /> v_ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -i :: ~"._ ~,: <br /> REQUIREMENT '~~ _{ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~" <br />~ <br /> REQUIREMENT ' <br />"~~ ~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ '_ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMFi/TITLE PRINCIPAL EXECUTIVE OFFICER I CedAy under penalty of law the/ mis document and an attachments were <br />' TELEPHONE DATE <br /> prepared under my Onenion or supervision m accordance with asystem dasgned / <br />t <br />1~ <br />I C )1:; 1" (~ ~VI1 ~ I S to aswre that qua4fietl personnel properly gather aM evaluate the n!o,mal~on / '~ <br />~ <br />. submined Based on my inquiry of the person or persons who manage the system, '~~(r(~~2 <br />~ p p <br />T~'~~~' <br />712 <br />[nvironmental h' <br />~nar <br />er orthosepersonstlnec[lyrasppnsiblelorgalhenngthemlormalion <br />theinlormation U/ L • f _7 - <br />. <br />; , <br />subminetl ~s , to the best of my Mnpwletlga and belie/. true, accurate, antl complete. SIGNATURE OF PRINCIPAL E%ECUTIVE ~ <br />~G ~~ <br />TYPED OR PRINTED I am aware that [Here are s~gnilicant penalties for submining /else inlormation, <br />mdudin Ina ossmili of line and im nsonmem for knowin violations OFFICER OR AUTHORIZED AGENT ARE4 <br />NUMBER <br />YEAR <br />MO <br />DAY <br />OUMMEIV 1 S AND EXPLANATION OF ANY VIOLATIONS (Re7erence all attachments here) <br />FLOW I--IMIT APPLIES TO COMBINED FLDW FROM U03. 022 •4a 024. L71L 8. GREASE GRAB SAMPLE ANALYSIS REQUIRED IF <br />VISIDLE SHEEN IS ODSERVED. C~RTRLY SAMPLING INSTRUCTIC7N5--Z.C 8, PC X <br />EPA Forrn 3320.1 (REV 3/99) Previous editions may be used. 00 1 94 / 00042TrIS ISft~41PART FORM PAGE 1 OF <br />