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PERMITTEE NAMEIADDRESS (/ndude Fatilin~ Name/Lotarion if DiQerenU <br />NAME CYPRUS EMPIRE CORPGRA"f ION <br />ADDRESSEAGLE MINE COMPLEX <br />P. D. DOX 68 <br />CRAIG CD 81626 <br />FACILITY <br />LOCATION <br />ATTN: AGEORGE E. VAJDA, 'J P. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMRJ <br />COOU34142 024 A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO_ DAY YEAR MO DAY <br />FROM v vi 'TO v v <br />Form Approved. <br />MINOR OMB No. 2040-0004 <br />(SUDR NW) <br />F - FINAL MOFAT <br />DEWATER MINE 5 TO WLLMS FORK R <br />~#+r NO DISCHARGE ) I ~+# <br />NOTE: Read Instructions before completing this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER E% of TYPE <br /> AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~'ALyS15 <br />U AN G ASt SAMPLE *iratr it tr ( 1 nnirx~ra +rua +rswax <br />(~ <br />~ <br />,JISl1A <br />VISUAL MEASUREMENT G ~ <br /> <br />8406b 1 U O r r i E5=1 i;{t ~ ##'rf <br />EFFLUENT GRO55 VAL <br />UI PERMIT INBT MAX N0=0 ~ <br />~' <br />*~ #~~~ <br />_ .REOUIREMENT ; <br />- <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;:, •.~ <br />>~'o ~ <br /> REQUIREMENT ~ <br />~?r <br />4, . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIF <br /> REpUIfiEMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ - ~ ?~~~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~ I, ~~~' ~ ~ ; <br /> REQUIREMENT - ~ ;~,:r_= <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ 'zw~ :` ~ , <br /> REQUIREMENT ~ ~-' ; <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I Cenity under penairy of law that tnis document antl all attachments were TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a system designed ~~ <br />~ <br />~ <br /> <br />~-t <br />' ' <br />ii11 <br />to azsure that qualified personnel property gather ano evaluate me information <br />n <br />i <br />i <br />tm <br />th <br />b <br />tl <br />B / <br />/~ <br />~ <br />~ <br />f <br />~~ <br />~~~-$~~-27I2 <br /> <br />tarr <br />~ <br />5 <br />2i <br />su <br />ased onmyinqu <br />ryo <br />epersonorpersonsw <br />omanage <br />esystem, <br />m <br />tte <br />. K'C J <br />~ <br />~ <br /> the information <br />or those persons tlnenly responsible for gathering the information ` <br />, ~ <br />~ <br />11'"IYU!l I^P"~t <br />l! ~~3'li ^?Y' , <br />l <br />b <br />tl <br />l Q /c <br />. <br />.- submittetl o,lo the best of my Nnow <br />edga and <br />elie(true. accurate. an <br />comp <br />ete. SIGNATURE OF PRINCIPAL E%ECUTIVE <br /> <br />TYPED OR PRINTED I am aware mat mere are si9nllicant penauies for submnling false information. OFFICER OR AUTHORIZED AGENT A <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> indudin the ssibio of fne and im risonment for knowin wolaeons. of <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rererence all attachments here) <br />FLOW LIMIT APPLIES TO COMBINED FLOW FROM 003r 022 & 424. OIL $ GREASE GRAD SAMPLE ANALYSIS REQUIRED IF <br />VISIBLE 5HEEN I5 OBSERVED. QRTRLY SAMPLING IN5TRUCTiDNS-I. C. Br PG X. <br />EPA Form 3320-1 (REV 3/99) Previous editions may be used. 00225/0004c ~IIS IS'f~41PART FORM PAGE 1 OF <br />_~ I <br />