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<br />PAelurT
<br />LOCATION _
<br />nl'1'h: kI`FIARD G. ATKIN~JN
<br />n AnonwvoLwr tclluo[ [urmwnDH wsr[M /NPDEJI
<br />DISC4IAR IONITORINO REPORT /~MRI
<br />I-fd~ 17-Ifl
<br />r
<br />•lRMIT NVMe[R oMCN•wcZ NUMttw
<br />MONITORING PERIOD
<br />Y[AR MO OAr YEAR MO DAY
<br />FROM ~ ( U TO ~ 1 L
<br />!I()Il/ 117-13/ /11~IJ/ /I6- 1 /18. l l 0. I
<br />- f
<br />M I Y.O R Form Approved
<br />(BURR NM) M®MI1TNo. 2040-0004 ,
<br />F - FILIAL Ezplres 9-30.91 1
<br />GULCH A SEDI POND/GOOD SPGS CR
<br />%ra NO DI SCRARCF. ~~~ 04Q
<br />NOTE: Re[d inetruetioro Mfort eomplatinp ehif form.
<br /> (J Card Only) QUANTITY OR LOADING (I Card Only) QUALITY OR CONCENTRATION
<br />PARAMR[R (16.JJ) (J161) (J8-1!) (I6J3) 1J167) Np, iREDU ENCr
<br />OF [AMPLC
<br />
<br />TYPE
<br />(37-J7) E% wnwLrtlB
<br /> AVERAGE MA%iM VM UNITE MINIMUM AVERAGE MA%IMUM UNITE 676J) (616
<br />8
<br />) 9-]0)
<br />ld
<br />I II BAMPL!
<br />MEABUREM ENT ...- r.. :t ;t Y:':i t1 t ( ) C7, /)
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<br />°'~ ~{. yg~~L.,d.y. 11
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<br />;JI.IDS, "OTAL [AMPL[ •Y a-.~ :xYt'`w-.: ( 1 "'~-~= a ( 19) o l/ R~$
<br />F,IIJPENDEU MG[UREMENT p` JlJ G
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<br />f.~530 1 D D
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<br />~
<br />Pe ;~.~;
<br />aw ~; , ~:p
<br />Y >
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<br />,.)LIDS, ';ETTLFaBLF. swMPL[
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<br />) ;:+.:1~5~?:: ;: t:{:::~7. ,I ( 25) O t/30 AT
<br />
<br />MEASUREMEN OI
<br />`I (iR
<br />3
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<br />III1. AND .A IiEASr: SAMPLE
<br />M[ABUREM[NT -rr 1::~4r IY:f:. ~:Fr ( ) :::: ::'v •'i K: f:.{: s;::f Li
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<br />l I{r)il, TOTAL [AMPL[
<br />M[A[UR[MENT = 13 •'.':~
<br />1•: C >::.yi::;::~:;: ( ) ,-.. ;:{:~{: O
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<br />I'LO11, IN CDIIDDLT OR BwMPL[
<br />MEASUREMENT O I(,~ ( G3) ~+'~'~r: :';"x''•"^~~ ~~=~:^ii4i ( ) O ~/7 ZNSTFN
<br />'I :IkU TkF'3TMPNT PLAN
<br />`_ILJ050 1 0 O ;;~iisriT°;;;
<br />a." 4~TE0'NAT.~.~_' :;REEQk~e:~ ';.*k~a~k+t~~k~i'ee ~A:Dr.ifF~edid.'a ~:°?~4L'ti#~?k~~
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<br />eFF1UENT GROSS VAL g., :. ( e fi., , «
<br />.y. n:. fF Tk iF Y8 ~
<br />..OL7DS TOTAL [wMPLe
<br />MEASUREMENT ':14K~)G: r..a:#;: ( ) :++kl:+t1:}:p `.C4'.:I.
<br />/ 61J
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<br />IILS~OLVED 7
<br />/Ii295 1 0 O Yy n, PRRM 'IT''/w
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<br />NAM [/TITLE PRINC VAL Q[CUTIV[ OFFICER I C[wTSI uNOER PENAITr OF LAw
<br />TNAT 1 NAVE vEwSONALL• FAAMm[D
<br />IAR MTN THE INFORMATION SUBMITTLD NCIIEIN AMD eASLD
<br />MD AY FAMI TCLlPNONE D A T [
<br /> A
<br />L
<br />OM Mr INOl11Rr OF THO^[ INdVId1AL5 IMMEdATELr gC5FON51BLE Fpi
<br /> OBTAIHIryG TNC MFOIIMATOV I BCIIE VE TN[ SUIMITTEO INFORMATION
<br /> IS TwU[ ACCURATE AND COMRRE I AM AwAw[ THAT TNERF AIR SIG
<br />MFICANT fENALTRS iW SUBMITTING FALSE INf ORMATgN InCWDINO
<br /> TN[ POSSIBILITr d iIN( AHD IMPRF,.ONMENT SCC le USC 1 1001 AND
<br />lln rvn
<br />SC I I]19
<br />A
<br />ld
<br />/
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<br />]
<br />d 61GNATURE OF PRINCIPAL EZECUTIVE 1
<br />TTP[D OR PRINT[D .r I
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<br />••d..1n..In.II..I,nP•.v,n.I.nl.,/A.:.wn A~n..n1A•and.5 ..a.., OFFICER OR AUTNORIZEO AGENT A NUNS[R Y[AR MO DAY
<br />COMM[NT AND [fIPLANATION OP ANY YIOLATIONe {Re1Tre11ce ull uHUa'llmenls here)
<br />:,4TILEABLE SOLIDS LI11IT APPLI::S ONLY IF <= LG-YrI, 24-11 'r PRECII' EVErIT IS CL.4111F.D. IP CLAIM APPROQED'B[
<br />~1CU, TS.i f. IRON LIMITS MILL NOT r~F, APPLIED TO R6POkTF1G `1LAS1!6F.f!EVTS--SE° [.6,1A, PG U AND I. B. 1D, PC 6.
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