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PERMITTEE NAME/ADDRESS tlrtclttrlr F'aciGts Aamc/Gfcatian iJUiJJirrnp <br />NAME ~_!.-'„ <br />ADDRESS ' ' -' ' <br />'r l•li=:~ f rIR 1 N .~J' TR EEC <br />`INIUAr~ CO X3108 <br />FACILITY ,~EtVC ITO CANYON MINE <br />LOCATION '~TfJt1 (', (_} $ 1 09 <br />~~ I I~+ AI?D I NG TC1N, MINE MANAGER <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) OMB No. 2040.0004 <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER - ~ I NAL I-A <br />•r<GE TO LORENC iTC3 CANYON <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO /` <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />; <br />~ <br />~ i <br /> PERMIT - - --'.~. . <br />.t <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT . -. , _ <br />• ,: . <br /> REQUIREMENT -'~'D'~ `~' " i•ix: <br /> SAMPLE <br /> MEASUREMENT •;~ <br /> PERMIT .... . - _ _ .. <br /> REQUIREMENT ~" i •'. ~ P'• r •::_,i••; T <br /> SAMPLE • ~ ~, C <br />] <br /> MEASUREMENT <br /> PERMIT .. . ,. „ .-, ~ - - .. ,. ' ~ .~ <br /> REQUIREMENT ,i;f~ i-; <br />.. (- :`~~ I ~. `: <br />' if••i i ~ I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. -. - <br />- <br />REQUIREMENT ~ .:~. i ~ ~ . ~~:f:~l~ 1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. .. - , .. _ ._~. .: <br /> REQUIREMENT I "!ST FiF~X L i=i~ i <br /> SAMPLE <br /> MEASUREMENT <br />- <br />- <br /> PERMIT " .... ,... .. --- -_ ~- <br /> REQUIREMENT - - ~; !~,'..'•: ; .(. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rrrtif~ under prnaln .~f law that thi. Afhnmrnl and all utwchmrnts were <br />dirartion ur +u <br />Mr~i.iun In a~onrd~m~e with u.r.lem dea¢ned <br />re <br />ared under m ~, ~? <br />/ TELEPHONE DATE <br />_ , / f <br />(~ !~V ~ I t'~ I L <br />- <br />~~' - ! t p <br />p <br />~ <br />l <br />to asavr thW rpfuhrnd per.nnnrl pn.p~rt. kullK•r and c~aluate the mfurmutinn ~ ` <br />~ ' y,f <br />- <br />_ <br />~ - ~ <br />.uhmittnl. Ilavvl n m~ impfin of Ihr perwn ur prrwm. wha manuRr Ihr .~atrm. ~ <br />/ <br />, yv /~~ / ( ~•-- <br />~ .1 _ i <br />• <br />. _ _ or th.r`r perwnn dtrr 11~ rolw rouble far Qutlw•rin>; Ihr inrormatiun. the informa8on L <br />1F'~~ <br />t/ ~, ~v / ~ <br />4~ ~ /~/_ <br /> <br />~ <br />! <br />wbmnted n. to the !w•.1 of my 4na w9rd~e and hrltrL true, xccuratr. and campkte. ~ <br />I r ~ 1 (~. / <br />v / O~ <br />! <br />_ <br />- • 1 um aw un• Ihut thrn• are +i <br />xnultirs for +uhmittin <br />ni0avm <br />fal+r infnrmrtian SIGNATURE OF PRINCIPAL EXECUTIVE J <br /> <br />TYPED OR PRINTED p <br />I <br />} <br />. <br />includin the + ibihq of fine and im rn nmrnt far knoxin ~ f dntion.. <br />u sm ~ r ~~ t. ~ ~ OFFICER OR AUTHORIZED AGENT <br />_ AREA NUMBER <br />CODE YEAR MO DAY <br />E COMMtNTS AND t>;YLArvia l lvrv ur Hrv r vIVLA l lvrva Irreverence are arracnmenrs nere~ ` <br />~ . P:~ _ :~~~~ 1 ~:•~. <br />I~!ii, is ;t -t {,.iri If~ini. <br />