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PERMITTEE NAME/ADDRESS prrrbfotulrylv../1.er.Hsr I/DlQwwvl <br />NAME <br />ADDRESS - ... ~ . - , : !- <br />BOX 4$3 <br />'IA CO 81428 <br />FACILITY ~ 8 NO. 2 MINE <br />~~-*~+ ~ I a c o s 1428 <br />_L_IAM A. BEAR JR. MINE MCR <br />NATIONAL f+OLLUTANT DISCHARGE ELIMINATION SY4TEM NPDESI <br />DISCHARGE MONITORING REPORT ID Rl <br />PERMIT NUMBER aSCNMOE Nt1M0ER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />.-orm Approved <br />pU1B Na 2040-0004 <br />- FINAL <br />HG OF ~R TO GU!'JN I SOrd R T'JER <br />NOTE: Reed Inetructlorn Mtore completing thb tam. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX EREOUENtr <br />of SAMPLE <br /> <br />TYPE <br /> ANAlrsts <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ., <br /> MEASUREMENT <br /> PERMIT ~tit•~-##~ ~ .~ 4 -. -- S #3t•~~•~ < ~ ~, I EEKLY 1. i•d~ I i~l. <br /> REQUIREMENT I MUM ~'!AX I Uf 1 <br /> SAMPLE <br />T -; <br /> MEASUREMEN , <br /> PERMIT ti•r•-IE•tF~•# -iE #~##~~ 05 :C} _ ••riAla <br />~, • REQUIREMENT ~;~ ~Ll^i ti~.,':J C~~:~ ; f I•.; <br />~1~ <br />_- ~' ~ ~ SAMPLE <br /> MEASUREMENT <br /> PERMIT ##3f if## ###### ~ ##~!•#3I-# REPORT F2Ef:'ORT i"JCci~ .='RKii <br /> <br />;.. <br />REQUIREMENT <br />3GI)A A`Jfr <br />DAILY MK <br />Ilt7hdTF1 <br />- SAMPLE <br />~~~ MEASUREMENT <br />~- PERMIT ,. , ..: , >r +r - ~-.~ir xx;r 300E u0Q0 NCE/ -; F3° <br />• <br />~.. REQUIREMENT 3U A A`,!G C?AIL.Y Pt' P?QP;TH <br />_ SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ 1 ~~ ; 1~ ~ ., <br /> <br /> REQUIREMENT Ir~fST MAX I <br />j SAMPLE C• <br />~~; MEASUREMENT <br />• PERMIT REPOR ,' REF'OR1 - - ~ ,. :._.~~i <br /> REQUIREMENT ;00A ~;: 13~,ILY MX <br />• SAMPLE <br /> MEASUREMENT <br />PERMIT #d4#~Itsfik - ~ ~•~ ~ ~ ~~ -y ... . ;F-i ~ #~• • i -; .. -~ <br />REQUIREMENT i iti3T h(a4X <br />NAME/71TLE PRINCIPAL EXECUTIVE OFFICER ' ctrtrte . pen. y o .. lhet UN dotvmsnl .nd .n ellsrhmtnls were TELEPHONE DATE <br />prepared coder rn~ direcllon or mperslsla+ In .ccord.nn wllh . s7riem desrtned <br />to mars ihsl ~u.M11ed personnel propeA~ t.lhef .nd eeNusls the Infnrwrllon <br />wtbrdlled- 6s~ed en m~ Inqulr~ of the person or persons who trunste the system, <br />- <br />or lhtee persere dlntttl~ rnpordble for tHheArrt the Inforwutlon, the Inforrrrllon <br />submltled b, la the best of m7 -nowfrdte .rW beMef, Iree, Kcv nle, .nd ctnnplele. <br /> <br />111 <br />1 thr <br />t.rs fl <br />YnesM <br />ea <br />ltl <br />IIONATLIRE OF -ttlNCt-AL EXECIlTEVE <br />1 <br />w <br />f <br />b <br />lttl <br />I <br />f <br />hb <br />tb _ <br />TYPED OR PRINTED p <br />p <br />un. <br />.re <br />s <br />r <br />s <br />a <br />or wr <br />m <br />nt <br />e <br />n <br />orm. <br />n, <br />InAtWlrtt the po.rblutf of nne.nd InrpAsprtnsrnt roc xno.lnt rlol.uorrs. OFFICER OR AUTHORIZED AGENT CODE NUMEiER YEAR MO DAY <br />' COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference ~M ~tt~chments herd <br />' ;F' PREC?P EV~TIT T '^I. AZthFD. IF CI_.AIM AF'PRDVEn I3Y ~J!~CD. <br />,. ._ -. ..-; '~r~L.rll'~I: tip ~; ~[_~>? BURR;=_;~: t~i -~, r <br />` ~ i t- err (.. F1 i 4t ~~-~i Tnl[_ ~ 1 F1••i•~~-T I-~:' 1 f) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. %i ~.~•~ ~ / ~~5 is a 4-p~t; form. PAGE ,OF <br />