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i PERMITTEE NAME/ADDRESS Unclude Farili{v Namdl~tatian iJUif/rrrnl'I <br />NAME Q~..l) i'~ ; ~. ~ : is <br />ADDRESS :W MQRIZI>iV MINE '` <br />I~. l;OX a28 <br />'"'I-_i~ CO 81424 <br />FACILITY i-IDR Z ZG~J MTf'~E ' <br />LOCATION A CQ E31424~ <br />L_ANC~ Wr:- 1IN~ :'iAiVAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEA MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />,/ ~ i <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> Of <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE .1 <br /> MEASUREMENT] <br /> I PERMIT ~ .. `; ~ ~, t - ~; - <br /> REQUIREMENT r~V'G riA,L'~ i~i~ ,-;~._ ~- <br /> SAMPLE ~ ~ - <br /> MEASUREMENT <br />- •- PERMIT ,. ,. ~~ ~ ~u•~ ~'. PO t I ~ . _ . <br />i. ' REQUIREMENT . %i Fl A V ~ ;jA 11 ~` F•::x `• _ ~~ ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT Fi>=~F~:i~ .r_r r~r_r•:_,- _, .. <br /> REQUIREMENT ~, F-r'v' `_ iic, i L ; i- f <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;; ~ ~--z:~~•~•~t r' _ ~ I <br /> REQUIREMENT )Dk ='t'•/t:~ i~t~ i `Y Pi X ~ I r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT sac ~ :- ;~iE-#~• ., .. ` - '- ' =,~ + ,- ..- <br /> REQUIREMENT ~:A AVG L~AIL-r i'-` ,-sV ~' <br /> SAMPLE <br />~_- f ~ i r ,: ~-_ ~ ..: ~ ;:'_. MEASUREMENT <br />..~ I :7 i7 PERMIT - s: ~: # ~ ~..r. sr z t- - ... <br /> REQUIREMENT - '~C1DA AV~~ DAILY MX MC!?; <br /> SAMPLE • <br /> MEASUREMENT <br /> PERMIT .. - it - .. ... ~ ,. ,. ... , , ; c ~ •: r _ _ ~ ,., _ . - - _ <br /> REQUIREMENT > :~ : _•;~.i-: ~-;','G i:~;'- .. i ..; is ;-,: . <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I irrtify unMv q~nah) of lass that Ihb document and all altachttxnls were TELEPHONE DATE <br /> prepurcd umler nn dirretkm or wp•nision In accordance with a sr+a~rtt designed _ _ <br />- <br />---- d. as+urr thw qualified perwnnel properly Rather end rs uluatc the information <br />+ubmittcd. Bu+rd un m~ inquin ,d the person or prrdm.+ whu manage the system. ---- - <br />'~ • <br />/ <br />~ i 1 - - <br />' <br />' <br />~ nr th,nr persons directly nrpm+ihk fur gathering the information, the informat{ua i <br />~ ' ' ` <br />- ~I'- <br />' <br />'~ ~ ~ <br />~ +uhmitt d t+. to the !w t of my knowledge and ballet. true, arcurvte. and rnmpirlr. / .' (.'' - - ~ <br />Z <br />~ <br /> aw <br />re th <br />1 <br />t thr <br />+i <br />ifn: <br />lti <br />n <br />t <br />f <br />h <br />f <br />l <br />i <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE - ~ - ~ i ~- <br />TYPED OR PRINTED <br />nis.... ~..~ am <br />a <br />a <br />rc arc <br />gn <br />an <br />pcma <br />or+u <br />nu <br />es <br />mg <br />a <br />se <br />n <br />ormat <br />on, <br />inchaling the fro+sibiliry of fmr and impri+onmrnt fns knowing ~inlation+. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />D E YEAR MO <br />_. - DAY <br />AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3,'99) Previous edrtiorls may be used. i ? S3 / t,,TiT;~; i~i-~t 4-parr form. <br />