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PERMRTEE NAME)AODRESS (tnelrJr F«iArryN.wf/Lerrrar dDlp6.t..y
<br />NAIVE
<br />ADDRESS , .- -
<br />~J, BOX 1B7
<br />r'1IG CO 8162b
<br />FACILri1r `APP ER MINE
<br />LOCATaN `iIG CO 81b25
<br />•'~YMOND G. DU BOISE PRE5/GM
<br />NATIONAL pOLLLRANT d5CHM0E ELIMINATION SY9TEIN NPDESI
<br />DISCHARGE MONITORING REPORT (D Rl
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<br />PERMIT NUMBER OISCHAJ{OE NtlMtifR
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM TO '
<br />Form Approved.
<br />OMB No. 2040-0004
<br />MINOR
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<br />F - FINAL MOFAT
<br />POND TO DEER GULCHp~
<br />NOTE: Rrtad k+atructior+e Mfos'e eompbtlny thia form.
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<br />COMMENTS AND EXPLANATION ur An>r vlv~A I IONS IRahranca Nt •rbcnmenta nasal
<br />- ,;TaLF SDL IDS LIMIT APPLI~D FOR 4=IOYR, =?nHR PP.FCIP F~J~NT-"
<br />EPA Form 3320-1 (Rev. 3199) Previous edrtiona maybe used. ~; ; ~_ / t`~j~{~+~¢_D~~•if9np, PAGE ~OF~
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