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PERMITTEE NAME)AODRESSQwr~irFwWryNa~/Lera/an~/D(Q'wwr) <br />NAME <br />ADDRESS <br />r~~x ~~ <br />i.G CO 81626 <br />FACILrrv ~ - i' P ER MINE <br />L~,~N ~ iG CO 81625 <br />- %MfkiVT) (, llkl RfITS. PRF~i/GM <br />NATIONAL POlLt1TANT aSCMAROE ELIMINATION SYSTEM /NPDESI <br />DISCHARGE MONITORINQ REPORT (OMRI <br />PERMIT NUMBER ascHAnuE NuMeEA <br />MONITORING PERIOD <br />Y AR MO DA YEAR MQ- DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />MINOR <br />tSUDR JC) <br />F - FINAL <br />DISCHARGE TO COYOTE GULCH <br />FTOFAT <br />_. ''~~:, <br />NOTE: R~~d k»trucdon~ b~fwi compl~tlny thl~ form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FAEOUENCY <br />of SAMPLE <br /> EX TYPE <br /> ANKY~s <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE "' ~ -- <br /> MEASUREMENT <br /> PER MIT - - . ~ <br />J sr <br />~ - : 1 :: , <br />Jl ~r-~:U: REQUIREMENT Mil~t21'?~ 1~AXIi•tU~•i <br />,, ,. SAMPLE - -. <br />~- ! jDED MEASUREMENT <br />. PERMIT ,-., ;r x• ,r , _ .._ ._ . 1 1 <br />_1~;='N i i.;,-Usti; V~, REQUIREMENT <br />i .3 )D ~ AVM DATL'r 1?: , ,. - l`ff~id i ; t <br />. ~ ~ ~_.~ ..-- - SAMPLE ~ - <br /> MEASUREMENT <br />5 1 0 '~ <br />~ PERMIT .~ .- <br />~ <br />~~ <br />~'~)DA RVG <br />IL'f MX <br />DF •: .. - ~ <br />NiONrf- <br />,:- <br />'~1T i_?i?`l~;,i- REQUIREMENT '-~ <br />~ ~ <br />, , <br /> SAMPLE <br />t A ~ ? }-. ~ MEASUREMENT <br />- ` 1 ~ ' PERMIT ~~ ~, ~ .- _ . ~... ! . , <br />I_UENT ~RG~•• REQUIREMENT ~ ..:Qn f1UG DAIL.'~' t~:>! l1lV/i t'iC:i•!~, <br />,_ , t, ,~ SAMPLE , <br />. ~~. <br /> MEASUREMENT <br />`-; `c' ~. Z U (.) PERMIT .. <br />~ k.., <br />' <br />- - r • ;: <br />" ~ i ~ -" f•: ; ~'RD~; -3 . r :_ . REQUIREMENT I h35T !'1A <br />)( ~ <br />r <br /> SAMPLE <br />r'1~ATMENT PL :''' MEASUREMENT <br />1 t7 O PERMIT -- - , .- r f. .} : ~.:c ~ = }° _ <br />. ; GRO~~ ~J~',~ REQUIREMENT .: <br />V ~~kl~`c, a - , # ~' <br />. - - SAMPLE • <br />+: ,- MEASUREMENT <br />' PERMIT "' ~ ~:.. .. - -. - <br />`~,- REQUIREMENT - -.: ~ A AVt; DAILY rix <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' ren,ly r r Pena tr o law thn Ihh docomeM and •n atl.chmente were TELEPHONE <br />prepared rndtr n.~ di reclbn or srpereislon In acrordann wllh • r~rtem desl[ned . DATE <br />_ to care thN gorMlkd perwnnN properly plMr rnA e•du.lr IM Infarnrllon <br />wrlrrititd. [iaaed en m~ {rpulr~ d UK perm a penaer who Irwra[e lM system, <br />! <br />~ ~.r <br />~. <br />%Z <br />~ <br />_ <br />_ <br />.- <br />~ t <br />t/t.' :1 ., ~ . , <br />~` ~~ ' ~ ~ ~ - M thine peteona dtnKtiy rtspowlA4 ra [atherlrl[ the InfgtnaUaw, tM Information <br />~ _ / 1 ~' <br />~'' <br />~ <br />ateunte <br />and nmpkle <br />- wsmltted b4 b the Mil of rtq lnewlyd[t •nd Ml/er <br />trve <br />' / <br />' ~ <br />` <br />- <br />*~ / / (~ <br />, <br />, <br />, <br />. <br />.~ <br />NAT <br />RE OF MtINCtrAI EXECUTIVE <br />I <br />" ~ ~ <br />' _ <br />' <br />/ / 1 am aware On then an /[dficsm penalties fer srlmlltln[ hlee Informatlon. E <br />O <br />V <br />TMpEp OR PRMITED ~ Ineirdirl[ tM po.rwuty of nne and Mryrleonment fw Ynowln[ .{daUwa OFFICER ON AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANAIIVn yr nnT VIVLAI WI'IJ 1/TI/I/IRCI err ~tucnrnwnlJ ntrrq <br />(,~ r~-l rLEADLF SOLIDS LIMiT APPLIED FOR <=lOYP., 24HR PP,ECIP EVENT- <br />EPA Form 3320-1 (Rev- 399) Previous editions may be used. (j () t ? 1 ! ';~~1-131b 8 1-~(~f4f(Tl. PAGE .OF <br />l ~~ <br />