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PERMITTEE, MAME/ADOflESS(h.Ad. i~t+M~/±../L«M!e~. (/D(a..tvl <br />NAME ~ <br />ADDRESS _ .r..;: .I Tr+ 1 ... t' j v}'{Wr~ s .=, <br />"'S~EI~,ER ' _ ~., CO 516 <br />'~~~..JWYO MINA ~ '~~ <br />FACILITY rt>»EKER ''-~ CfJ E316~ <br />~~~ KFLLY' D. SANDERS, ~!P QF QP5 <br />NATIONAL pOILUTANT O{SCNAROE ELIMINAT70N SY3TER1 //NPDES~ <br />DISCHARGE MONITORING REPORT (OMRI <br />r <br />PERMIT NUMBER OISCHAltOE NUbtBE~ <br />MONITORING PERIOD <br />YE R MO. DA Y IviD.~ DAY'. <br />FROM :., ~.~- ~.- TO ~ <br />Form Approved. <br />M I NCP Done No 2oaaoooa <br />(SURF? ..i~ ) <br />F - FIriAL ''~'~F <br />GOSSARD PONi~ TO WILSON CR <br />NOTE: R~r+d Irwfructlon~ b~fw~ cornpbtinp thb fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX caEOUENCr <br />OF SAMPLE <br /> <br />TYPE <br /> ~,y.Ygg <br /> AVERAGE MAXIMUM UNITS MINIMUM. AVERAGE MAXIMUM ~1NITS <br />, <br />~ r x ~ <br />_ <br />_ <br />f <br />> SAMPLE ~~ ~~ ~ ~' '~•% <br />~'~ ~.~~ <br />. <br />t . MEASUREMENT -. - .. <br />. ~p <br />_ ,..- ,.. R , Iz_, <br />, <br /> <br />~ `SAL I <br />LV 4 i i 1 ~ R i i;` ?ERMIT <br />~ ~ <br />:'ODA r~4'G <br />urz~ I L. Y P'f X <br />. <br />, REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />_---- --- -- REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />-_--- REQUIREMENT <br />- <br />- <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />- <br /> <br />NAME/TITLE PRIf1CIPAl EXECUTIVE OFFICER 1 nntl) r pen^ ly 1^s. <br />IA^1 th <br />prep^red nn6er rnr dlrecllen or wpe is decurntnl ^nd ^H ^IlKbnrnb were <br /> <br />rvllon In ocevrd^nre wllh . aTslem defl[ned <br /> <br />, <br />~j <br />/ ~ <br />TELEPHONE <br />DATE <br /> <br />r ~ <br />ti to .estlre thN u^x}led nonnN A ^IMr ^rd er^lu^te IM Infnern^Ibn <br />, a raw r ~ ~ <br />/ <br />/ <br />':~. <br />~ <br />~ <br />. <br />~- <br />~ <br />~ <br />. <br />~/If ; - r <br />^ebMlled. /.wd ew m. IngwrT of tAe person a persenn .An nun^Re tM s.strm, " <br />~ , <br />, <br />.; <br />l <br />/ ,' r <br />/ / <br />~ <br />~ <br />rl <br />/ M Iho^r persona dlrecllr respelsd bk fa (^tlteArK IAe Inform^Ilnrt. the Inforrrt^Ilon `- <br />y <br />~ ' ~`~~ . , ~~ <br />~ <br />~ / , <br />' ~ `, _ ' % !~ ", -:;rr /_ ~- <br />~.- .~ i JC ~< subntllled ft, to ltte best of m~ tnor.ted~e •tW t+extf, Irve, ^mtrlle. ^nd rornplele. <br />1 ans .warn tll^I Iltere ^rr d~dM1ralll <br />en^ttle for sabmlltln <br />f^br inf <br />rnYx <br />n <br />{IUNATURE OF FAINC~PAI E7(ECVTIVE " <br />i <br />,t - - "~ ~ •. _ <br />TYPED OR p~Tm p <br />E <br />o <br />e <br />, <br />InAW1nE IM pos/Dltltr of floe ^nd Iwsprtsentnenl for tno.InE .iof^uoln OFiICER OR AUTHORIZED AGENT COflE NUMBER YEAR MO DAY <br />corvtMENTS AND EXPLAir1AIwN yr Ani vfvlr~LtwrvS (KI71/MCI ~a~r ncnrn~nran~r~I :;NR PRECIP cVENT i5 CLAIMED. IF' CLA_TM APF'ROV>=D $Y WQGD. <br /> <br /> <br /> <br />EPA Form 33Zat (Rev 3/99) Previous eddions may be used. ~' t ~ ~'fi'thiS i5 9 "4- art fOErn. PAfiE OF <br />~ ~ <br />