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PERMfTTEE NAME/ADDRESSQnni/rFrtl~yN~r/l~c~r/o.IJD(Qir.w.q <br />NAME <br />ADDRESS t <br />:IA CO 6142 <br />FACIIfTY E N^ • 2 M I ~~ <br />~~T,~,, , z A c o a l 42 <br />~iAM ~'~. BEAR JR. , MINE MGR <br />NATIONAL POlltlTANT dSCNAROE ELIMINATION SY4TEA1 (INPDESI <br />DISCHARGE MOfViTORING REPORT (OMR/ <br />PERMIT NUMBER ascltAnclE NuMeE>~ <br />MONITORING PERIOD <br />Y AR MO DA Y • D Y <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MINOR <br />(SUI3R MH ) <br />F - FIfdAL L~LTh <br />SR/MINE iJTR TO ~iEER TRAiL %TCH <br />NOTE: R~~d k»trvetiorr b~for~ complAtlnO thi. form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. ~'EO~N~ <br />of SAMPLE <br /> EX TYPE <br /> ANAlrsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />- SAMPLE .. _ - . <br /> MEASUREMENT <br /> PERMIT ~ - ~ .c ~ ~ •iE'•;. r .. _ .- <br />~JF'd1 f;US:~ 'J~`:l REQUIREMENT IPIST' f"i{~~7( .~-`~`:~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />I <br />EMENT <br />REQ <br /> U <br />R <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t rector u r pen. l~ o le. th.l thM davmcnl .nd .u .Il.rhrnent. were TELEPHONE DATE <br />pRp.red coder m~ dlrertMn or euperHlon In eRrord.nre wllh . flfleen dnl[ned <br />to aaure Ih.l ~uMM1ed ptrso.nel pmpecl7 ether .rd c•W.le the Inrerwutbn <br />wrbrrilted. 6eaed on m~ Inquiry or the Perron a pertoru whe Irrna[t tin rrrtetn, <br />a Ihoee prnorn dlrecty recperelbk for piherln[ the Infor•n.llow. the Infortrrt{on ' •- <br />wrbwtltled b. W the bat of m~ lnowkd[t .nd beMer. True. t.eunte. .nd entnPkle. <br />tiIONATVRE OF Nt11NC11Al EXECUTIVE . <br /> 1 .m ...n thn Ihere.re rl[rJfktul Penattla roc wbmlltln[ flee Infortrrlbn, <br />TYPED OR PRMITED Inrhrdln[ Ibe P^sr•btxlr or I1ne.nd ImPr4..ntrw^! roc krtowln[ •td.tlaa OFFICER OR AUTNOR12E0 AGENT CODE NVM9ER YEAR MO DAY <br />COMMENTS AND EXPLANATION Ur An r vw~n 1 Ivna I/f~itr~trnc• err •rr~rnmtrnra n~rq <br />'~.F:~' i:_ ~?- ~ 24HR PRECIP FVENT I5 CLAIMED. IF CLAIM APPROVED DY WOCD, <br />- ~ - 'TED ~REMEI`;-' _ _ .. _ ~; .,.. ~., r~ <br />_ _ _ -r' _ <br />.. This is. a 4-part form. PAGE of <br />ma be used <br />_ v s editio <br />ns - <br />r Ilw <br />Pe <br />3/991 Y <br />EPA Form 3320 1 Rev <br />