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PERMITTEE NAME)ADDRESS(lneM4F"tyMmeWLocetlon(/D(terms) <br />NAME SS*-,-;if u1'.; <br />ADDRESS ma, 3 MINE <br />P.0- BCC.; 1754 <br />F :-?:) 1I13! A 00 81428 <br />FACILITY ..ZE R N G1. '.3 MINE <br />LOCATIONSO ERSE i CO 01434 <br />'_4.'•r"-rsa_ •t•e.a?,r??-i r rts•'^_er• °...5'S?"C?•YY'^t?ht"F •. <br />OMB No. 2040-0004 <br />Form Approved. POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) DISCHARGE MONITORING REPORT (DA R) 5 I NOR <br />CGoof- 1713 77 004 t SUBR M11 <br />PERMIT NUMBER DISCHARGE NUMBER 1= --• FINAL GUN It ? <br />RUNOFF TO N FK 'UNN I SON RIVER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM Q t k.)-c- W I TO Vt v-+ Jv NO I) I SGHAIRGF I ?/1 #;r }r <br />NOTE: Read Instruedons botoro complstind this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREGUENCr <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />ttLA SAMPLE lid f£# ?I; ;x#?### k3C''###kk 3 12) <br /> MEASUREMENT <br /> <br />EFFLUENT t rrwa5 VALUE itEQUIpEMENY # t ;: :? . S U <br />t?L. 105: S T I L iL SAMPLE <br />MEASUREMENT i k i; #', 4z #?:?. h k lE ie 1 i G <br />00545 1 0 0 :PERMIT 71 <br /> <br />GROSS VALUE <br />EFFLUENT <br />REQt11REMENT <br /># ##i£ <br />NL r L. <br />-": <br />OIL AND GREASE SAMPLE #>~ is k ii 3z ?i iris fi ss is !; ? # k 3fi t? ii ky? # ti i? i <br /> MEASUREMENT <br />GSSS 0 0 PERMIT iz 3## > <br />EFFLUENT G"iS VA1-U REQUIREMENT A#k Ei?f <br />3- LUW IN CONDUIT O SAMPLE ; 03) i #i: 3i ?i ? # LEA # Y !e # fz .: iiti ?b <br />T HRU TREATMENT PLAN-1 MEASUREMENT _ <br />;rw}E;i} t3 0 PERMIT <br />EFFLUENT ,-'R(3SS VALUE REQUIREMENT ? ??,• ?. , <br />.: x <br />(s.: <br />GD <br />I?? <br /> <br />r### <br />%I L A19`W z ;EAU;1 SAMPLE > k r I i c l/?l ? k z t • k ;c; : c # i # t: i# r : ? ti t <br />V I'SUAL MEASUREMENT <br />64,066 1 t iT PERMIT r ;` c 1 x#3$ - <br />-:-_-- L?rZ!_73 R?l11REMENT NO= O = - -- - _ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> `REQUIREMENT <br />s <br /> SAMPLE <br /> MEASUREMENT t <br />- 'i?ERMIT " <br /> AEdUIREMENT <br />TLE PRINCIPAL EXECUTIVE OFFICER <br />law that t <br />'tt 11 y under pem ly o <br />? <br />his document and oil attachments were <br /> <br />t <br />h <br />d <br />i <br />d <br /> <br />TELEPHONE <br /> <br />DATE <br />NAMEM • sys <br />em <br />es <br />gne <br />my direction or supervision in accordance wit <br />nparsd under <br />p .1 <br />. to assure that qualified Personnel Properly Lather and evaluate the information <br /> submitted. Based on my inquiry of the person or Persons who manage the system, - - <br /> or those persoro directly responsible for gathering the information, the information <br /> accurate <br />and com <br />kn <br />l <br />t <br />e <br />lete <br />b <br />t <br />f <br />d <br />d b <br />li <br />f <br />Sh <br />i ( ? <br /> ow <br />e <br />ru <br />, <br />, <br />p <br />. <br />o <br />my <br />ge an <br />e <br />e <br />, <br />s, to <br />e <br />es <br />submitted <br />e <br />P <br />EXECUTIVE j • <br /> m are significant penalties for submitting robe Information, <br />I am aware that th SIGNATURE OF PRINCI <br />AL C <br />E NUMBER YEAR MO DAY <br />TYPED OR PRINTED Including the possibility ovine and Imprisonment for knowing vldatio? OFFICER OR AUTHORIZED AGENT OD . <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IUNS /Referonco avi orfacnmenfa narar <br />I-..'}:="iIT APPLIED FOR -.==A0YR,2.4HR F'RL:.C-!P E4)E1°:T - SETT1".E,ABLE SOL.IbS L"t'F,'.i :a trAivF--) FOR >10YR. <br />C? U Z . GREASE REPORT ING _ i3EE I. R !'. ;:30 ?3c`Y AVG 2 r- AT"Tt' C1-i rlt <br />D001; <br />o Z«' ,'_"f.^? 5.. ?:. .? ,.=r....:w ., ::. --ci. ?..•.;. r.s? Sv= •'1 .•t.'i('1 t"?,":"?r3•3.... .. lift'. ;3 _ -'F:?l^. Yi:^ i f.} `.9 <br />PAGE of <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.