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I <br />PERMITTEE NAME/ADDRESSt7-&&r "byAr..wL .,,.(/Dl _.,) <br />NAME <br />ADDRESS <br />P. 0. Box 483 <br />^?IA CO 81428 <br />FACILITY ; C NO. 2 MINE <br />LOCATION IA CO 81428 <br />-LIAM A. BEAR JR. MI :14E: MGR <br />NATIONAL POLLUTANT DISCHAAW ELIMINATION SYSTEM //NPDES/ Form Approved <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040 0004 <br />PERMIT NUMBER ascHAROE NtIMeER : IJAL DEL <br />MONITORING PERIOD _iEER TRL ? C OR UNMD TR IB <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions bolwn compleEing this tam. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FltEOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT rLALY <br />c ':= <br /> REQUIREMENT <br />ROsb VALU - ;,II I`lr X I11Ut•1 <br />TrjT ;,L SAMPLE <br />LADED MEASUREMENT <br />30 1 PERMIT IVCt.i <br />UENT IR:.tSo 'Y AL • REQUIREMENT MONTH <br />r DS, S ET i I.. 1_0 F- SAMPLE <br /> MEASUREMENT <br />45 ]. 0 PERMIT ### # # #3l ; ii it > REOOP F REPORT 71 1 41:' <br />_UEN'f CRt7r REQUIREMENT -70DA AV-3 DAILY MONTH <br />1TAL SAMPLE <br />(AS FE MEASUREMENT <br />45 1 C-1 PERMIT <br />= FLUENT GR:.I` REQUIREMENT «7DA A ^F,it_`/ is hi 7'J7Ii <br />AND GR I SAMPLE <br /> MEASUREMENT <br />1 C. PERMIT --t it tF tE C #xi "?# !t !? 1? t- tt w t N r A175 <br />-FLUENT GROSS VP REQUIREMENT INST MAX <br />W, IN C014DUI T SAMPLE # ?.??-dam <br />J TREATMENT PL MEASUREMENT <br />,SO 1 r PERMIT REPORT REPO Jr 77 17-7 , 7 <br />_UEN? VI- . REQUIREMENT .•;;A AVG r'-AIL,,' <br />,j 1 AIJL' r SAMPLE ?u# I -- <br />• •; ;F?; MEASUREMENT <br /> <br /> PERMIT RT=onc , <br /> REQUIREMENT - , , <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 «n"y ° r terra ly o Iaw Ihal fhb document and all ¦ttachmrnts wrn <br />TELEPHONE <br />DATE <br /> prepared under my dlrsrllon a fuper.!/ow In accordance with • fyflem ddgrmd <br /> to amcrn that qualified personnel property tether and evaluate the information <br /> trpmllled. bawd on my Imqulry of the person or persons who manage the system, <br />, <br /> w <br />how penes directly rsspemlkle for gathering the Imformatloet. the Information - <br />- mis milled K to the hell of my knowledge and beset. Ime. ecrurate. and complete. .. <br /> 1 ¦m .ware that there am slgnif "I penalties for oils-Itltng ralfe Infor aitlen. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Inciuding the podblsty of nor and Imprbonotent for knowing vlelatletn OFFICER OR AUTHORIZED AGENT CAREA ODE NUMBER YEAR MO DAY <br />GUMMItN 1, ANU g:ArLAINPt 1 evn yr .+.. r e,v?r. r cvrw lnwrwrwne• err .ruenm?nlJ "WrW1 <br />IF, 'F1 Tp F`1'FNIT Tr '.TMFD I1- Vii..^,?*q AF"RnVFD rY WOC:'ti, <br />Previous editions may be used <br />DO 186