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PERMITTEE NAME/ADDRESSpw.ibF.etiMryN..?Lecr/w.l/DIQG..w) <br />NAME <br />ADDRESS <br />J. LOS( 433 <br />:)NIA CO 8142E <br />FACILITY : I E NO. 2 MINE <br />LOCATION ?y I A CO 8142£ <br />I_LIAM A. BEAR JR., MINE MGR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION Sy3TuA INPOESI <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER 04SCHAAOC NUMBER <br />MONITORING PERIOD <br />YEA MO D Y LYEAn 1. MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040.0004 <br />MINOR <br />, <br />(SUBR MH) <br />F - FINAL DEL <br />CHRONIC WET TESTING FOR 006A <br />NOTE: Read Inettrucdof» before completing thb form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FAEQUENCY <br />L' SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />?(, :;( MEASUREMENT <br />- - PERMIT <br /> <br /># <br /> <br />t r<3i <br />REPORT <br /> <br />fc#i <br /> <br />##ie <br /> <br />, . <br />PEL&A REQUIREMENT SINGSAMP <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' "Mit ° r penalty o I.w that this do-ment and ap .Itwhments were TELEPHONE DATE <br />pmp.rad under my dlrertlon or supervision In sseordaner with a system ddgned <br />to assure MN quallfled penonnei propeAy gather and evaluate the Informrllon <br />I <br />i <br />f th <br />b <br />itt <br />d <br />B <br />d <br />on my <br />ry o <br />su <br />m <br />e <br />. <br />ase <br />nqu <br />e peraon or persons who manage the system. <br />or those <br />enors dlreetl <br />res <br />onsible For <br />atherin <br />the Infor <br />ti <br />th <br />I <br />fo <br />ti <br />n <br />p <br />y <br />p <br />g <br />g <br />ma <br />on, <br />e <br />n <br />rma <br />o <br />t of m <br />?n <br />nl <br />itted I <br />th <br />b <br />d bal <br />1 <br />b <br />t <br />s <br />t <br />d <br />l <br />t <br />' <br />m <br />e <br />a <br />y <br />o <br />e ge an <br />e <br />, <br />r . aecon <br />e. an <br />su <br />s. <br />o <br />comp <br />e <br />e. . <br />._ <br />t th <br />l <br />itk <br />BIGNAnME OF MIIN1DWAL EXECUTIVE <br />I <br />o <br />t <br />ltl <br />f <br />i <br />ti <br />r <br />f <br />- <br /> em are s <br />gn <br />an <br />am aware <br />u <br />pma <br />a <br />or subm <br />t <br />ng <br />ate In <br />orwrtbn, <br />TYPED OR PRINTED Induding the Possibility of Mm and imprisonment for knowing vlul.tlora OFFICER OR ALITHORVEO AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IONS (Reference of erracrlmenfs nerel <br />??wT PESULTS OF LETHALITY DERIVS AS " EFFECT CRnWTH AND <br />TISTICAL _Y i - <br />EPA Form 3320 1 (Rev 3/99) Previous editions maybe used - T?1JS•tS,1 4- 4-4 fQrrn. PAGE OF