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PERMITTEE NAMElADDRESS Nmdmlr FaxxA. Nalne2rxmial iif mffe w) <br />NAME :i_S .C)Et1:LL.C <br />ADDRESS ;tf? MINE <br />629 <br />C O <br />FACILITY _ 8142 <br />i HOIF ?;)N MINE <br />LOCATION : LA CO 6142 <br />p LANCE WADE, MINE- MANAGiEf? <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) oMB No. 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER - T NAL <br />MONITORING PERIOD TESTING FOR 012A <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />?,'_• MEASUREMENT <br /> PERMIT # #;>r~<# >< i3? 00. 0001 ? k3t# ####x3t , F '- EMT -i <br />• r,-r; REQUIREMENT MN VALUE ANNUFt <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT ?_• ..y#rst tut * tri x: s tY 100. 0001 ER- F-rl _ RAfJ-3 <br /> REQUIREMENT l: # MN VALUE CENT ANNO-A - <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all anachmenLs were <br />d <br />d <br />d <br />t <br />i <br />i <br />i <br />d <br />ith <br />d <br />i <br />d TELEPHONE DATE <br /> ion nr superv <br />prepare <br />un <br />er my <br />irec <br />s <br />on <br />n accor <br />ance w <br />a system <br />es <br />gne <br /> to assurr that qualified persormcl properly gather and evaluate the mfortnation <br /> submitted- Based on my inquiry of the person or persons who manage the system. <br /> or those pcm)ns directly responsible for gathering the information. the information <br /> <br />` J f „ I - <br />submntcd is, to the best of my knowledge and belief, true, accurate, and completes <br />I am uc. are that there arc si¢nificlutt penalties for submitting false informamon <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />f - "'- ?c <br />= // <br />to <br /> <br />TYPED OR PRIN D . <br />including the possibility of fine and nnpriso ment for knoa ing violatioru OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE <br />(r1QICICIII.C all attatilllll Cllr) IICr CJ <br />REPORT LOWEST DILUTION (% EFFLUENT) <br />!CITY TEST REPORT FORM TO DMR. <br />EPA Form 3320-1 (Rev. 3189) Previous editions may be used. ;+ti38 /,j bi5 JC;B 4-pact. Orm.