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PERMITTEE NAME/ADDRESS (/nch.&Fe tbry)VaaWLeea i m l/DW6,mq <br />NAME <br />ADDRESS <br />bU\ i4JU <br />'SAUL CG b1?) 1! <br />FACILITY S1Db 14jhTH t; Z t;UTh M1NL6 <br />LOCATION PALISADb CO b15::! <br />tiny t _ 11 rn1IwL u <br />NATIONAL POLLUTANT DISCHAROE FUMINATION SYSTEM //NPOESI <br />DISCHARGE MONITORING REPORT WMR/ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MIYCIt <br />(SUBR Lii) <br />F - Final <br />NO b IC COAL Li <br />NOTE: Reed Instruction Wore c' opleting this fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> OF <br />YP <br /> EX ANALYSIS T <br />E <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />4.Jr .? J „ PERMIT _ <br /> <br />' REQUIREMENT <br />4 - <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 /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />1 FFM y u «pena If o law that thh document and all attachments were <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />d <br />d <br />DATE <br />prepare <br />un <br />er m direction or su <br />y pervidon In accord.nce with .stem designed <br />_ to amens that quaMlkd personnel properly gather and evaluate the lnfnrmatlon <br />' <br />rbmilled. Bred on my Inquiry of the person or persons who manage the system, <br />Ih <br />tl <br />di <br />ibl <br />f <br />or <br />oae persons <br />rec <br />y respons <br />or gathering the Informatlon, the Information r c <br />e <br />- <br />submitted b. to the best of my bna»ledge and belief, Irse. amurele, and complete. - - <br />I am aware that there are significant penalties for subniltln <br />rein Informati <br />SIGNATURE OF PRIFICWAL EXECUTIVE ' <br /> g <br />on, <br />TYPED OR PRINTED Incumng the possibility or flow and Imprisonment for knowing vWathms OFFICER OR ALITHORIIED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference eH attachments here! <br /> <br /> <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-part form. PAGE OF