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PERMr77EE NAME/ADDRESS Unclude Pacilirr NamdLocadon iJUt%jerenfi <br />NAME .'- N I NG <br />ADDRESS <br />INVERNESS <br />. EWOOD CO 80112 <br />FACILITY A MINE <br />LNE <br />LOCATION CREEK CO 80467 <br />VI LEACH, SR ENV ENGINEER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />M I NC)A OMB No. 2040-0004 <br />F - FINAL ROUT] <br />SURFACE RUNOFF TO TROUT CREED, <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />URE <br />!D r ? <br />e 0' 50 <br />Y' <br />/I ? <br />C'0 <br /> MEAS <br />MENT <br /> PERMIT ...._ <br /> REQUIREMENT x ANN' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT _ r:1 i1 l?j= _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />'I <br />L <br /> MEASUREMENT <br /> PERMIT r ::. >. . . <br /> REQUIREMENT A ti`c'+r `1" a L I-', <br /> SAMPLE 9 <br /> MEASUREMENT . <br /> PERMIT .. t-r it;`x ti ?• a <br /> REQUIREMENT JGDA <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r : - <br /> REQUIREMENT L 1= . ` ', Mi X F„ <br /> SAMPLE <br />L I <br />I ?? <br />Il _ <br /> MEASUREMENT l <br /> PERMIT K. <br />r <br /> REQUIREMENT _ 11d}•;± t?; <br />NAME/TITLE P NCIPAL EXECUTIVE OFFICER 1 sertifs under penalh of law that this document and all attachments were <br />preparrd under my direct{rnt or uprrvi%inn in arordunce with a system designed <br />. TELEPHONE DATE <br /> <br />?'- - - <br />? <br />J <br />" <br />to assure that qualified pe-nel prnperly gather and evaluate the inrormatitat ? <br />. <br />' <br />1. <br />• G- suhmittrd. Bawd on ms inquin of the pertm or persons who manage the .ystcm. - - ? <br />-? <br /> or those persons dim-tis respsnsibie for gathering the information, the information <br />/ <br />• _ <br />1 s '}- <br />t ° <br />K wbmitteti is. to thv best of ms knowledgr and btik/. true, acarratr, and complete. ~ ,` 't <br />' ` C I <br /> <br />- <br /> <br />I am aware that thcrr jr, iXnifkvnt penalties for submitting false Information <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />ai <br />- (i _ V <br />TYPED OR PRINTED , <br />including the la,-sddlu7 d rinr and imprisonment for km,wing viulatloas. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />GUMMtN I J ANU tAYLA"M I lvPt yr mi'l r YtVLA I lvtva Irfererence an affacnmenrs here/ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used, nis is it 4-(tint ron-n. PAGE IOF