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FERMITTEE NAME)ADDRESS (YmA-& Fw okfy Afnw?Loesriew tyDfOWw") <br />NAME <br />ADDRESS <br />BOX ISi <br />IG CO 8162E <br />FACILITY ' ?PER M I PJ L <br />LOCATION <-, I G CO 8162E <br />.-?,mnNn n PRFS/GM <br />NATIONAL POLLUTANT DISCHMGE ELIMINATION SYSTEAJNPDES) <br />DISCHARGE MONITORING REPORT (O _ R) <br />PERMIT NUMBER dSCHMat NUMBER <br />MONITORING PERIOD <br />YEAR MO, DA YE MO DAY. <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL MOFAT <br />POND #3 TO MIDDLE PYEATT GULCH <br />NOTE: Reed Itnetruetione before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FRECUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />AIL- J REQUIREMENT M1I?11 }l?'; ,`)f;X I h1UM <br />I f7 .,_ SAMPLE <br />7' ;=NDEP MEASUREMENT <br /> PERMIT <br />W REQUIREMENT 30DA AVG DAILY MX „_ = (} <br /> SAMPLE <br /> MEASUREMENT <br />r? 1 O PERMIT <br />7-jr IF -W <br /> <br />! ` <br /> <br />s s: <br />l <br /> <br />?, <br /> <br />. z <br />SS V ?. REQUIREMENT ' 'UDA AVG DAILY MX _ MONTH <br /> SAMPLE I t <br /> MEASUREMENT <br />_ <br /> <br />- <br />PERMIT <br />} 1 TIT <br />^ 15 <br />VENT GRU'c'-_• t'r:•, REQUIREMENT 30DA ;.4 DAILY MX MONTt- <br />?. -- t- SAMPLE <br /> MEASUREMENT <br /> <br />1 O <br />PERMIT <br />.. <br />r.: <br />_7* <br /> <br />- '-Ur4 11 1 K F1 L, <br />VENT GRO :_, REQUIREMENT r MAX <br />INS i': GENT <br />1. - SAMPLE <br />TRL.ATMENT P1_-V MEASUREMENT <br />0 1 0 n PERMIT <br />_UENT GRDS'S V •!- REQUIREMENT JOI)f- LILY ` <br /> SAMPLE <br />SOLI F. '1 MEASUREMENT <br />PERMIT - <br />REQUIREMENT ;ODD AW; DAILY MX <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t rr penalty i o (low that this document and aN e sys were , TELEPHONE <br />prepam pared coif der my dlrectton or fuperMSion In .eeordante with wltA a syefem darned DATE <br />• to more that quaNned penonrtel property gather and evaluate the Infenrslion <br />% - , -- submllted. Bmaed on my inquiry of the prnon or pervo s who ansauige the grim,, <br />L? <br />'?' <br />- ? <br />_ <br />? <br />or those pervors directly responsible for gathering the Inrormatiow, the Information <br />? 1 <br />submitted bL to the bat of my knewladge and belief. $nre• arevm1e. and compkie. ._ <br />IGNATURE OF PMCWAL EXECUTIVE <br />E <br />- - I am aware that there are 911nifta tt penatna for submitting hie Infor"OtIM S A <br />A <br />TYPED OR PRINTED inrtwing the posdbiNg of nm and Imp I= menl for knowing violetsoem OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION vi- ^rv T V IVLA t tvna imarsrancs an ettecnrrrenrs neref <br />-,DLE SOLIDS LIMIT APPLIED FOR <=10YR, 24HR PRECIP EVENT- <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 'M 1 X13 i f;T-Gt&j4 : N,,4_p4;Yif9rrn. PAGE OF