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PERMI'ME NAME/ADDRESSpmhwref.rwyNm*WL atie i(olIwvwJ <br />NAME <br />ADDRESS <br />BOX 18! <br />?G CO 8162E <br />FACILrTY PER MINE <br />LOCATION - -. I G CO 8162 <br />vMnnln r nil R`ITS, PRFR/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION Sr9TE1N NPOES) <br />DISCHARGE MONITORING REPORT /OAR/ <br />PERMIT NUMBER asCHAioE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR 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: Read k»tructione before completing thlB form- <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />t SAMPLE <br /> MEASUREMENT <br />-?6 1 O PERMIT sr :} ## RE ORT' ::: a NIS A <br />i- `UENT GROSS REQUIREMENT 1. NS T I IAX '•1._J <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />NT <br /> MEASUREME <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER i <br />s direction or that <br />w p th <br />ared ° of under pen m <br />rrre " <br />h r document and 41 a with ae system dereeigned <br />erHlen In accordance with a <br /> <br />/ <br />TELEPHONE <br />DATE <br /> <br />j ` p <br />p <br />7 <br />to assure that q-1111,d personnel property gather and erdnste the information <br />submitted. Bawd on my Inquiry or the person or persona who manage the "em, ' J <br />- - <br />.. or those persam directly responlbM for gathering the Informatum the Information <br /> to the best or my knowledge and beilef <br />lent <br />accurate <br />and complete <br />submmad b <br />_ , <br />, <br />. <br />. <br />. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am sweet as there are sigdfkinl peaaieb for sabmdtdng false Informatlon, ARE <br />TYPED OR PRINTED Inchedhq the poselbnity of Ilse and Imprisonment for knowing .iolsdons. OFFICER OR AUTHORIZED AGENT CODEE NVMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fReferonC1 N/ arffircnmenrs new <br />ABLE SOLIDS LTMIT APPLIED FOR f=10YR,24HR PRECIP EVENT- <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 00 : rF4 / G 3&%W 4-?IifpfrTl. PAGE OF