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PERMITTEE NAME ADDRESS 11-,6& F-*Vry NawsatLacarlan ((D(& mw) <br />NAME <br />ADDRESS <br />BOX 18/ <br />iG CO 81626 <br />FACILITY 1 P ER MINE <br />LOCATION IG CO 61625 <br />r'MOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (MPOESI <br />DISCHARGE MONITORING REPORT JDMRI <br />PERMIT NUMBER [EsEiAnGE NUMOM <br />MONITORING PERIOD <br />YE O. DAY I Y AR MO DAY <br />FROM TO <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />FOND TO DEER GULCH <br />Form Approved <br />OMB No. 2040-0004 <br />r1OFAT <br />NOTE: Reed Instructions befitw completing thi* form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> •; . ,' <br /> PERMIT .. a - <br />N Li` REQUIREMENT - M I N I t'IL+M MAX I MUM <br /> SAMPLE <br /> MEASUREMENT <br />0 -' PERMIT r . sr sr _ y • -.:`. <br />ROS` REQUIREMENT x ;?jr)" AV1 DAI Y MX i•CI <br />,.._. ?,. SAMPLE <br /> MEASUREMENT <br /> <br />0 PERMIT _ <br />ROE: REQUIREMENT 11A X - NT <br />- '- SAMPLE <br />MENT P'i - MEASUREMENT <br />O 0 PERMIT :: 7 sr <br />GROSS REQUIREMENT 10DA AVG•, DAILY MX <br />y SAMPLE <br /> MEASUREMENT <br />= G PERMIT :r : .. <br />_UENT GROL REQUIREMENT - x' !'A AVG DAILY MX <br />AMID " - SAMPLE <br /> MEASUREMENT <br />`' <br /> <br />- <br />PERMIT <br />r- t, UK I .. x - <br /> <br />F <br />ri .)_...: `.. REQUIREMENT iNST MAX ONTH <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEJTTTLE PRINCIPAL EXECUTIVE OFFICER I mrlay Y K pen¦ ty o how that thin da rrwnt and an ¦itschmerrts were TELEPHONE <br />pmpamd under my dlmcllon or superon In accordance with a system designed DATE <br />to aswm that qualified personnel properly gather arA evaluate the Informatln <br />subrrrtted. Owed on my Inquiry of the Prrson or persona who manage the system <br />or those persons dimity responsible for gathering the Inform,ti". Ike Information <br />?- submitted le, to the best of me knowledge and b~. Iroe, a role. and complete. <br />EXECUTIVE <br />I <br />A <br />' - <br /> I son swam that them on slgnincant Penalties for wbmllting fain tnfernrdon. SIGNATURE OF PR <br />NCIP <br />L AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED InckWng the Possibility or fine and Imprborrrrsnt for knowing violations. OFFICER OR AUTHORIZED AGENT CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Referents sat attachments hors/ <br />',7n# TDS LIMIT APPLIED FOR <=10YR, 24HR PRECIP EVENT- <br />DIL <br />_4* 019144k6 0, A"44,00;i-- i0l.w_iI. <br />?,:a' <br />1027i' _ <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. ftTtrc4i 4 P .f4? PAGE OF <br />- f -