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PERMTTTEE NAME)ADDRESS (7.e&k Fwro y V.../Lerwew (/Do6r m) <br />NAME <br />ADDRESS <br />BOX 187 <br />,IG CO 81i <br />FACILITY ;aPER MINE <br />LOCATION I G CO elf <br />YMT1Nn a nil RIITR. PRFR/GM <br />NATIONAL POLLUTANT DISCHAROE EUMINATION SYSTEM /INPDESI <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHAROE 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 TO FAR EAST BUZZARD GULCH <br /># t} i~ <br />NOTE: Read instruction befwo completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOVENCr <br />Or SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />_ PERMIT ## REPORT -NGE/ )I UAL <br />__UENT t:Ftr; REQUIREMENT INST MAX - MONTH <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 /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER I "nny ° r pens y o low that this eocamem and ail ¦llachmenh were TELEPHONE <br />prepared ander my direction or superrh{oo In accordance with a system designed _ DATE <br />j n to amum that quallned personnel property galbsr and eeafaate the Information J I <br />_ <br />submitted. Based on my Inquiry of the person or persons who manage the system, <br />" <br />or thane persons directly "sperrslbie W gathering the Information, the information <br />f <br />k <br />l <br />d <br />l <br />t <br />d <br />/ submllied Is, to the best o <br />my <br />now <br />e <br />ge and be <br />W, tore. accura <br />e. an <br />aempWe. <br />fr <br />SIGNATURE OF PRINCIPAL EXEM)TNE <br /> 1 am swam mat there are sigNBcaa(penaltks for nbmilting faW Information, <br />TYPED OR PRINTED Including the possibllly of Bar and Imprisonment for knowing Aolatk? OFFICER OR AUTHORIZED AGENT CODE NUMEiER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANT VIULA I IUN5 (Hararanc• on arracnmenrs name <br />_ABLE SOLIDS LIMIT APPLIED FOR .=10YR,24HR PRECIP EVENT- <br />_ T r <br />EPA Form 3320-1 (Rev. 3M) Previous editiorts may be used. ' 0334 /dWIb0IPat4-paxff6rm. PAGE ;OF