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FERMITTEE NAMEIADORESSan.&&F.rWryN..?Larrlan(/D{si.wu) <br />NAME <br />ADDRESS R <br />U. BOX IS7 <br />PP,IG CO 81626 <br />FACILITY P PER MINE <br />LOCATION I G CO 81625 <br />YMOND G. Dt) Rf1Ts. PRFC;/GM <br />NATIONAL POLLUTANT 04SCHMOE ELIMINATION sYsTEM //NPOES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER asCHAME NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MID DAY <br />FROM TO <br />Form Approved. <br />OMI5 No 2040-0004 <br />MINOR <br />(SUBR JC ) <br />F - FINAL MOFAT <br />RUNOFF/MINE WTR TO OAK GULCH <br />NOTE: Read frtetructiorle before eompleW9 thW form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUINCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ##?? ;, r# r. b - 9. O EE %' I IySI <br />VL''J I JAL 4.+: REQUIREMENT ill IN 1 MU!°i_.- ` MAX I M <br />DS, TAI-; , .;.. SAMPLE <br />NDED MEASUREMENT <br /> PERMIT #?E#itit# ## ?x x:z#t?#ti ?? _ 'i0 1t?1C1; =cAB <br />( REQUIREMENT j A VG A T l_Y t`1 MONI'i- <br /> SAMPLE <br />I <br /> MEASUREMENT <br />i ?J <br /> PERMIT ####+ #IE # F # OPTIONAL REP RT 'NCE/ ,RAB <br /> <br /> REQUIREMENT 30pA AV(l DAI Y MX hif -NT <br /> SAMPLE <br /> MEASUREMENT <br />I <br /> PERMIT OO NCF / <br /> REQUIREMENT SODA A;IG" DAILY MX MOOT' <br /> SAMPLE <br /> MEASUREMENT <br />"? 1 O O PERMIT 1 rJ "r1B <br />= r.! i REQUIREMENT I hdSl P;/iX <br />l itil CJ SAMPLE <br />RED ";;_ MEASUREMENT <br /> PERMIT -.: < -. - i AI, <br />ISS l REQUIREMENT - <br />AL. SAMPLE <br /> MEASUREMENT <br />PERMIT :i xtrltit# ,..iF a! R -. 1 <br />REQUIREMENT :._Y MX <br /> <br />1 certuy under penalty o low that this ds ffwrit and ell atlachments wire <br />TELEPHONE <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />Prepared under my dtreeuon w srperef>ton in accordance with • system designee <br />to tsure that qualified personml property gather and eroluste the Inrorneulon <br />eabmlued. Based on m7 Inquiry *(the per am or Persons who manage the spterrn, C - <br /> <br />^ or those persons directly responsible far gathering the lntormauots, the Information <br />t <br />t <br />kn <br />wl <br />b <br />i <br />d I <br />t <br />th <br />b <br />r m <br />d <br />d <br />f ^ <br />su <br />s, <br />e <br />es <br />o <br />o <br />e <br />m <br />t <br />e <br />o <br />y <br />ge an <br />belie <br />. true, accurate, and complate. <br />r .? I am aware that :hen art 0 <br />reeItcanl <br />.. <br />SIGNATURE Of PRINCIPAL EXECUTIVE <br />enalties f <br />r w <br />br <br />lttl <br />f <br />I <br />t <br />l <br />tl <br /> <br />TYPED OR PRINTED t <br />P <br />o <br />l <br />n <br />n <br />n <br />orma <br />on, <br />a <br />ls <br />g <br />Including the paeslblillr otllse and Imp.= meet rw knowing Aotouorel. <br />OFFICER OR AUTHORIZED AGENT N <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aN attachments here! <br />M T T APPL. 1ED FOR 10YR, ' 4HR PREC IP FVFIIT-. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. PAGE OF