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PERMITTEE NAME/ADDRESS pnaW.F.,&,,N..?L«r/ew ((Dor,,. r) <br />NAME <br />ADDRESS _ <br />). BOX 187 <br />CO 61626 <br />FACILITY ';iPPER MINE <br />LOCATION i I G CO 81625 <br />AYMOND G. DU BOIS, PRES/GPI <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOESI <br />DISCHARGE MONITORING REPORT /D R) <br />PERMIT NUMBER ISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY 1? I YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR JC ) <br />F - FINAL MOFAT <br />ACUTE WET TESTING FOR 017 A <br />NOTE: Reed Instructions before completing tale fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />-: SAMPLE <br /> MEASUREMENT <br /> PERMIT ###### ?! 100.0001 <br />:r##;r <br />t# sE <br />N REQUIREMENT M VALUE <br />Tr SAMPLE <br /> MEASUREMENT <br />1 C. PERMIT #ittt :r r r# z :? 100. 000 1 ??` ##-: ? ?1 tr# <br />-NT REQUIREMENT MN <br />VALVF- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT' i. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />-- <br />------------- <br />- <br /> PERMIT - <br />- <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT `- __?-- <br /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br /> <br />t cert?ty under pen, ty o 1.w that u.le dorv mcnl and all .ttachmenu were <br />NAME(TITLE PRINCIPAL EXECUTfVE OFFlCER prepared under my direcilon or wper?hlon In accordance w11b a system dedgnM TELEPHONE <br />/ to assure that qualified personnel Properly ether and evaluate the Inrormallon f <br />; r ' n <br />in <br />? <br />1 ( <br />b <br />d <br />B <br />d <br />i <br />f t <br />DATE <br />. <br />wl <br />rn <br />e <br />. <br />se <br />on my <br />nquiry o <br />he person or persons who manage the "em. <br />1 <br />??. <br />or <br />than penr directly nspoadbk for gathering the lakrrstsatlow. 1M InformatMn <br />submitted u, to the best of my keowirdp and brIW, trove. aresrrate. and eam 4 <br />I am aware that then: are significant prrtdtles for submittin <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />false Information <br />TYPED OR PRINTED g <br />. <br />lad.ding the poaslbimy of fine and imprisonment far knowing violation.. OFFICER OR AUT14ORIZED AGENT CODE NUMBER YEAR DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (R*4r*nC' eN ett&chments hsrsl <br />PEPUPT L CSO - STt:?Ic; TCAL r-'(-'TNT' <br />:L fix I'- PST REFL. 'WL. <br />EPA Form 3320-1 (Rev. 3/%) Previous editions may be used. <i . ; ;; T#?? s;a;4-p Y)jpFip. PAGE pF I