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PERMITTEE NAMEJADORESS p.ddr iarMyXalowLeeaNe s ((Dlp'wr.) <br />NAME <br />ADDRESS <br />1. BOX 117 <br />:G CO 81626 <br />FACILITY ° P ER MINE <br />LOCATION • IG CO 81625 <br />,YMOND G. DU BOIS, PRE.S/GM <br />NATIONAL POLLUTANT DISCHARGE EUMINA710H SYSTEM NVPOES) <br />DISCHARGE MONITORING REPORT /D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY [TEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />DISCHRG TO FLUME GULCH <br />MOFAT <br />NOTE: Read klatrucdone before comp tlnp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. J <br /> <br />EX FREOUENCV <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE f <br /> MEASUREMENT <br /> PERMIT ###tt## ##3t##;: #ii : 3 E !:I ' 1T! <br /> REQUIREMENT ,.? `: , i, .}•? - 1AX f <br /> SAMPLE :: 1. .., <br /> MEASUREMENT <br /> <br /> PERMIT ### . # j : tx r > :'Ci e=I =RAG <br /> REQUIREMENT HUNT1.4 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #tF#?I## : #?t#?t# :? \t #i? _.PTIONAI_ REPORT ;NC E/ GRAB <br /> REQUIREMENT SODA r'. DAILY MX f^ONTi <br /> SAMPLE <br /> MEASUREMENT I <br /> <br />,. <br />PERMIT <br />## ## <br /># # <br />at##dt## <br />300 <br />"(1000 -II <br /> <br />NC'E/ <br /> <br />GRAB <br />W. REQUIREMENT 2 AA A'•/l_ DAILY MX MONTI° <br /> SAMPLE <br /> MEASUREMENT <br />82 ? O :.: PERMIT x s .. ... ,.. IFdI # ; . tJ C7Pd i I I 3 <br />iSS I REQUIREMENT TNST MAX (?ENT <br />ddUI' SAMPLE t <br />._NT F MEASUREMENT <br />0 <br />O PERMIT <br />REQUIREMENT <br />- .._ T # t'.r t i F i <br />`UF- JS r <br />T Ds, rAt. SAMPLE <br />SOL MEASUREMENT <br /> PERMIT <br />REPORT <br />REPORT <br /> REQUIREMENT -,ODA A%:r,? DAILY MX <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 KMlly r r pens ty *flow that ihN dotnmtnl and ell ¦tlorhrrrnla were <br />prspored antler my dlrsction or nrper+•lslon In accordance with ¦ system designed <br />/ <br />4 <br />TELEPHONE <br />DATE <br />- <br />rte: to care that gaaMMd personnel properly, gather and evaluate the Information <br />submllud. Bred on my inquiry of the person a persons who manage the system, <br /> <br /> <br />' or thaw persom directly resperdble for gathering the Informauoa. the Informadon r <br />(? <br /> <br />•'' <br />% <br />- ou"mitled b• to the ben or my knowledge and betlef. Well. mcm-le, and complete. <br />I am ewers abet there am 1) <br />gNfltanl pertoRks for erbtnltun <br />fade informaeo <br />SIONATURE OF PRINCIPAL EXECUrM <br /><. - f ,.. / <br />v ` <br /> <br />TYPED OR PRINTED n• <br />g <br />Inle-h ding for porbibly of Bne and Imprisonment rot knowing etolauoea <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />ANY VIOLATIONS (Reference aN attachments hors) <br />COMMENTS AND EXPLANATION OF .- I1 Tnc= r J;?TT 'tPPl.. TEI? FOR 1C?YR, 24HR PREC TP FI- F:t <br />r_ASE - SEE <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. _ (?4-p3fL.jfQ?. PAGE OF <br />1 'Q?/