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FERMITTEE NAMEIADDRESS(tneYbFwdmyNam?Lweria l/DWwwr) <br />NAME <br />ADDRESS i!. <br />BOX 187 <br />TG CD 8162E <br />FACILITY ''PER MINE <br />LOCATION I G CO 8162E <br />YMONn a nil RnTS. PRFS/f,'M <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM_ (NPOESI <br />DISCHARGE MONITORING REPORT /OMR) <br />PERMIT NUMBER DISCHAAGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Fc,,m,Approved. <br />:FMB No 2040-0004 <br />MINOR <br />(SUBR ,JC ) <br />F - FINAL <br />DISCHARGE TO FLUME GULCH <br />MOFAT <br />NOTE: Reed instrucdom before completing this form. <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 3:-J:-;:, <br /> MEASUREMENT <br /> PERMIT #1.?Yr!<## tt##SF#i #.. _ 0 tiL? (_• IIVSI"i1 <br /> REQUIREMENT tt r? I ! 1 ; ; . !r! MAXIMUM <br /> SAMPLE <br />MEASUREMENT , ., -7 <br /> PERMIT n ?t a 3t # ?i it #+t F : # ?? t PIC E / <br />-I REQUIREMENT AVG UA I L Y MX I` ONTf <br /> SAMPLE <br />T <br /> MEASUREMEN <br /> PERMIT ;: t ## " #n### ###### OPTIONAL REPORT IIJ=: i ARAB <br />:- 1• REQUIREMENT :,)DA AVG DAILY Mx <br /> SAMPLE <br />T <br />l f'I J MEASUREMEN <br /> ! P <br />c 1 PERMIT 3000 6060 "E <br />N , <br />!T IROC REQUIREMENT " 0DA AVG DAILY Iv!X !NTI <br />r: EAc J_ <br />L,. SAMPLE <br /> <br />M <br />NT <br /> MEASURE <br />E <br /> PERMIT t ,i s.. rr sr It . .u t •tt _ r .-.>. ... 10 I T 111 - !3 <br /> REQUIREMENT 11`45T MAX '!T <br />Lt: SAMPLE <br />SUREMENT <br />ME - <br />' <br />h'r 'LAIN A <br /> PERMIT F? PCf7 .., ct ,. - . <br />1 GROSS VALU REQUIREMENT Y Mit <br />LTA!-- SAMPLE <br />- <br />-.c .; MEASUREMENT c <br />I- REPURT7 <br />PERMIT I( lE II k : t# - s zrai iE## It P <br />v ; iL <br />REQUIREMENT 301m ' A I LY MX <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER 1 ft11j under penalty ° ow that this d°`°mem and ag attachments were TELEPHONE <br />prepared under my dlrectlM or pup- on In accordance with • system designed <br />/ - to asnn that qualified personnel properly tather and eeahrale the Informallm DATE <br />bmined. owed or, my inquiry of the Person w persona who manse the system. _ <br />` <br />r - • <br />or them pen°ne directly respo Isk for gathering the Information. the inrornstion . 'l/ I'1i <br />- ?,. --. <br />wbmilled K to the be" of my knowledge and be#W, Ime, atturate, and complete. <br />SIGNATURE OF PRINCIIAL EXECUTIVE ^ <br />st <br />in <br />t <br />lti <br />N <br />l J ?] ''7 <br /> gn <br />can <br />I am aware that there an <br />es for str <br />N <br />ling raise lnformaeon. <br />Pena ARIEA <br />TYPED Oq PRINTED Includlnt the passibility or floe and Iwprlsoarnent for knowing .Idatiores OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS 1Re%rence s# sttschments herel <br />t?I c SC?!_ IDS LIMIT APP!-TFD FrIR -=_=10YR, 24HR PRFDIP EVENT- <br />a PAGE IOF ^ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used _. <br />Irk