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PERMITTEE NAME)ADDRESS (l et& eFatreryMo.?Le etia IIDW m) <br />NAME <br />ADDRESS <br />BOX 187 <br />IG CO 8162E <br />FACILITY P P ER MINE <br />LOCATION -.G CO 8162 <br />."MOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT 04SCHAROE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER D19 40E 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 />DISCHARGE TO FLUME GULCH <br />NOTE: Reed Instruction before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - t # t- st#=r / <br /> MEASUREMENT <br /> PERMIT f3 E. OFt -. ###sE ?## t? ?> ffl6iE ?' .t?.l K 13IJA <br />I? f fl. <br />;; REQUIREMENT I14ST MAX NU:- <br />_ <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 /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certty under penalty o ow that thh document and all attachments were TELEPHONE <br />prepared under my direction or Pipe reiflon In accordance with ¦ sMem deigned , DATE <br />/ r to swum that quaM(W personnel property gather and evaluate the Information - <br />submitted. Sawed on my Inquiry of the person or persons who manase the ryrtsm. <br />or throe persons dfrmly responsible for gathering the lnfo ooa, the inimenallon <br />d f <br />b <br />t <br />k <br />' <br />b <br />it <br />t <br />th <br />l <br />d <br />( <br />es <br />now <br />Su <br />m <br />te <br />, <br />o <br />e <br />e <br />ge and belle(. Irve, accvnte. and romptete. <br />o <br />my <br />?- - - I am aware that there are 1ltnln-1 <br />rnattln for submittin <br />rape inf-don <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> p <br />g <br />, <br />TYPED OR PRINTED fndnding the poa lbnlty or fl- end in,prIso rnt for knowing 1.1.11- OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a)I attachments here) <br />r1!3LE SOLIDS LIMIT AP-ill_IFP FOR '=10YR, 74HR PRT C;' =•,tt= •;T <br />E3 MONITORING - I - I <br />i s+y f F R i B S R i 9 R+ F+ <br />EPA Form 3320-1 (Rev. 3199) Previous edibofls may be used. PAGE OF