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PERMITTEE NAME/ADDRESS (I-&&FerYrryNaw?Lwaeraw yDW-vaet) <br />NAME <br />ADDRESS <br />BOX 187 <br />•IG CO 81626 <br />FACILITY ''PER MINE <br />LOCATION I G CO 81625 <br />, , YMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM IINPOES) <br />DISCHARGE MONITORING REPORT (DMR/ <br />PERMIT NUMBER DISCHARGE NWOER <br />MONITORING PERIOD <br />YEAR MO DAY F EAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. 2040.0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />WEST TESTING FOR 021A <br />MOFAT• <br />? NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOl1ENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE < ut= <br /> MEASUREMENT <br /> PERMIT r ##### 100. 0001• <br /> REQUIREMENT N VALUE <br /> SAMPLE \ <br /> MEASUREMENT <br />1 PERMIT t?#### i it##i(iE 1017 OUOI It###ir3r ##s?### TRL Y 3RAB <br />NT REQUIREMENT MN VALUE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REOUIREMENT <br /> S A MPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />t "l-ty u er penalty o sw thal this doromeM and all allwhrnents went <br />TELEPHONE <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />prepared Ynder my direction w wPervhlon In accordance with a system designed <br />•. <br />?. to .mare that quabiltel personnel Properly gather and evaluate the Information l <br />r- <br />?.. sobmltted. bawd on my Inquiry of the Person or Persons who manage the system, <br />at Show Penorn dirwcny responsible for gathering the lnfwm¦tloet, the Information i -7 <br />. ` <br />^ <br />• <br />1 <br />" - [; 4 <br />Submitted Lv <br />to the best of my knowledge and belle!. tme, ace mle, and complete <br />% !?i <br />/ / <br />r- / <br />, <br />. <br />l <br />dllnat <br />emeirl" Fa <br />llfln <br />EIONATURE OF PRINCIPAL EXECUTWE <br />I ¦m <br />wa <br />t the <br />b <br />Wis <br />Inf <br />m <br />th <br />e <br />TYPED OR PRINTED a <br />re <br />a <br />am s <br />y <br />p <br />m <br />g <br />e <br />or <br />on• <br />r w <br />a <br />Induding the poadblMty of flor and Imprisonment for knowing vlatatlorm OFFICER OR AUTHORIZED AGENT CODE HUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference this attachments hers) <br />• r-, T T -. ! 1 l .. .. ! •. t ICI h^ T E W H <br />T [ ' <br />:j" ; N .-_. REPOIRT F-I.3RM TO Di11'? 1a ti t_, ttii:. Tr t"1i<h NOT <br />EPA Form 3320.1 (Rev. 3/99) Previous ed bons may be used. C, L j 6.5 7 /J JJWjg,?.Q-Qa?'(•fi?fitt. PAGE OF