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PERMITTEE NAME/ADDRESS (1meYbFaraiyNsoa?Lrew,aw (/D(oirvW) <br />NAME <br />ADDRESS s <br />HOX 167 <br />:IG CO 81626 <br />FACILITY - , P P ER MINE <br />LOCATION I G CO 81625 <br />1 r w .... rn.n nnrr+ intA <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTUA INPOES) <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER D19C7-MOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. 20404)004 <br />MINOR <br />(SUBR JC ) <br />F - FINAL <br />POND #10 TO JOHNSON GULC <br />MOFAT <br />## <br />NOTE: Read Inet-ctione bsfoes completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FnEDUENCr <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />E/0-.` rr_ SAMPLE <br /> MEASUREMENT <br />7 PERMIT ###### REPORT _ ###### #?####lE r• ?-it3t : <br /> REQUIREMENT T NS7 MAX %i 7 <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 /> I PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I nrtdy under pens y o law that this document and all attachments were TELEPHONE <br />prepared under my dlmrtlon or supervision In accordance with a system designed DATE <br />to inure that qusMfkd personnd properly gather and evehaste the Information <br />d on m <br />In <br />uir <br />of the <br />erson or <br />erwas who mana <br />e the s <br />slrm <br />b <br />itt <br />B <br />d <br />/ <br />y <br />q <br />y <br />g <br />y <br />. <br />m <br />e <br />. <br />aw <br />p <br />p <br />• /i?. <br />_ r su <br />at thaw persere directly respetdble for gathering the Intermatlon. the IMormNbn <br />_ <br />f <br />k <br />wt <br />t <br />l <br />b <br />t <br />d <br />d b~ <br />t <br />d <br />o <br />my <br />m <br />e <br />ge an <br />rue. atesers <br />e, an <br />coertp <br />submitted If, to the <br />es <br />, <br />ete. <br />E Of PRINCfPAI EXECUTIVE <br /> 1 am aware that then art dgnincant praskie for sabmitting war Info.. tbn, SIGNATUR AREA N <br />WR Y AY <br />TYPED OR PRINTED Including the poodbilly of floe and Imprisonment for knowing rfetatlorn OFFICER OR AUTHORIZED AGENT L <br />CODE EAR MO D <br />COMMENTS AND EXF'LANA I IUrv yr nn T Ylv WILL na frttrrsrmc• an .et.c,,,n.r,ra ,r.,•, -ABLE SOLIDS LIMIT APPLIED FOR <=1 OYR, 24HR PR EC I P EV <br />_ .IREMITDS MONITORING - I. B. 2 <br />I <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used.