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PERMITTEE NAME/ADDRESSVrrw+..rirtkty Na..VL. .ti-(fD(fwwa) <br />NAME <br />ADDRESS <br />SOX 187 <br />IG CO 8162E <br />FACILITY ,PPER MINE <br />LOCATION ? G CO 8162E <br />YMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT 04SCHARGE ELIMINATION SYSTEM fNPOES) <br />DISCHARGE MONITORING REPORT fDMRI <br />PERMIT NUMBER DISCHARGE NUMSER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO . <br />Form APProved <br />OMB No 2040-0004 <br />M I NOF <br />F - FINAL MOFAT <br />DISCHARGE TO WEST HORSE GULCH <br />NOTE: Road kwtrucdorm Wore complotlr+p this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX IllEOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ;r > <br /> MEASUREMENT <br /> PERMIT ##3iirtkii RE ##3r### ?x#z> x r ".' "; S, ri. <br />UEtd i REQUIREMENT 1 J-J"T MAX <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT J <br /> REQUIREMENT <br /> SAMPLE / <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certuy urvder pens ly o law that thh document and all ¦ttachments were TELEPHONE <br />prepared under my direction or %uperMslort in seem ante with a syslem designed <br />to assure that qualified personnel peoyerty Lather and evaluate The Informal" <br />submitted. Bawd on my Inquiry of the person or persons who manage the system, /`car <br />i??-- DATE <br />or than perawr directly responsible For gathering the Information, the InfornuUrm :_.;. • // ,,? - ? r^, <br />_ submitted la, to the best or my knowlrcip and better, true. accurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 am aware out then: are sigolficaaf penaltb for wnbmliting raise Information. <br />TYPED OR PRINTED Including the possibility of fine and Imprisonment for knowing etelattorm OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reforence dl attachments here) <br />?I'LE -nLTDS LIMIT APPLIED FOR <=IOYR: 24HR PRECTP EVFNT- <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used r-- C) 794 / CRk« sbit4'p fprm. PAGE `QF?