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PERMITTEE NAME/AODRESS pwetY4 FarWry Ha.?Lurrfew l/D?brwy <br />NAME - <br />ADDRESS i 1V: t Nr_ <br />). BOX 483 <br />PAONIA CO 81428 <br />FACILITY AIE NO. 2 MINE <br />LOCATION I N I A CO 81428 <br />r. ; r.' i I I TAM A RFAR .Iii MTAIG MP-0 <br />NATIONAL POLLUTANT OISCNMGE ELIMINATION SYSTEM (NPDESI For' Approved. <br />DISCHARGE MONITORING REPORT fOMR) OMB No 2040-0004 <br />' NOR <br />;UIIR MH ) <br />PERMIT NUMBER DISCHARGE NUMIIER - FINAL DELTA <br />MONITORING PERIOD '';DEER TRL DTC OR UNMD TRIB <br />YEAR MO DAY YEAR MO DAY <br />FROM TO _ , ,i ,• ?:., ?: ,c a <br />NOTE: Reed InstruCElone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX FIIEOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />i _. AND GREA..... SAMPLE < < <br />--)', IAL MEASUREMENT <br />? ,b 1 0 PERMIT ###iE - t?Rl Y _ rt 7,?..#jtdt EEKL.Y ISUA <br />-FLUENT GREI!:? REQUIREMENT r MAX _I 0 <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 />NAME/TTLE PRINCIPAL EXECUTIVE OFFICER ' nru y ¦ er P"' T" o fa. that this dewument and aff atfachmenb were TELEPHONE DATE <br />prepared and" my dirertfon or supervt/on In atrordanse with a system designed <br />to atmin that q-11ned penonnef properly Sather and eealuair the Inr-floe, <br />smbmltted. Batted on my Inquiry d tM person or perswu who manage the system, <br />ne those persws directly responsible row gathering the Inrormauon, the Information <br />wbmftied ls, to the best of my knwwiedte and belief, true, accurate, and complete. <br />I are that there are si <br />nificant <br />enalties for rubmlttin <br />War Info <br />tratl <br />SIGNATURE OF PRINCIPAL EXECUTIVE - <br />w <br />- <br />- <br />?` - <br />I <br />TMpED OR PRINTED g <br />p <br />,,:z:, <br />g <br />r <br />on, <br />t hepedblufy or n x and Imprtsonment for knowing .Idatloru ] <br />OFFICER OR AUTHORIZED AGENT V <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fRNerence aM attachments here/ <br />Zr7 nl-.ATM ^P?T2111!FP, PY W(3,-r) <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This is 3 4- y( {OEill. PAGE OF