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PERMITTEE NAME/ADDRESS phi f.emryN..?Lor.rren (/D(Qwrv) <br />NAME <br />ADDRESS <br />?. iiux ors <br />F'AONIA r CO 81428 <br />FACILITY BOWIE NO. MINE <br />LOCATION' ON I A ; 0 81428 <br />ILLIAM A. BEAR JR, , IIINE MGR <br />NATIONAL POLLUTANT 04SCHAFIGE ELIMINATION SYSTEM INPOESI <br />DISCHARGE MONITORING REPORT /DMA! <br />PERMIT NUMBER [TSI.AIGE NUMBER <br />MONITORING PERIOD <br />Y R O DA Y E-AR D Y <br />FROM TO <br />Form APProved. <br />OMS No. 20404004 <br />MIN ?qGf^ <br />(SUB) l l W _0 <br />F - FINAL DELTA <br />SR/MINE WTR TO DEER TRAIL ETCH <br />NOTE: Reed Inetructlone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALrSIS <br /> AVERAGE MAXIMUM :UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE [ <br /> MEASUREMENT <br /> <br /> PERMIT . <br /> REQUIREMENT NS T MA K ' <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I «rtlq under pen. ty o I.w Iha thh document and all attsehm ents were TELEPHONE DATE <br /> pmp.rwd under my dlreetlon oe supervision In oceord.nre with • syslem designed <br /> 10 Mare that qualified personnel properly gsthe and evaluate the Infortoatlon <br />submitted. Bawd on my Inquiry of the permon w prrawu who urtanagm the system. <br />-- - , <br /> w than persons directly respomlble for gathering the Intwrnstlon. IM Information <br /> submitted k, to the best or my knowledge and bdW. Irw, ate rate, and mmpkw, <br />nificant <br />1 am swam that there are si <br />-114" for s <br />bmitti <br />fsb <br />Inf <br />d <br />n <br />SIGNATURE Of PRINC1?AL EXECUTIVE <br />/ _- - - L. <br /> g <br />P <br />u <br />ng <br />e <br />o <br />o <br />. AMEA <br />TYPED OR PRINTED InchsAing the possibility of line and ImPrtronmml for knowing riol.ocum OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReforence aft artacnment: hare/ <br />141R PRECIP EVENT IS CLAIMED. IF CLAIM APPROVED BY WGCD, <br />A, P' <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. i : (l.• This w ;L4-part form. PAGE Of