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PERMITTEE NAME/ADDRESS (7nr6iefariksyNae.a?Lurntam I/D(ff vni) NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM (/WDESJ <br />NAME DISCHARGE MONITORING REPORT fDMR) <br />ADDRESS <br />BOX r; t PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY ?ON I A - - MONITORING PERIOD <br />j I E NO. L2 MINE YEAR MO DAY YEAR MO DAY <br />LOCATION ;,NIA CO $l t._ : FROM TO <br />L-I t_ IAM A. BEAR JR.. MINE MGR <br />Form Approved <br />OMB No. 2040.0004 <br />ELTA <br />NOTE: Read Inatructiom beiefortit completln9 this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENcY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT CA <br />F1 <br /> REQUIREMENT <br /> i ` : ?? \ ! f'll <br /> SAMPLE <br /> <br />. MEASUREMENT <br />Y2O PERMIT ,? m s F?f "..3t? <br />LUE V ! REQUIREMENT <br />.j <br />t DS r SAMPLE <br /> MEASUREMENT <br /> PERMIT ^ o- s}ii jt u - t l lhri( E / ?i r <br /> REQUIREMENT <br />R I-) N SAMPLE <br />I H5 MEASUREMENT <br /> PERMIT .4#?E ta•:•':,•: :t?O r C;f'„j P':'F/ rKrls <br /> REQUIREMENT "OD(a ,1` r)f1 i _ MY. !TH <br /> SAMPLE r .. <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT = {, <br /> SAMPLE <br />;, - MEASUREMENT <br /> PERMIT r..GOP T i?rPUFi'r r' i ti' <br />VP REQUIREMENT ;L'F3 F3'' <br />• <br />' II <br />Y MX <br />: <br />. . <br />_ _ <br />. <br /> SAMPLE <br />_ MEASUREMENT <br />PERMIT REPORT <br /> <br />: <br />Yr?. ,,. <br />1 <br />REQUIREMENT i,RTR IvIAX <br />1 <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t reruty under penalty ° law thal this documwnl and all attechmemb were TELEPHONE DATE <br />Prepared under my dimerlon or weer lelan Ina m tinre with a system designed <br />to inure that quallned penonnN property gather and evaluate The Inf°rmstbn <br />submitted. Bred on my inquiry of the person or persons who mamate the system. <br />- <br />or Moat penes directly responsible nor gathering the Information, the Inr°nnaUon <br />. submitted K to the be" or my it -a It Cc and beans. Imt, ae'emumlr. and complete. - <br />in <br />t th <br />r <br />a <br />t <br />e <br />ltl <br />itti <br />r <br />t <br />l <br />r <br />SIGNATURE OF PRINCIPAL EXECUTWE <br />I <br />r <br />th <br />t <br />f <br />b <br />o _ - , <br />- <br />' <br /> <br />TYPED OR PRINTED am we <br />a <br />en am <br />gm <br />e <br />n <br />p <br />n <br />n <br />or su <br />m <br />ng <br />a <br />e <br />n <br />°r.ma <br />e <br />e <br />om, <br />Including the podblIly or tine and Imprisonment for ?no.Int Ooliiu ms. <br />OFFICER OR AUTHORIZEO AGENT AWrA <br />CODE NUMBER <br />YEAR <br />MO <br />OAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Roforenco aN afrachments herel <br />r rep;=r TO r- 11T_"! -r j?• MST !C I r?T QFQpf)%)FT : fin Ir?nl.l? <br />.- - .. .i . <br />EPA Form 3320-1 (Rev 3199) Previous editions maybe used J This. is a 4-Part form. PAGE OF