Laserfiche WebLink
PERMITTEE NAME)ADDRESSRmA.irwryN.?L«alen((oownv) <br />NAME <br />ADDRESS <br />.l. BOX 483 <br />.?iJNIA CO 814.' <br />FACILITY :4 I E NO. 2 MINE <br />LDcAT*R _ JNIA CO 5142 <br />T'1 1 TAM A Lt1=AA .10 MTKlim Mr?_G <br />Form <br />NATIONAL POLLUTANT DISCHARGE EUMINATION SYSTEM fNPDESI OMB Approved. <br />DISCHARGE MONITORING REPORT (DMRI OMB No. 2040 0004 <br />!JUF2 <br />JBR MH) <br />PERMIT NUMBER DISCHARGE NUMBER FINAL DELTA <br />MONITORING PERIOD Tt? I !3 <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Imtruc ions boforo completing thla form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX Ncr <br />OF <br />r SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> <br />VERAGE <br />A <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />! L AND Gf 1. SAMPLE <br />i SUAL MEASUREMENT <br />14066 f PERMIT t( . 't : 70: =sE Tt i-..'. KL Y : T 5UA <br />'• F LUENd i :,f?OS 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 /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />J <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER t tr tay . ' pe.. ty o •" that thh docameal and .n.ll.rhrnenls -ere TELEPHONE DATE <br />prepared ender my direction or aup?relslon In accordance with • system designed <br />In a!!.re that quaMtled personnel properly gather and evaluate the Infornutlon <br />submitted. Based on my Inquiry of the person or person who manage the system. <br />or those per"ne dimity respo"ble for gathering the Informatiat, the Information i-: <br />submitted ts, to the bat of my knowledge and belief. true, amtrste. end eomptele. - <br />- I am ..are that there are Si <br />enahles for <br />ubmtltin <br />fak <br />Inf <br />SIGNATURE OF PRINCWAL EXECUTIVE <br />nificant <br />ll <br />n -. ) <br /> g <br />p <br />e <br />g <br />e <br />onne <br />o <br />. ARE <br />TYPED OR PRINTED Inehsdtng it* posslbiWy of one and Imprisonment for knowing violations- OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION yr ANT vtvL^ I ivNb rfferorenc• M arracrimenra noraF <br />?HR PRECTP F`;FN-r IS ri N-MFn ?r CLATM APr=Rf-') r) f3Y li!C'vr D. <br />_ASUR:_ E <br />,. r <br />This is a 4-part form. PAGE OF <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used.