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PERMITME NAMEMDDRESS (7m-&&Fwdwy Na-WLocrfaw IfDOWwet) <br />NAME <br />ADDRESS , <br />). BOX 535 <br />i sERSET CO B3 <br />FACILITY ,480PN CRK & ELK CRK MINES <br />LOCATION "`1ERSET CO 81 <br />?AMFS T. CO(IPFR, FXFC V P. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPOESI <br />DISCHARGE MONITORING REPORT /DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 20404Og4 <br />MINOR <br />(SUBR <br />F" - 1- <br />RUNOF- <br />MH ) <br />NAL <br />GUPli 1 S <br />., v <br />NOTE: Read Instructions before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br /> <br />EX FREpUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###;r b NCE IFIS T <br /> REQUIREMENT ^ f t1 t'! t IMilf'! C"Ot•i"; <br />c SAMPLE <br /> MEASUREMENT <br /> PERMIT _ F#iF# #3i•n a #it ii ##a _` i 7r'7??I3 <br /> REQUIREMENT ;" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ####=+ ### ### REPORT REPORT <br /> REQUIREMENT 30 DA AVG DAILY MX TH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###### It##3F## ####3t ;QQI`j 6000 NCE/ _.S'F <br /> REQUIREMENT O IAA AV-.~ DA P Y r 1X INT <br /> SAMPLE <br /> MEASUREMENT <br />0 PERMIT :i ? a a x 10 I?lti!Y Ii' i7r?) <br /> <br />c ... REQUIREMENT IPd`?', MAX EIdT <br />'_.Of,!l l! f. l SAMPLE <br />r._ATMEN' r MEASUREMENT <br />G 0 j PERMIT REPORT REPORT ?? ±:..... NCE/ <br />_UEra? GROSS ? ,; REQUIREMENT I MONTH <br />1 DS, )TAL. SAMPLE <br /> MEASUREMENT <br />PERMIT sr?tir> stx it##?t## REPORT REPORT <br />R.. <br />REQUIREMENT t-tRTR ILY MX <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I C Fuly " er penalty ° law that thb document and all allwhmrnts were TELEPHONE DATE <br />prepared under my dlrectlon or supereblon In accordance with a system ddrned <br />?- "- - to aware that quahfled Personnel properly rather and eralusle the Inhwntatlon <br />sobmllted <br />Sawd on m <br />of the pr non or <br />in <br />uir <br />ersoeu who mana <br />the s <br />stem <br />- <br />. <br />y <br />q <br />y <br />p <br />K <br />. <br />y <br />I or Ihoae <br />ersons dlredl <br />res <br />orolbk for <br />atherin <br />Ink <br />th <br />tj <br />th <br />I <br />f <br />rn <br />lfo <br />y <br />p <br />p <br />g <br />g <br />e <br />o <br />on• <br />e <br />n <br />o <br />r <br />n <br />kn <br />lu <br />th <br />bev <br />f m <br />wl <br />d bath( <br />t <br />b <br />d f <br />t <br />d <br />t <br />d <br />" <br />w <br />m <br />s, <br />e <br />o <br />y <br />o <br />e <br />ge an <br />rue, accura <br />e <br />o <br />, <br />e. an <br />complete. <br />t I <br />dfl <br />l <br />AIGNATURE OF PRINCIPAL EXECUTNE <br />r l 1 <br />t <br />l <br />M <br />I <br />4 <br />- <br />- <br />TYPED OR PRINTED am aware <br />nn <br />ha <br />hr are s <br />{n <br />pena <br />es for wbmlldng tabs <br />nfonrwtlon• <br />InAudln[ the p-alblllty of floe and Imprisonment fw knowing .1oltdorm OFFICER OR AUTHORIZED AGENT CODE NUNWR Y <br />EAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference sat attachments hers) <br />i L T ED FOR - >>YP 77 4HR PFR.F? -r. ?. <br />.._ r_ - tit--. t3•-. , <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This i5.a -P87t forth. PAGE OF